A qualitative exploration of factors that influence engagement with a digital mental health intervention for women with metastatic breast cancer: Finding My Way-Advanced.

Purpose: While digital mental health interventions (DMHI) may improve access to timely support for women with metastatic breast cancer (MBC), scant research exists on how metastatic survivors engage with these programs and what factors impact usage. This study therefore qualitatively explored barriers and facilitators influencing engagement with (a) digital resources (e.g., information websites) generally and (b) in particular, Finding My Way-Advanced (FMW-A), an interactive self-directed DMHI containing psychoeducation, therapeutic activities, and multimedia content tailored for women with MBC.

Methods: Twenty women with MBC, who received either the FMW-A 6-week intervention (n = 13) or a digital-resource control (n = 7) as part of a larger RCT, participated in semi-structured interviews. Transcripts were coded using framework analysis against three domains of Bowen's feasibility framework (acceptability, demand, practicality).

Results: Engagement was high among intervention participants overall (six modules completed n = 3; five n = 5; four n = 1; two n = 4). Five overarching themes were identified. Three a priori domains related to FMW-A have high acceptability and practicality, but some demand barriers. Two inductively derived themes related to varied perceptions of navigability/layout and deriving personal benefits/impact. Key subtheme facilitators were program satisfaction, convenience, experiencing personal benefits/impact, and ease of navigation. Subtheme barriers were technical access barriers, experiencing time burden, and suboptimal intervention timing relative to time since diagnosis.

Conclusions: This study confirms that while many DMHI facilitators and barriers are consistent with those identified in curatively treated settings, some factors become more salient in metastatic populations (e.g., time burden). This research also offers novel insights that deriving early personal benefit promotes engagement and provides targets for future program improvements to address navigation and optimal-timing challenges.