Participatory Research as One Piece of the Puzzle: A Systematic Review of Consumer Involvement in Design of Technology-Based Youth Mental Health and Well-Being Interventions

An Application of Evidence-Based Approaches to Engage Young People in the Design of a Global Mental Health Databank

INTRODUCTION

Engaging youth in mental health research and intervention design has the potential to improve their relevance and effectiveness. Frameworks like Roger Hart's ladder of participation, Shier's pathways to participation and Lundy's voice and influence model aim to balance power between youth and adults. Hart's Ladder, specifically, is underutilized in global mental health research, presenting new opportunities to examine power dynamics across various contexts. Drawing on Hart's ladder, our study examined youth engagement in mental health research across high- and middle-income countries using Internet-based technologies, evaluating youth involvement in decision-making and presenting research stages that illustrate these engagements.

METHODS

We conducted a directed content analysis of youth engagement in the study using primary data from project documents, weekly AirTable updates and discussions and interviews with youth and the research consortium. Using Hart's Ladder as a framework, we describe youth engagement along rungs throughout different research stages: cross-cutting research process, onboarding, formative research and quantitative and qualitative study designs.

RESULTS

Youth engagement in the MindKind study fluctuated between Rung 4 ('Assign, but informed') and Rung 7 ('Youth initiated and directed') on Hart's Ladder. Engagement was minimal in the early project stages as project structures and goals were defined, with some youth feeling that their experiences were underutilized and many decisions being adult-led. Communication challenges and structural constraints, like tight timelines and limited budget, hindered youth engagement in highest ladder rungs. Despite these obstacles, youth engagement increased, particularly in developing recruitment strategies and in shaping data governance models and the qualitative study design. Youth helped refine research tools and protocols, resulting in moderate to substantial engagement in the later research stages.

CONCLUSION

Our findings emphasize the value of youth-adult partnerships, which offer promise in amplifying voices and nurturing skills, leadership and inclusiveness of young people. Youth engagement in project decision-making progressed from lower to higher rungs on Hart's Ladder over time; however, this was not linear. Effective youth engagement requires dynamic strategies, transparent communication and mutual respect, shaping outcomes that authentically reflect diverse perspectives and mental health experiences.

PATIENT OR PUBLIC CONTRIBUTION

There was substantial patient and public involvement in this study. This paper reports findings on youth engagement conducted with 35 young people from India, South Africa and the United Kingdom, all of whom had lived experience of mental health challenges. Youth engagement in the MindKind study was coordinated and led by three professional youth advisors (PYAs) in these contexts, who were also young people with lived experience of mental health challenges. Each of the three study sites embedded a full-time, community-based PYA within their study team to inform all aspects of the research project, including the development of informational materials and the facilitation of Young People's Advisory Group (YPAG) sessions referenced in this paper. Each PYA also consulted with a site-specific YPAG that met bi-monthly throughout the project, shaping the formation of study materials and serving as a test group in both the quantitative and qualitative studies. Youth participants in this study also contributed extensively, engaging in data collection and manuscript writing. The following youth advisory panels members (J.B., L.B., D.O.J., M.V.) and all PYAs (E.B., S.R., R.S.) in the MindKind study contributed to the writing of this manuscript and are acknowledged as co-authors.

Evaluation of research co-design in health: a systematic overview of reviews and development of a framework

BACKGROUND

Co-design with consumers and healthcare professionals is widely used in applied health research. While this approach appears to be ethically the right thing to do, a rigorous evaluation of its process and impact is frequently missing. Evaluation of research co-design is important to identify areas of improvement in the methods and processes, as well as to determine whether research co-design leads to better outcomes. We aimed to build on current literature to develop a framework to assist researchers with the evaluation of co-design processes and impacts.

METHODS

A multifaceted, iterative approach, including three steps, was undertaken to develop a Co-design Evaluation Framework: 1) A systematic overview of reviews; 2) Stakeholder panel meetings to discuss and debate findings from the overview of reviews and 3) Consensus meeting with stakeholder panel. The systematic overview of reviews included relevant papers published between 2000 and 2022. OVID (Medline, Embase, PsycINFO), EBSCOhost (Cinahl) and the Cochrane Database of Systematic reviews were searched for papers that reported co-design evaluation or outcomes in health research. Extracted data was inductively analysed and evaluation themes were identified. Review findings were presented to a stakeholder panel, including consumers, healthcare professionals and researchers, to interpret and critique. A consensus meeting, including a nominal group technique, was applied to agree upon the Co-design Evaluation Framework.

RESULTS

A total of 51 reviews were included in the systematic overview of reviews. Fifteen evaluation themes were identified and grouped into the following seven clusters: People (within co-design group), group processes, research processes, co-design context, people (outside co-design group), system and sustainment. If evaluation methods were mentioned, they mainly included qualitative data, informal consumer feedback and researchers' reflections. The Co-Design Evaluation Framework used a tree metaphor to represent the processes and people in the co-design group (below-ground), underpinning system- and people-level outcomes beyond the co-design group (above-ground). To evaluate research co-design, researchers may wish to consider any or all components in the tree.

CONCLUSIONS

The Co-Design Evaluation Framework has been collaboratively developed with various stakeholders to be used prospectively (planning for evaluation), concurrently (making adjustments during the co-design process) and retrospectively (reviewing past co-design efforts to inform future activities).

