The Impact of Mobile Technology-Delivered Interventions on Youth Well-being: Systematic Review and 3-Level Meta-analysis

State of the Science: Using Digital Mental Health Interventions to Extend the Impact of Psychological Services

In recent years, digital mental health interventions (DMHIs) have emerged as a paradigm shift in care delivery that could expand the scale, efficiency, and effectiveness of psychological services. However, DMHI impact is constrained by issues related to limited reach, poor adoption, implementation barriers, and insufficient long-term maintenance. Organized by the Reach, Effectiveness, Adoption, Implementation, and Maintenance(RE-AIM) framework, this paper surveys the current state of DMHIs, highlighting research and practice gaps as well as potential strategies to move the field forward. Similarly, we discuss the role that emerging technologies and changes in the profession will play in shaping DMHIs in years to come. Finally, concrete and actionable steps to advance equity in the DMHI field are provided, with an emphasis on strategies to increase the representativeness of marginalized populations in DMHI research, the inclusion of these groups in the design and testing of DMHIs, and how to improve the contextual and cultural fit of DMHIs.

The current evidence of solution-focused brief therapy: A meta-analysis of psychosocial outcomes and moderating factors

PURPOSE

Solution Focused Brief Therapy (SFBT) focuses on the strengths and resources of clients, and is assumed to achieve positive results on various psychosocial outcomes. This meta-analysis is an extension of previous meta-analyses on SFBT, and examines if the effectiveness of SFBT is influenced by participant, intervention, study and publication characteristics.

METHODS

Experimental and quasi-experimental studies were included. A three-level meta-analysis was performed on 72 studies and 489 effect sizes, accounting for within and between study differences.

RESULTS

The overall effect of SFBT on psychosocial problems was large (g = 1.17). Moderator analyses revealed larger effects of SFBT in non-clinical samples (g = 1.50) than in clinical samples (g = 0.78). Studies with treatment-as-usual (TAU) as control condition reported smaller effects (g = 0.58) than studies with a no-treatment control condition (g = 1.59). Relatively large effects were found for couples (g = 3.02) compared to other client groups (0.41 < g < 1.70), and marital functioning (g = 3.02) compared to other outcomes (0.23 < g < 1.31). Group therapy (g = 1.64) yielded a larger effect than individual therapy (g = 0.48).

CONCLUSION

The findings indicate that SFBT is applicable for a variety of clients and psychosocial problems.

Determinants of behavioral intentions to use an E-Pharmacy service: Insights from TAM theory and the moderating influence of technological literacy

BACKGROUND

The growing significance of E-Pharmacy services in healthcare necessitates investigating the factors influencing users' behavioral intentions on these platforms. Comprehending these variables is imperative to maximize service provision, elevate customer satisfaction, and ultimately elevate healthcare accessibility and results.

OBJECTIVE(S)

The main goal of this study is to explore the factors that shape consumers' inclination to use E-Pharmacy services, focusing on the framework provided by the Technology Acceptance Model. Additionally, we aimed to investigate how technological literacy plays a moderating role in this context, specifically within the South African setting.

METHODS

Using a sample of 480 South African clients, the Technology Acceptance Model (TAM) and partial least squares structural equation modeling (PLS-SEM) were used to investigate the factors influencing behavioral intention to use E-Pharmacy services.

RESULTS

The findings underscore perceived usefulness, trust, performance expectancy, and social Influence as fundamental drivers influencing users' intentions to adopt E-Pharmacy systems. Additionally, the study shows that consumers' intention to use E-Pharmacy services is significantly and favorably affected by their desire to utilize such services. This suggests that individuals are more likely to act on positive intentions when they are interested in using E-Pharmacy platforms. Intriguingly, technological literacy has emerged as a moderating factor in the relationship between the intention to use and the actual behavior of utilizing E-Pharmacy platforms. This demonstrates the importance of consumers' technical knowledge and skills in bridging the intention-behavior gap and highlights the necessity of adapting treatments and instructional strategies to account for various levels of technological literacy.

CONCLUSION

This study provides valuable insights into the complex relationships between factors influencing the acceptance of E-Pharmacy services in South Africa. This knowledge can have practical implications for lawmakers, developers of E-Pharmacy platforms, and healthcare professionals who aim to enhance user acceptance and utilization.

Digital Disconnection: A Qualitative Study of Youth and Young Adult Perspectives on Cyberbullying and the Adoption of Auto-Detection or Software Tools

PURPOSE

The purpose of this study was to understand the needs of youth and young adults, current gaps around safeguarding social media, and factors affecting adoption of data-driven auto-detection or software tools.

METHODS

This qualitative study is the first step of a larger initiative that aims to use participatory action research and co-design principles to develop a digital tool that targets cyberbullying. Youth and young adults aged 16-21 years were recruited to participate in semistructured focus groups between March 2020 and November 2021. Thematic analysis was used to develop themes, with a member-checking process to validate the findings.

