Factors Influencing Engagement in a Digital Substance Use Prevention Program: Qualitative Study Using the Capability, Opportunity, Motivation Model and Theoretical Domains Framework.

Background: Digital interventions are promising for the prevention of substance use in young people. However, engagement with these interventions is often insufficient, and their full potential remains unrealized. Given the established link between engagement in digital interventions and their effectiveness, understanding user factors that influence involvement in eHealth and mobile health (mHealth) interventions is essential. Objective: This study aimed to identify factors influencing user engagement in a mobile phone-based life skills training program for substance use prevention among adolescents and to collect suggestions for program optimization. Methods: A qualitative study was conducted with 171 participants of the mHealth prevention SmartCoach (Pathmate Technologies) program. The program provided individualized text messages to foster life skills for 4 months and proved to be effective in preventing the onset of cigarette and cannabis use. Semistructured phone interviews were conducted with program participants to explore factors associated with program engagement and to gather suggestions for program optimization. Interviews were recorded, transcribed, and analyzed using thematic analysis with both inductive and deductive coding. The capability, opportunity, and motivation model of behavior change (COM-B) model and Theoretical Domains Framework (TDF) were used to assess behavioral influences. Results: Key factors positively influencing program engagement included the timing of text messages, social influences and support, engaging and helpful content, and rewards (points and prizes). Conversely, barriers to engagement were identified as forgetfulness, short response time limits, limited time resources, lack of interest, concerns related to personal disclosure, and difficulty identifying with the challenge task type (posting). Suggestions for optimization included implementing reminders, providing better guidance for using tips, allowing personalization of message timing and content, extending time limits for tasks, and reducing the concerns related to personal disclosure. Conclusions: The study confirms the critical role of timing, content relevance, and social support in enhancing engagement with digital interventions. Specific recommendations for optimizing the SmartCoach program were derived, highlighting the importance of reminders, personalization, and addressing concerns related to personal disclosure.