From diagnosis to dialogue - reconsidering the DSM as a conversation piece in mental health care: a hypothesis and theory

The Diagnostic and Statistical Manual of Mental Disorders, abbreviated as the DSM, is one of mental health care's most commonly used classification systems. While the DSM has been successful in establishing a shared language for researching and communicating about mental distress, it has its limitations as an empirical compass. In the transformation of mental health care towards a system that is centered around shared decision-making, person-centered care, and personal recovery, the DSM is problematic as it promotes the disengagement of people with mental distress and is primarily a tool developed for professionals to communicate about patients instead of with patients. However, the mental health care system is set up in such a way that we cannot do without the DSM for the time being. In this paper, we aimed to describe the position and role the DSM may have in a mental health care system that is evolving from a medical paradigm to a more self-contained profession in which there is increased accommodation of other perspectives. First, our analysis highlights the DSM's potential as a boundary object in clinical practice, that could support a shared language between patients and professionals. Using the DSM as a conversation piece, a language accommodating diverse perspectives can be co-created. Second, we delve into why people with lived experience should be involved in co-designing spectra of distress. We propose an iterative design and test approach for designing DSM spectra of distress in co-creation with people with lived experience to prevent the development of 'average solutions' for 'ordinary people'. We conclude that transforming mental health care by reconsidering the DSM as a boundary object and conversation piece between activity systems could be a step in the right direction, shifting the power balance towards shared ownership in a participation era that fosters dialogue instead of diagnosis.

Yoga as an adjunct treatment for eating disorders: a qualitative enquiry of client perspectives

BACKGROUND

This qualitative enquiry explores the experiences and perspectives of individuals with an eating disorder (ED) regarding their perceptions of yoga as an adjunct intervention to psychotherapy. It also explores the feasibility, acceptability, and safety of yoga from their perspectives.

METHODS

This study used a practice-based evidence framework and employed semi-structured interviews with 16 females with an ED. Participants were asked about their perspectives on the use of yoga as an adjunct intervention in ED recovery, perceived risks and what factors supported or hindered engagement. Thematic template analysis was used.

RESULTS

Three topic areas were elaborated. The first included participants' perceptions of how yoga enhanced their ED recovery. The second included how and when participants came to find yoga in their ED recovery. The final topic explored factors that supported participants with ED to engage in yoga. These resulted in the development of guiding principles to consider when designing a yoga intervention for EDs.

CONCLUSIONS

This study adds further to the emerging evidence that yoga can bring complementary benefits to ED recovery and provides a biopsychosocial-spiritual framework for understanding these. Findings provide an understanding of how yoga programs can be adapted to improve safety and engagement for people with an ED. Yoga programs for people with EDs should be co-designed to ensure that the physical, social, and cultural environment is accessible and acceptable.

Involvement of children and young people in the conduct of health research: A rapid umbrella review

BACKGROUND

Patient and public involvement and engagement (PPIE) have long been considered important to good research practice. There is growing, yet diverse, evidence in support of PPIE with children and young people (CYP). We must now understand the various approaches to involvement of CYP in research.

AIMS

This rapid umbrella review aimed to provide an overview of when, how and to what extent CYP are involved in the conduct of health research, as well as the reported benefits, challenges, and facilitators of involvement.

METHODS

We searched OVID Medline, Embase and PubMed. Published reviews were included if they reported meaningful involvement of CYP in the conduct of health research. Extracted data were synthesised using thematic analysis.

RESULTS

The 26 reviews included were predominately systematic and scoping reviews, published within the last decade, and originating from North America and the United Kingdom. CYPs were involved in all stages of research across the literature, most commonly during research design and data collection, and rarely during research funding or data sharing and access. Researchers mostly engaged CYP using focus groups, interviews, advisory panels, questionnaires, and to a lesser extent arts-based approaches such as photovoice and drawing. Visual and active creative methods were more commonly used with children ≤12 years. The evidence showed a shared understanding of the benefits, challenges, and facilitators for involvement of CYP, such as time and resource commitment and building partnership.

CONCLUSION

Overall, the review identified consistency in the range of methods and approaches used, and stages of research with which CYP are commonly involved. There is a need for more consistent reporting of PPIE in the literature, both in terminology and detail used. Furthermore, the impact of approaches to CYP involvement on research and community outcomes must be better evaluated.

PATIENT/PUBLIC CONTRIBUTION

This review forms part of broader research initiatives being led by the authors. Together, these projects aim to support embedding of child voices in research practice and to explore the desirability and suitability of Young Persons Advisory Groups within birth cohort studies. The findings from this review, alongside public and stakeholder consultation, will inform development of resources such as practice recommendations to guide future involvement of CYP in health research undertaken at the author's respective institutions.

HCI Contributions in Mental Health: A Modular Framework to Guide Psychosocial Intervention Design

Many people prefer psychosocial interventions for mental health care or other concerns, but these interventions are often complex and unavailable in settings where people seek care. Intervention designers use technology to improve user experience or reach of interventions, and HCI researchers have made many contributions toward this goal. Both HCI and mental health researchers must navigate tensions between innovating on and adhering to the theories of change that guide intervention design. In this paper, we propose a framework that describes design briefs and evaluation approaches for HCI contributions at the scopes of capabilities, components, intervention systems, and intervention implementations. We show how theories of change (from mental health) can be translated into design briefs (in HCI), and that these translations can bridge and coordinate efforts across fields. It is our hope that this framework can support researchers in motivating, planning, conducting, and communicating work that advances psychosocial intervention design.