RESULTS

Six focus groups were completed with 39 participants and five themes were generated from the analysis. Participants described the mental health impacts of cyberbullying on young people, the stigma associated with it, and the need for more mental health resources. They felt that additional efforts are needed to improve the school environment, school-based interventions, and training protocols to ensure that youth feel safe reporting cyberbullying. Most participants were open to using a digital solution but raised concerns around the trustworthiness of artificial intelligence and wanted it to be co-designed with young people, integrated across platforms, informed by data-driven decisions, and transparent with users.

DISCUSSION

Youth and young adults are accepting of a low-risk digital cyberbullying solution as current interventions are not meeting their needs.

Current evidence and opportunities in child and adolescent public mental health: a research review

BACKGROUND

A public mental health lens is increasingly required to better understand the complex and multifactorial influences of interpersonal, community and institutional systems on the mental health of children and adolescents.

METHODS

This research review (1) provides an overview of public mental health and proposes a new interactional schema that can guide research and practice, (2) summarises recent evidence on public mental health interventions for children and adolescents, (3) highlights current challenges for this population that might benefit from additional attention and (4) discusses methodological and conceptual hurdles and proposes potential solutions.

RESULTS

In our evidence review, a broad range of universal, selective and indicated interventions with a variety of targets, mechanisms and settings were identified, some of which (most notably parenting programmes and various school-based interventions) have demonstrated small-to-modest positive effects. Few, however, have achieved sustained mental health improvements.

CONCLUSIONS

There is an opportunity to re-think how public mental health interventions are designed, evaluated and implemented. Deliberate design, encompassing careful consideration of the aims and population-level impacts of interventions, complemented by measurement that embraces complexity through more in-depth characterisation, or 'phenotyping', of interpersonal and environmental elements is needed. Opportunities to improve child and adolescent mental health outcomes are gaining unprecedented momentum. Innovative new methodology, heightened public awareness, institutional interest and supportive funding can enable enhanced study of public mental health that does not shy away from complexity.

Acceptability and Utility of a Smartphone App to Support Adolescent Mental Health (BeMe): Program Evaluation Study

BACKGROUND

Adolescents face unprecedented mental health challenges, and technology has the opportunity to facilitate access and support digitally connected generations. The combination of digital tools and live human connection may hold particular promise for resonating with and flexibly supporting young people's mental health.

OBJECTIVE

This study aimed to describe the BeMe app-based platform to support adolescents' mental health and well-being and to examine app engagement, usability, and satisfaction.

METHODS

Adolescents in the United States, aged 13 to 20 years, were recruited via the web and enrolled between September 1 and October 31, 2022. App engagement, feature use, clinical functioning, and satisfaction with BeMe were examined for 30 days. BeMe provides content based on cognitive behavioral therapy, dialectical behavior therapy, motivational interviewing, and positive psychology; interactive activities; live text-based coaching; links to clinical services; and crisis support tools (digital and live).

RESULTS

The average age of the sample (N=13,421) was 15.04 (SD 1.7) years, and 56.72% (7612/13,421) identified with she/her pronouns. For the subsample that completed the in-app assessments, the mean scores indicated concern for depression (8-item Patient Health Questionnaire mean 15.68/20, SD 5.9; n=239), anxiety (7-item Generalized Anxiety Disorder Questionnaire mean 13.37/17, SD 5.0; n=791), and poor well-being (World Health Organization-Five Well-being Index mean 30.15/100, SD 16.1; n=1923). Overall, the adolescents engaged with BeMe for an average of 2.38 (SD 2.7) days in 7.94 (SD 24.1) sessions and completed 11.26 (SD 19.8) activities. Most adolescents engaged with BeMe's content (12,270/13,421, 91.42%), mood ratings (13,094/13,421, 97.56%), and interactive skills (10,098/13,421, 75.24%), and almost one-fifth of the adolescents engaged with coaching (2539/13,421, 18.92%), clinical resources (2411/13,421, 17.96%), and crisis support resources (2499/13,421, 18.62%). Overall app engagement (total activities) was highest among female and gender-neutral adolescents compared with male adolescents (all P<.001) and was highest among younger adolescents (aged 13-14 years) compared with all other ages (all P<.001). Satisfaction ratings were generally high for content (eg, 158/176, 89.8% rated as helpful and 1044/1139, 91.66% improved coping self-efficacy), activities (5362/8468, 63.32% helpful and 4408/6072, 72.6% useful in coping with big feelings), and coaching (747/894, 83.6% helpful and 747/894, 83.6% improved coping self-efficacy). Engagement (total activities completed) predicted the likelihood of app satisfaction (P<.001).

CONCLUSIONS

Many adolescents downloaded the BeMe app and completed multiple sessions and activities. Engagement with BeMe was higher among female and younger adolescents. Ratings of BeMe's content, activities, and coaching were very positive for cognitive precursors aimed at reducing depression and anxiety and improving well-being. The findings will inform future app development to promote more sustained engagement, and future evaluations will assess the effects of BeMe on changes in mental health outcomes.