ArticleJournal of affective disorders2024
Small Steps over time: A longitudinal usability test of an automated interactive text messaging intervention to support self-management of depression and anxiety symptoms.
Article in Journal of affective disorders, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
What it found
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Who cites it
7 citing papers in PubMed, 10 citations in OpenAlex.
- Framing Helper Therapy to Support User Engagement: Causal Evidence from a Public Deployment of a Mental Health Support Text Messaging Program.Proceedings of the SIGCHI conference on human factors in computing systems. CHI Conference · 2026Article
- Investigating the Role of Situational Disruptors in Engagement with Digital Mental Health Tools.CSCW : proceedings of the Conference on Computer-Supported Cooperative Work. Conference on Computer-Supported Cooperative Work · 2025Article
- Large Language Model Agents for Improving Engagement with Behavior Change Interventions: Application to Digital Mindfulness.Proceedings of the ACM on human-computer interaction · 2025Article
- Designing Digital Mental Health Tools to Support the Needs of Black Adults in the United States: Qualitative Analysis.JMIR formative research · 2025Article
- Designing Digital Mental Health Interventions to Meet the Needs of Older Adolescents: Qualitative Interview and Group Discussion Study.JMIR formative research · 2025Article
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Corrections and comments
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Authors and funding
11 authors at 4 institutions in 2 countries.
Funding
Abstract
backgroundDigital mental health interventions (DMHIs) offer potential solutions for addressing mental health care gaps, but often suffer from low engagement. Text messaging is one promising medium for increasing access and sustaining user engagement with DMHIs. This paper examines the Small Steps SMS program, an 8-week, automated, adaptive text message-based intervention for depression and anxiety.
methodsWe conducted an 8-week longitudinal usability test of the Small Steps SMS program, recruiting 20 participants who met criteria for major depressive disorder and/or generalized anxiety disorder. Participants used the automated intervention for 8 weeks and completed symptom severity and usability self-report surveys after 4 and 8 weeks of intervention use. Participants also completed individual interviews to provide feedback on the intervention.
resultsParticipants responded to automated messages on 70 % of study days and with 85 % of participants sending responses to messages in the 8th week of use. Usability surpassed established cutoffs for software that is considered acceptable. Depression symptom severity decreased significantly over the usability test, but reductions in anxiety symptoms were not significant. Participants noted key areas for improvement including addressing message volume, aligning message scheduling to individuals' availability, and increasing the customizability of content. LIMITATIONS: This study does not contain a control group.
conclusionsAn 8-week automated interactive text messaging intervention, Small Steps SMS, demonstrates promise with regard to being a feasible, usable, and engaging method to deliver daily mental health support to individuals with symptoms of anxiety and depression.
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Registered trials
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