A systematic review and meta-analysis of the effectiveness of co-designed, in-person, mental health interventions for reducing anxiety and depression symptoms

BACKGROUND

Co-design is recommended in mental health fields and has been associated with improved intervention efficacy. Despite its growing popularity, syntheses of evidence on the effectiveness of co-designed interventions are scarce, and little is known about their impact on anxiety and depression.

METHODS

The purpose of this systematic review and meta-analysis was to consolidate evidence on the effectiveness of in-person, co-designed mental health interventions for reducing anxiety and depression symptoms. An exhaustive search was conducted across six electronic databases (PubMed, PsycINFO, Embase, CINAHL, CENTRAL, and ProQuest) and grey literature. Criteria for inclusion comprised studies utilizing randomized or quasi-randomized methods, implementing non-digital/in-person, co-designed interventions for mental health enhancement, and assessing anxiety and/or depression. Intervention impacts were evaluated using random-effects meta-analyses.

RESULTS

The review identified 20 studies, with only three using the term 'co-design'. Other terminologies included 'co-developed' (n = 2), 'co-produced' (n = 2), and 'CBPR' (n = 11). Seventeen studies exhibited moderate risk of bias, while three demonstrated high risk. Meta-analyses demonstrated a moderate non-significant effect size of 0.5 (95 % CI: -0.8, 1.08; p = 0.08) on depression outcomes, and a small non-significant effect size of 0.12 (95 % CI: -0.1, 0.33; p = 0.23) on anxiety outcomes.

LIMITATIONS

The majority of studies lacked sufficient statistical power to detect between-group differences. Following GRADE criteria, confidence in estimates was low.

CONCLUSIONS

Notwithstanding widespread enthusiasm for co-design, the current evidence base is inadequate to confirm the impact of in-person, co-designed mental health interventions on anxiety and depression. More full-scale evaluation trials of higher quality are urgently needed, along with uniform terminology and measurement.

Characterizing Canadian funded partnered health research projects between 2011 and 2019: a retrospective analysis

BACKGROUND AND AIMS

Involving research users in collaborative research approaches may increase the relevance and utility of research findings. Our primary objectives were to (i) identify and describe characteristics of Canadian federally and provincially funded health research projects that included research users and were funded between 2011 and 2019; (ii) explore changes over time; and (iii) compare characteristics between funder required and optional partnerships.

METHODS

Retrospective analysis. Inclusion criteria were projects that included research users. We analyzed publicly available project variables, and coded field and type of research using established classification systems. We summarized data with descriptive statistics and compared variables across three funding year blocks and partnership requirement status.

RESULTS

We identified 1153 partnered health research projects, representing 137 fields of research and 37 types of research categories. Most projects included a required partnership (80%) and fell into health and social care services research (66%). Project length and funding amount increased from average of 24.8 months and $266 248 CAD in 2011-2013 to 31.6 months and $438 766 CAD in 2017-2019. There were significantly fewer required partnerships in 2017-2019.

CONCLUSIONS

Between 2011 and 2019 Canadian federally and provincially funded partnered health research reflected primarily care services research across many fields. The observed breadth suggests that partnered health research approaches are applicable in many fields of research. Additional work to support partnered research across all types of health research (especially biomedical research) is warranted. The administration of larger grants that are funded for longer time periods may address previously identified concerns among research teams engaging in partnered research but may mean that fewer teams receive funding and risk delaying responding to time-sensitive data needs for users. Our process and findings can be used as a starting point for international comparison.

Mobile Technologies for Supporting Mental Health in Youths: Scoping Review of Effectiveness, Limitations, and Inclusivity

BACKGROUND

Over the past decade, there has been growing support for the use of mobile health (mHealth) technologies to improve the availability of mental health interventions. While mHealth is a promising tool for improving access to interventions, research on the effectiveness and efficacy of mHealth apps for youths is limited, particularly for underrepresented populations, including youths of color and economically marginalized youths.

OBJECTIVE

This scoping review study sought to evaluate the following research questions: (1) What is the extent of the current literature on mHealth apps that provide intervention for mental health problems in children and adolescents? (2) What is known from the existing literature about the effectiveness or efficacy of delivering mental health services via mHealth apps? (3) What are the gaps in the knowledge base in the fields of technology and mental health? (4) Do the reviewed mHealth apps address issues of cultural sensitivity or have they been tested with underrepresented groups (ie, youths of color or economically marginalized groups)?

METHODS

An electronic database search was conducted using relevant search terms. Seven independent reviewers screened identified studies, including title and abstract review to determine if studies met the following inclusion criteria: (1) targeted samples with mental health symptomology or disorders, (2) studied youth participants aged 6-17 years, and (3) examined the use of a mobile app-based platform for intervention. Relevant studies were subjected to full-text review to extract and chart relevant data based on a priori research questions.

