Practical Implications
CHRONIC ILLNESSES
The unpredictable nature of chronic conditions underscores the importance of developing programs that are physically and cognitively accessible during periods of physical limitations. As demonstrated in prior research [Retention in this study was 66.9% (101/151), and Teachable metrics indicated that 46.05% (35/76) of the participants did not complete the program. Although we believe this latter figure to be an overestimate of noncompletion, retention was below the average of 79% reported in a recent systematic review of digital mental health interventions for children and young people (range 15.79%-100%) [Most of the young people who reported reasons for noncompletion cited lack of time as the primary reason for noncompletion. Although a relatively small proportion of young people cited health concerns as a reason for noncompletion, young people with chronic health conditions often experience demanding health treatment and maintenance regimens that limit the time available for other activities. Furthermore, our interview data revealed that program use was also influenced by symptom fluctuations. On the basis of these findings, an interesting avenue for future research is to design interventions comprising brief components that young people can engage with separately, or in combination, at times that suit them (eg, a series of single-session interventions rather than a 4-week consecutive program) [Additional strategies to increase engagement include personalizing the intervention, including features that allow participants to connect with others, and using SMS text message reminders to engage in the program. Participant feedback indicated that the provision of information in various formats was a key element in enhancing accessibility and promoting engagement with the program. Ultimately, given that similar numbers of young people reported preferences for each information format, researchers who are designing internet-based programs for youth with chronic illnesses should ensure that any information supplied is available in a wide variety of formats, giving the young person the ability to choose how they would like to receive the information. In the future, it is recommended that researchers use digital programs that collect program use data in a more nuanced manner than that provided by the Teachable platform to allow for a deeper understanding of program use and attrition patterns.