Exploring participant engagement in the coping with infertility program

Abstract

Infertility affects approximately 15% of reproductive-aged couples worldwide, with significant physical and psychological consequences. Individuals experiencing infertility report elevated distress, particularly the intended pregnant parent who often bear greater physical burdens related to conception difficulties. The Coping with Infertility (CWI) Program is a cognitive behaviour therapy-based self-guided intervention that was co-created with patients to target infertility-related distress. The CWI program consists of 7 brief weekly module videos, paired with post-module homework assignments. While a recent randomized controlled trial (n = 170) has confirmed the program's efficacy in improving mental health outcomes, the current analysis examined 1) which baseline characteristics predicted the number of module videos viewed and self-reported homework engagement, as assessed using the Homework Rating Scale and 2) the degree to which these markers of engagement predicted pre-to-post changes in fertility-related quality of life (FertiQoL), anxiety symptoms (GAD-7), and depressive symptoms (PHQ-9). Results revealed that program engagement was high, with 78% of participants watching all 7 module videos. Younger age and greater perceived program credibility and expectations of benefit predicted greater homework engagement. A higher number of modules viewed predicted pre-to-post improvements in quality of life while greater homework engagement predicted improvements in all three mental health outcomes assessed. These findings suggest that, in the context of a self-guided mental health intervention, increasing users’ perceptions of the intervention’s credibility and potential efficacy may optimize intervention efficacy through greater homework engagement.