RESULTS

The initial database search yielded 304 papers published from 2010 to 2021. After screening and selection, the final review included 10 papers on the effectiveness and efficacy of mental health intervention apps for youths aged 8 to 17 years. Identified apps targeted a broad range of mental health challenges in youths (ie, depression, self-harm, autism spectrum disorder, anxiety, and obsessive-compulsive disorder). Results identified only a small number of studies suggesting that current effectiveness and efficacy research in this area are limited. While some studies provided general support for the effectiveness of mHealth apps in improving mental health outcomes in youths, several notable limitations were present across the literature, reducing the generalizability of findings. Additionally, considerations around racial, ethnic, and socioeconomic diversity were scarce across studies.

CONCLUSIONS

Although some studies cited in this scoping review provide support for the effectiveness and efficacy of mHealth apps targeting mental health concerns in youths, the overall body of literature remains quite limited. Moreover, mHealth apps expressly developed to be culturally responsive are almost nonexistent. Further efforts are needed to recruit youths who are typically underrepresented in research and invite stakeholder participation and collaborative input in the early stages of the mHealth app development process.

An emerging framework for digital mental health design with Indigenous young people: a scoping review of the involvement of Indigenous young people in the design and evaluation of digital mental health interventions

BACKGROUND

Indigenous young people worldwide possess unique protective factors that support wellbeing. However, they experience mental illness at higher rates than their non-indigenous counterparts. Digital mental health (dMH) resources can increase access to structured, timely, and culturally tailored mental health interventions by reducing structural and attitudinal barriers to accessing treatment. The involvement of Indigenous young people in dMH resource development is recommended, however, no guidelines exist on how this can best be facilitated.

METHODS

A scoping review examining processes to involve Indigenous young people in developing or evaluating dMH interventions was conducted. Studies reported between 1990 and 2023 involving Indigenous young people aged 12-24 years, originating from Canada, the USA, New Zealand, and Australia, in the development or evaluation of dMH interventions were eligible for inclusion. Following a three-step search process, four electronic databases were searched. Data were extracted, synthesized, and described under three categories: dMH intervention attributes, study design, and alignment with research best practice. Best practice recommendations for Indigenous research and participatory design principles derived from the literature were identified and synthesised. Included studies were assessed against these recommendations. Consultation with two Senior Indigenous Research Officers ensured Indigenous worldviews informed analysis.

RESULTS

Twenty-four studies describing eleven dMH interventions met inclusion criteria. Studies included formative, design, pilot, and efficacy studies. Overall, most included studies demonstrated a high degree of Indigenous governance, capacity building, and community benefit. All studies adapted their research processes to ensure that local community protocols were followed and most aligned these within an Indigenous research paradigm. Formal agreements regarding existing and created intellectual property and implementation evaluations were rare. Outcomes were the primary focus of reporting, with limited detailed descriptions of governance and decision-making processes or strategies for managing predictable tensions between co-design stakeholders.

CONCLUSIONS

This study identified recommendations for undertaking participatory design with Indigenous young people and evaluated the current literature against these criteria. Common gaps were evident in the reporting of study processes. Consistent, in-depth reporting is needed to allow assessment of approaches for this hard-to-reach population. An emergent framework, informed by our findings, for guiding the involvement of Indigenous young people in the design and evaluation of dMH tools is presented.

TRIAL REGISTRATION

Available via osf.io/2nkc6.

Mapping young people's journeys through mental health services: A prospective longitudinal qualitative study protocol

Mental ill health is a major health risk for young people. There is unmet need for mental health assessment and treatment across Australia despite significant investment in government-funded plans to cover mental health and youth-oriented services. Understandings of mental health care for young people are impeded by a lack of longitudinal research. Without this research, it is difficult to understand how services do or do not support the recovery of young people over time. This project will analyse the healthcare journeys of young people aged 16-25 years experiencing their first episode of mental ill health for which they have sought GP support, over 12 months in the Australian Capital Territory. The study team will recruit up to 25 diverse young people and their general practitioners (GPs), and conduct four qualitative semi-structured interviews over 12 months with each participant. GP interviews will explore their role in the mental health care and care coordination for the young person. Interviews with young people will explore experiences and perceptions of navigating the health system, and the supports and resources they engaged with during the 12-month period. In between interviews, young people will be asked to keep a record of their mental health care experiences, through their choice of media. Participant-produced materials will also form the basis for interviews, providing stimuli to discuss the lived experience of care. Through analysing the narratives of both young people and their GPs, the study will establish how young people understand value in mental health care delivery. The study will use longitudinal qualitative mapping of healthcare journeys to identify key barriers and enablers to establishing effective, person-centred health care for young people with mental ill health.

Adaptation of ACTivate Your Wellbeing, a Digital Health and Well-being Program for Young Persons: Co-design Approach

BACKGROUND

ACTivate your wellbeing is a digital health and well-being program designed to support and encourage positive lifestyle behavior change. The website includes 5 lifestyle behavior change modules and a 12-week well-being intervention based on acceptance and commitment therapy. It was timely to adapt the resource for a new audience in the wake of the COVID-19 pandemic. Young persons' mental health needs have increased substantially, and lifestyle behaviors play a critical role in both mental and physical health statuses.

OBJECTIVE

This study aimed to adapt an existing health and well-being website for use by young persons aged 16 to 24 years.

METHODS

A 3-staged participatory, co-design approach was adopted. The participants reviewed the existing program and provided feedback (stage 1) before cocreating new content (stage 2). Finally, the updated program underwent formative evaluation (stage 3). Two groups were created: one had access for 3 weeks and the other could self-select their study duration. The options were 3 weeks, 60 days, or 90 days. Outcome measures were the Warwick and Edinburgh Mental Well-being Scale, 4-item Patient Health Questionnaire, and Acceptance and Action Questionnaire version 2.

