Identifying Time-Variant Predictors of Interest in Completing Brief Digital Mental Health Interventions Among Adult Survivors of Cancer: Ecological Momentary Assessment Study.

BACKGROUND: Digital microinterventions have strong potential to improve the lives of adults diagnosed with cancer. However, little is known about which types of digital microinterventions are most desired and how contextual factors may influence those preferences. This potentially limits guidance for personalized and timely digital microintervention delivery. OBJECTIVE: This study aims to identify time-varying and person-level predictors of relative digital microintervention interest among adult survivors of cancer. METHODS: We enrolled US adults within 5 years of a cancer diagnosis in a 5-week observational study using ecological momentary assessment. Participants (N=407) were asked 3 times a day for 5 weeks which of 9 brief, mobile-delivered interventions, if any, they would have been interested in completing within the past hour. Intervention options were (1) reducing worry, (2) reducing negative thoughts, (3) problem solving, (4) increasing positive emotions, (5) connecting with values, (6) guided relaxation, (7) getting support from others, (8) setting goals, and (9) something else. Multinomial models were used to identify demographic (ie, age), cancer-related (ie, treatment status), and psychological (ie, depression symptom severity, anxiety symptom severity, history of major depressive diagnosis, history of anxiety disorder diagnosis, and psychotherapy status) predictors of individual differences in modal intervention preference. Multilevel logistic and multilevel multinomial models were used to identify momentary negative affect, positive affect, and pain predictors of relative intervention interest. RESULTS: Participants indicated interest in completing a digital microintervention in 87% (20,429/23,472) of completed surveys. The most frequently selected intervention option was guided relaxation (8611/20,429, 42%). Neither cancer treatment status (χ29=6.5; P=.69) nor psychotherapy status (χ29=14.0; P=.12) differentiated between modal intervention preferences. Participants with greater anxiety (χ29=35.1; P<.001) and depression symptom severity (χ29=23.0; P=.006) were less likely to modally endorse guided relaxation compared to other intervention options like increasing positive emotions, reducing negative thoughts, and getting support from others. Higher momentary negative affect and pain and lower momentary positive affect each predicted a greater likelihood to endorse interest in completing an intervention (vs not completing an intervention; P<.05) and to endorse interest in completing multiple interventions (vs only one; P<.001). Finally, higher momentary negative affect generally predicted greater interest in completing an intervention other than guided relaxation, whereas higher momentary pain generally predicted greater relative interest in guided relaxation. CONCLUSIONS: Adult survivors of cancer differ in their digital microintervention preferences between and within persons. Guided relaxation alone is less appealing to survivors of cancer when they are in greater emotional distress but may be more appealing in response to instances of increased pain.