AbstractBackgroundDespite the demonstrated efficacy and potential scalability of self‐guided digital treatments for common mental health conditions, there is substantial variability in their uptake and engagement. This study explored the decision‐making processes, influences and support needs of people taking up a self‐guided digital treatment for anxiety and/or depression.MethodsAustralian‐based adults (n = 20) were purposively sampled from a trial of self‐guided digital mental health treatment. One‐to‐one, semistructured interviews were conducted, based on the Ottawa Decision‐Support Framework. Interviews were transcribed verbatim and analysed thematically using framework methods. Baseline sociodemographic, clinical and decision‐making characteristics were also collected.ResultsAnalyses yielded four themes. Theme 1 captured participants' openness to try self‐guided digital treatment, despite limited deliberation on potential downsides or alternative options. Theme 2 highlighted that immediacy and ease of access were major drivers of uptake, which participants contrasted with gaps in access and continuity of care in face‐to‐face services, especially rurally. Theme 3 centred on participants as the main agents in their decision‐making, with family and health professional attitudes also reportedly influencing decision‐making. Theme 4 revealed participants' primary motivations for deciding to take up treatment (e.g., the potential to increase insight and coping skills), while also acknowledging that pre‐existing characteristics (e.g., health and digital literacy, insight) determined participants' personal suitability for self‐guided digital treatment.ConclusionFindings help to elucidate the decision‐making influences and processes amongst people who started a self‐guided treatment for depression and anxiety. Additional information and decision support resources appear warranted, which may also improve the accessibility of self‐guided treatments.Public or Patient ContributionPatients were interviewed about their views and experiences of decision‐making about accessing and taking up treatment. As such, patient contribution to the research was as study participants.