RESULTS

Stage 1 identified that the website was appealing to the new audience (19/24, 79%), and the 3 web-based focus group discussions explored data from the written review in more depth to identify and clarify the main areas for update and adaptation. Overall, 3 themes were developed, and the data informed the creation of 6 tasks for use in 5 web-based co-design workshops. Stage 2 led to the cocreation of 36 outputs, including a new name, new content, scenarios, images, and a new user dashboard, which included streaks and an updated color scheme. After the website update program was completed, 40 participants registered to use the website for formative evaluation (stage 3). Data analysis revealed differences in engagement, completion, and mean well-being after intervention between the 2 groups. The completion rate was 68% in the 3-week duration group, and well-being scores improved after intervention.

CONCLUSIONS

Young persons engaged actively with the participatory design process. The participants discussed the updates they desired during the web-based discussions, which worked well via Zoom (Zoom Video Communications Inc) when small groups were used. The participants easily cocreated new content during the web-based co-design workshops. The web-based format enabled a range of participants to take part, share their ideas, search for images, and design digital content creatively together. The Zoom software enabled screen sharing and collaborative whiteboard use, which helped the cocreation process. The formative evaluation suggested that younger users who engage more with the website for a shorter duration may benefit more.

From participants to partners: reconceptualising authentic patient engagement roles in youth mental health research

The value of involving people with lived experience in the research process (ie, patient engagement) is increasingly being recognised within youth mental health research. The wide-reaching benefits of patient engagement have been documented in the literature, including the empowerment of patients, improvement of research outcomes, and increased relevance of research findings. Although various models exist to guide patient engagement, there are key concepts that deserve exploration to ensure the authentic implementation of these models and development of patient roles. Our Personal View aims to: identify and discuss barriers to patient engagement roles in the context of youth mental health research; consider how key concepts of relational empowerment, fluidity, and flexibility can address some of these barriers; and provide tangible recommendations for implementing authentic patient engagement throughout the research process.

Recruiting and engaging adolescents in creating overweight and obesity prevention policies: The CO-CREATE project

The CO-CREATE project aims to collaborate with adolescents across Europe in developing policy ideas that contribute to overweight and obesity prevention. In this paper, we present the theoretical basis and methodological approach to recruitment and engagement in the project. The principles of youth-led participatory action research were employed to design Youth Alliances in which adolescents and adults could collaborate. These Alliances should serve to promote and support adolescent participation and to develop policy ideas that would contribute to obesity prevention. Alliance members were recruited in two local geographical areas per country with a focus on reaching out to underrepresented youth. We started with fieldwork to assess locally relevant forms of inclusion and exclusion. The methodology entailed a handbook combining existing tools which could be used flexibly, a collaborative organization, and budgets for the alliances. Engagement started in local organizations, that is, schools and scouts, and with peers. Health- and overweight-related challenges were addressed in their immediate surroundings and supported the inclusion of experiential knowledge. Adolescents were then supported to address the wider obesogenic system when designing policy ideas. The CO-CREATE Alliances provide a concrete example of how to engage youth in public health, in a manner that strives to be participatory, transformative, and inquiry based.

Application of Two-Eyed Seeing in Adolescent Mental Health to Bridge Design Thinking and Indigenous Collective Storytelling

BACKGROUND

eMental health apps are increasingly being considered for use in health care with growing recognition of the importance of considering end-user preferences in their design and implementation. The key to the success of using apps with Indigenous youth is tailoring the design and content to include Indigenous perspectives. In this study we used a Two-Eyed Seeing perspective to integrate Indigenous and human computer interaction methodologies to identify end-user preferences for a tablet-based mental health screening app used in a primary care clinic serving Indigenous youth.

OBJECTIVE

The research objectives used a Two-Eyed Seeing approach to (i) collectively create stories about Indigenous youth lived experiences accessing integrated primary care for their mental health concerns; and (ii) engage Indigenous youth in Design Circles to determine their usability preferences for digital mental health screening tools.

METHOD

Eight adolescents (n = 4 young women; n = 3 young men; and n = 1 Two Spirit) between 20 to 24 years old who self-identified as Indigenous participated. Indigenous youth joined Design Circles to co-create a story about accessing mental health care and their needs and preferences for an eMental Health app.

RESULTS

Findings highlighted the importance of collective Indigenous storytelling about accessing integrated primary care for mental health needs. Participants created three persona stories about their challenges accessing mental health care and the role of social support. Participants sorted their usability design preferences for an eMental Health app to be inclusive of Indigenous knowledges.

CONCLUSIONS

A Two-Eyed Seeing perspective was useful to incorporate a design thinking approach as collective storytelling among Indigenous youth. This research may inform and shape the design of eMental health apps used in health clinics to better engage Indigenous youth.

What Do Adolescents and Their Parents Need From Mental Health Integration in Primary Care? A Qualitative Exploration of Design Insights

INTRODUCTION

The design of integrated adolescent mental health care should address needs and preferences of patients and parents/guardians.

