User engagement is recognised as a critical and pervasive challenge that has limited the potential evidence base being developed for mental health apps.

To understand young people’s motivations for participating in a randomised controlled trial for a mental health app and the role of intrinsic (e.g. improving well-being) and extrinsic (e.g. financial incentives) drivers in engagement.

Emotional Competence for Well-Being (ECoWeB) was a superiority parallel three-arm randomised cohort trial recruiting a cohort of 16–22 year-olds across the UK, Germany, Spain and Belgium, who, depending on risk, were allocated respectively to the PREVENT (n = 1262) versus PROMOTE (n = 2532) trials. We conducted in-depth semi-structured interviews in the UK (n = 18, mean age = 17.7, s.d. = 1.5) and Spain (n = 11, mean age 20.6, s.d. = 1.7) to explore participants’ self-reported motivations and engagement. The trial was registered at ClinicalTrials.gov: NCT04148508.

Across arms, 21% of participants never set up an account to access the app and approximately 50% did not complete the 3-month follow-up assessment. Engagement was not significantly higher in the intervention arm compared to the control arms across metrics. Qualitative findings demonstrated that although extrinsic factors alone may be enough to prompt someone to sign up to research, intrinsic drivers (e.g. finding the app useful) are needed to ensure longer-term engagement.

Incentivising participation in clinical trials needs to be consistent with incentives that might be utilised at the point of dissemination and implementation to ensure that findings are replicated if that intervention is adopted at scale.

Insufficient sample sizes threatened the fidelity of the primary research trials. Even if the research group recruits a sufficient sample size, the sample may lack diversity, reducing the generalizability of the results of the study. Evaluating the effectiveness of online advertising platforms (e.g., Facebook & Google Ads) versus traditional recruitment methods (e.g., flyers, clinical participation) is essential.

Patients were recruited through email, electronic direct message, paper advertisements, and word-of-mouth advertisement (traditional) or through Google Ads and Facebook Ads (advertising) for a longitudinal study on monitoring COVID-19 using wearable devices. Participants were asked to wear a smart watch-like wearable device for ∼ 24 hours per day and complete daily surveys.

The initiation conversion rate (ICR, impressions to pre-screen ratio) was better for traditional recruitment (24.14) than for Google Ads, 28.47 ([0.80, 0.88]; p << 0.001). The consent conversion rate (CCR, impressions to consent ratio) was also higher for traditional recruitment (66.54) than for Google Ads, 2961.20 ([0.015, 0.030]; p << 0.001). Participants recruited through recommendations or by paper flier were more likely to participate initially (Χ2 = 23.65; p < 0.005). Clinical recruitment led to more self-reporting white participants, while other methods yielded great diversity (Χ2 = 231.47; p << 0.001).

While Google Ads target users based on keywords, they do not necessarily improve participation. However, our findings are based on a single study with specific recruitment strategies and participant demographics. Further research is needed to assess the generalizability of these findings across different study designs and populations.

Community advisory boards (CABs) are a promising approach for strengthening patient and partner voices in community health center (CHC) evidence-based decision-making. This paper aims to describe how CHCs used CABs during the COVID-19 pandemic to improve the reach of testing among populations experiencing health disparities and identify transferable lessons for future implementation.

This mixed methods study integrates brief quantitative surveys of community engagement (N = 20) and one-on-one qualitative interviews (N = 13) of staff and community partners engaged in CHC CABs with a cost analysis and qualitative feedback from CHC staff participating in an online learning community (N = 17).

Community partners and staff engaged in the CHC CABs reported high ratings of engagement, with all mean ratings of community engagement principles above a 4 (“very good” or “often”) out of 5. Qualitative findings provided a more in-depth understanding of experiences serving on the CHC CAB and highlighted how engagement principles such as trust and mutual respect were reflected in CAB practices. We developed a CHC CAB toolkit with strategies for governance and prioritization, cost estimates to ensure sustainment, guidance on integrating quality improvement expertise, testimonies from community members on the benefits of joining, and template agendas and facilitator training to ensure meeting success.

In alignment with the Translational Science Benefits Model, this study expands research impact through comprehensive mixed methods measurement of community engagement and by transforming findings into an action-orientated guide for CHCs to implement CABs to guide evidence-based decision-making for community and public health impact.

Early intervention in psychosis (EIP) services improve outcomes for young people, but approximately 30% disengage.

To test whether a new motivational engagement intervention would prolong engagement and whether it was cost-effective.

We conducted a multicentre, single-blind, parallel-group, cluster randomised controlled trial involving 20 EIP teams at five UK National Health Service (NHS) sites. Teams were randomised using permuted blocks stratified by NHS trust. Participants were all young people (aged 14–35 years) presenting with a first episode of psychosis between May 2019 and July 2020 (N = 1027). We compared the novel Early Youth Engagement (EYE-2) intervention plus standardised EIP (sEIP) with sEIP alone. The primary outcome was time to disengagement over 12–26 months. Economic outcomes were mental health costs, societal costs and socio-occupational outcomes over 12 months. Assessors were masked to treatment allocation for primary disengagement and cost-effectiveness outcomes. Analysis followed intention-to-treat principles. The trial was registered at ISRCTN51629746.

Disengagement was low at 15.9% overall in standardised stand-alone services. The adjusted hazard ratio for EYE-2 + sEIP (n = 652) versus sEIP alone (n = 375) was 1.07 (95% CI 0.76–1.49; P = 0.713). The health economic evaluation indicated lower mental healthcare costs linked to reductions in unplanned mental healthcare with no compromise of clinical outcomes, as well as some evidence for lower societal costs and more days in education, training, employment and stable accommodation in the EYE-2 group.

We found no evidence that EYE-2 increased time to disengagement, but there was some evidence for its cost-effectiveness. This is the largest study to date reporting positive engagement, health and cost outcomes in a total EIP population sample. Limitations included high loss to follow-up for secondary outcomes and low completion of societal and socio-occupational data. COVID-19 affected fidelity and implementation. Future engagement research should target engagement to those in greatest need, including in-patients and those with socio-occupational goals.