METHOD

We conducted interviews and focus groups with adolescents aged 13-17 years who received care at Kaiser Permanente Washington in 2020 and interviews with parents of such adolescents. We sought to (1) understand the challenges of primary care-based mental health and substance use screening and care for adolescents and (2) identify program design solutions. Sessions were audio-recorded, transcribed, and coded. Thematic analysis was applied to identify key challenges and design solutions.

RESULTS

Emerging themes from interviews (n = 41) and focus groups (n = 10) were summarized in five overarching design principles: Engagement, Privacy, Communication, Choice, and Ease. Each design principle was expanded for operationalization within a new health system program.

DISCUSSION

Health systems serving adolescents in primary care may consider application of these design principles to the development of mental health integration programs.

Introduction of Technology to Support Young People’s Care and Mental Health—A Rapid Evidence Review

Background

Technology and its use within mental health services has advanced dramatically over recent years. Opportunities for mental health services to utilise technology to introduce novel, effective, and more efficient means of delivering assessment, and treatment are increasing.

Objective

The current rapid-evidence paper reviews evidence regarding the introduction of novel technology to support young people’s mental health and psychological well-being.

Methods

A rapid evidence review was conducted. PSYCHINFO and CINAHL were searched for research articles between 2016 and 2021 that were specific to young people, mental health, and technology developments within this domain. N = 27 studies which explored the introduction, feasibility, and value of technology for mental health purposes were included in a narrative synthesis. Quality or risk of bias analyses were not completed.

Results

Overall, technological advancements in young people’s care were considered positive and engaging for young people. Factors including resources, efficiency of care, engagement, therapeutic effectiveness, ethical considerations, therapeutic alliance, and flexibility were considered within this review. Nevertheless, potential barriers include clinician concerns, socioeconomic factors, and motivation.

Conclusion

Effective and sustained use of technology within young people’s mental health services will depend on the technology’s usability, efficiency, and ability to engage young people. This paper expands on existing research by reviewing a broader range of technology proposed to support young people’s mental health and well-being. This will assist in the application of novel technological advancements by indicating effectiveness, preferences, potential barriers, and recommendations for the feasibility and efficacy of introducing technology into young people’s services.

"Something for us": Co-development of the COVID-19 Social Site, a web app for long-term care workers

Background

Improving confidence in and uptake of COVID-19 vaccines and boosters among long-term care workers (LTCWs) is a crucial public health goal, given their role in the care of elderly people and people at risk. While difficult to reach with workplace communication interventions, most LTCWs regularly use social media and smartphones. Various social media interventions have improved attitudes and uptake for other vaccines and hold promise for the LTCW population.

Objective

We aimed to develop a curated social web application (interactive website) to increase COVID-19 vaccine confidence (a 3-arm randomized trial is underway).

Methods

Following user-centric design and participatory research approaches, we undertook the following 3 steps: (1) content identification, (2) platform development, and (3) community building. A LTCW and stakeholder advisory group provided iterative input. For content identification (step 1), we identified topics of concern about COVID-19 vaccines via desktop research (published literature, public opinion polls, and social media monitoring), refined by interviewing and polling LTCWs. We also conducted a national online panel survey. We curated and fact-checked posts from popular social media platforms that addressed the identified concerns. During platform development (step 2), we solicited preferences for design and functionality via interviews and user experience testing with LTCWs. We also identified best practices for online community building (step 3).

Results

In the interviews (n=9), we identified 3 themes: (1) LTCWs are proud of their work but feel undervalued; (2) LTCWs have varying levels of trust in COVID-19–related information; and (3) LTCWs would welcome a curated COVID-19 resource that is easy to understand and use-"something for us". Through desktop research, LTCW interviews, and our national online panel survey (n=592) we found that participants are interested in information about COVID-19 in general, vaccine benefits, vaccine risks, and vaccine development. Content identification resulted in 434 posts addressing these topic areas, with 209 uploaded to the final web application. Our LTCW poll (n=8) revealed preferences for personal stories and video content. The platform we developed is an accessible WordPress-based social media web application, refined through formal (n=3) and informal user experience testing. Users can sort posts by topic or subtopic and react to or comment on posts. To build an online community, we recruited 3 LTCW “community ambassadors” and instructed them to encourage discussion, acknowledge concerns, and offer factual information on COVID-19 vaccines. We also set “community standards” for the web application.

Conclusions

An iterative, user-centric, participatory approach led to the launch of an accessible social media web application with curated content for COVID-19 vaccines targeting LTCWs in the United States. Through our trial, we will determine if this approach successfully improves vaccine confidence. If so, a similar social media resource could be used to develop curated social media interventions in other populations and with other public health goals.

Peer Facilitators as Core Co-developers of an Online Peer Encouragement Network (OPEN2chat) for Austrian Adolescents

Adolescence is a crucial developmental time, and it is essential to ensure stable mental health during the transition to adulthood. Peer-to-peer networks seem to be a promising tool to support adolescents during that time. While co-development often concentrates on the end-user, this paper focuses on the peer facilitators of an online peer encouragement network (OPEN2chat), where adolescents can chat with peer facilitators about their problems. We conducted 3 group discussions with 18 peer facilitators after a testing phase to improve the process of these interactions. Thematic analysis was used to analyse the data after transcription. The four main themes were the responsibility of the peer facilitators toward their peers, especially their role of giving advice; the interaction process itself; time management; and technology aspects of the application. Including these stakeholders in the development process empowered the young people, helped eliminate problems with the application, and made the researchers more sensitive toward potential issues and emotions that peer facilitators encounter that may have been missed without a co-development process. Eliminating these problems might also help establish a better environment and support system for the actual end-users.

Human-Centered Design Approaches in Digital Mental Health Interventions: Exploratory Mapping Review

BACKGROUND

Digital mental health interventions have a great potential to alleviate mental illness and increase access to care. However, these technologies face significant challenges, especially in terms of user engagement and adoption. It has been suggested that this issue stems from a lack of user perspective in the development process; accordingly, several human-centered design approaches have been developed over the years to consider this important aspect. Yet, few human-centered design approaches to digital solutions exist in the field of mental health, and rarely are end users involved in their development.

OBJECTIVE

The main objective of this literature review is to understand how human-centered design is considered in e-mental health intervention research.

METHODS

An exploratory mapping review was conducted of mental health journals with the explicit scope of covering e-mental health technology. The human-centered design approaches reported and the core elements of design activity (ie, object, context, design process, and actors involved) were examined among the eligible studies.

RESULTS

A total of 30 studies met the inclusion criteria, of which 22 mentioned using human-centered design approaches or specific design methods in the development of an e-mental health solution. Reported approaches were classified as participatory design (11/27, 41%), codesign (6/27, 22%), user-centered design (5/27, 19%), or a specific design method (5/27, 19%). Just over half (15/27, 56%) of the approaches mentioned were supported by references. End users were involved in each study to some extent but not necessarily in designing. About 27% (8/30) of all the included studies explicitly mentioned the presence of designers on their team.

CONCLUSIONS

Our results show that some attempts have indeed been made to integrate human-centered design approaches into digital mental health technology development. However, these attempts rely very little on designers and design research. Researchers from other domains and technology developers would be wise to learn the underpinnings of human-centered design methods before selecting one over another. Inviting designers for assistance when implementing a particular approach would also be beneficial. To further motivate interest in and use of human-centered design principles in the world of e-mental health, we make nine suggestions for better reporting of human-centered design approaches in future research.

A mixed-methods systematic review of suicide prevention interventions involving multisectoral collaborations

Background

Governments and third-sector organizations (TSOs) require support to reduce suicide mortality through funding of suicide prevention services and innovative research. One way is for researchers to engage individuals and services in multisectoral collaborations, to collaboratively design, develop and test suicide prevention services and programmes. However, despite widespread support, to date, it remains unclear as to the extent to which stakeholders are being included in the research process, or if they are, how these partnerships occur in practice. To address this gap, the authors conducted a systematic review with the aim of identifying evidence of multisectoral collaborations within the field of suicide prevention, the types of stakeholders involved and their level of involvement.

Methods

The authors conducted a strategic PRISMA-compliant search of five electronic databases to retrieve literature published between January 2008 and July 2021. Hand-searching of reference lists of key systematic reviews was also completed. Of the 7937 papers retrieved, 16 papers finally met the inclusion criteria. Because of data heterogeneity, no meta-analysis was performed; however, the methodological quality of the included studies was assessed.

Results

Only one paper included engagement of stakeholders across the research cycle (co-ideation, co-design, co-implementation and co-evaluation). Most stakeholders were represented by citizens or communities, with only a small number of TSOs involved in multisectoral collaborations. Stakeholder level of involvement focused on the co-design or co-evaluation stage.

Conclusion

This review revealed a lack of evidence of multisectoral collaborations being established between researchers and stakeholders in the field of suicide prevention research, even while such practice is being espoused in government policies and funding guidelines. Of the evidence that is available, there is a lack of quality studies documenting the collaborative research process. Also, results showed that the inclusion of co-researchers from communities or organizations is defined as co-creation, but further analysis revealed that collaboration was not consistent across the duration of projects. Researchers and practitioners should consider issues of power and equity in multisectoral collaborations and encourage increased engagement with TSOs, to rigorously research and evaluate suicide prevention services.

A mobile self-control training app to improve self-control and physical activity in people with severe mental illness: Protocol for two single-case experiment designs (Preprint)

BACKGROUND

Lack of physical activity is a common issue with detrimental consequences for the health of people with severe mental illness (SMI). Existing physical activity interventions show suboptimal effects as they require substantial cognitive skills, including goal setting and writing, whereas cognitive deficits are common in this population. To bolster the effectiveness of physical activity interventions, self-control training (SCT), in which users practice the ability to override unwanted thoughts and behaviors, can be used in addition. Recent research has demonstrated the initial effectiveness of a mobile SCT app, but this has not been studied in psychiatric clinical practice.

OBJECTIVE

This study aims to evaluate to what extent adding a mobile SCT app designed for and with people with SMI to a mobile lifestyle intervention aimed at increasing physical activity increases physical activity and self-control levels.

METHODS

A mixed methods approach incorporating 2 single-case experimental designs (SCEDs) and qualitative interviews was used to evaluate and optimize SCT. Overall, 12 participants with SMI will be recruited from 2 organizations offering outpatient and inpatient care to people with SMI. Each experiment will include 6 patients. SCED I is a concurrent multiple-baseline design across participants that explores initial effectiveness and optimal intervention duration. Using accelerometry and experience sampling questionnaires, participants' physical activity and self-control will be monitored for ≥5 days from baseline, followed by the sequential introduction of Google Fit, the physical activity intervention, for 7 days and the addition of SCIPP: Self-Control Intervention App for 28 days. SCED II is an introduction/withdrawal design in which optimized SCT will be introduced and withdrawn to validate the findings from SCED I. In both experiments, the daily average of total activity counts per hour and the state level of self-control will serve as the primary and secondary outcome measures. Data will be analyzed using visual analysis and piecewise linear regression models.

RESULTS

The study was designated as not subject to the Dutch Medical Research Involving Human Subjects Act by the Medical Research Ethical Committee Oost-Nederland and approved by the Ethics Committee/domain Humanities and Social Sciences of the Faculty of Behavioural, Management, and Social Sciences at the University of Twente. Participant recruitment started in January 2022, and we expect to publish the results in early 2023.

CONCLUSIONS

The mobile SCT app is expected to be feasible and effective. It is self-paced and scalable and can increase patient motivation, making it a suitable intervention for people with SMI. SCED is a relatively novel yet promising method for gaining insights into whether and how mobile apps work that can handle heterogeneous samples and makes it possible to involve a diverse population with SMI without having to include a large number of participants.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/37727.

Determining Priorities in the Aboriginal and Islander Mental Health Initiative for Youth App Second Phase Participatory Design Project: Qualitative Study and Narrative Literature Review

Background

Digital mental health tools can promote access to culturally safe early intervention mental health services for Aboriginal and Torres Strait Islander young people. Participatory design methodology facilitates user engagement in the co-design of digital resources. However, several challenges have been identified that limit the methodological rigor of this approach.

Objective

This paper aims to present an in-depth account of the second phase of participatory design in the development of the Aboriginal and Islander Mental Health Initiative for Youth (AIMhi-Y) app.

Methods

A first idea storyboard, generated from a formative phase of the AIMhi-Y project, was refined through a series of youth co-design workshops and meetings. A narrative review of the literature, 6 service provider interviews, and engagement with an expert reference group also informed the design process. Generative design activities, storyboarding, discussions, and voting strategies were used.

Results

The participatory design process identified the app features preferred by young people and service providers and assessed their alignment with current recommendations from the scientific literature. Findings from the co-design process are presented across 9 app characteristic domains. Integration of findings into app design proved complex. Although most preferred features identified by young people were included to some degree, other inclusions were restricted by budget, time, and the need to integrate best practice recommendations. A process of prioritization was required.

Conclusions

Participatory design is often cited in the development of digital mental health resources; however, methods are diverse and often lack detailed descriptions. This study reports the outcomes and strategies used to determine priorities in the second phase of the development of the AIMhi-Y app. We provide an example and the key learnings to inform others seeking to use participatory design with a similar cohort.

Do young men and women differ in well-being apps usage? Findings from a randomised trial

Introduction: The potential of mobile applications (apps) as a resource to support well-being in young people is hampered by low usage. Suggested reasons for this vary from technical issues to users' psychological and personal characteristics like gender, mood and perceptions on well-being. Objectives: To identify and understand predictive variables related to the use of well-being apps by young people in the context of the 'Online Wellbeing Centre' (OWC) Randomised Controlled Trial (a study assessing changes in well-being of young people who use well-being apps). Methods: A cross-sectional analysis using binary logistic regression was conducted, taking into account previous app usage of participants at baseline versus demographic, ecological momentary assessments, and well-being variables, of data collected in the OWC-RCT. To explore predictors further, follow-up post-RCT surveys were coded to better understand user's predisposition towards apps. Results: Mood (p < 0.006) and gender (p < 0.03) are significantly associated with the use of well-being apps. Female participants with elevated mood were more likely to use well-being apps before signing up into the study. Two themes were identified from participants at follow-up that related to the design of the app and engagement of the app user. Females were more likely to focus on the purpose of app, whereas males were more likely to focus on specific goals and features (e.g. tracking) offered by the app. Females were able to mention the link between well-being and app usage. Conclusion: Personal characteristics explain engagement with well-being apps, with mood and gender significant in the current sample. Further qualitative research may help identify other individual characteristics that explain why and how young people use well-being apps and the impact of these on a user's health.

Understanding what we know so far about young people's engagement with wellbeing apps. A scoping review and narrative synthesis

Background

Increased levels of wellbeing contribute to people being more productive, resilient, physically healthy and showing lower levels of mental illness. Using mobile apps to increase wellbeing in young people is becoming the method of choice. This study sought to critically appraise the current evidence base with regards to young people's (16–24 years of age) engagement with wellbeing apps.

Methods

A systematic review of the literature and narrative synthesis was conducted to investigate users’ characteristics and other potential engagement elements. A total of 11,245 titles, 160 abstracts and 68 full-text articles published between 2002 and 2021 were screened, of which 22 studies were included.

Results

Main themes/findings indicated that a user's engagement with wellbeing apps was dependant on the presence of strong identity elements, including motivation, mood and values; design elements such as meaningful rewards, short duration of studies and seamless automatic delivery with low contact with researchers; and being innovative and contextualised. The majority of the studies did not report outcomes by social determinants such as ethnicity, education and others.

Conclusion

This research reflects on the need to consider participants’ individuality when designing app mediated wellbeing interventions.

Embedding lived experience expertise across the mental health tertiary education sector: An integrative review in the context of Aotearoa New Zealand

WHAT IS KNOWN ON THE SUBJECT?: An important step towards improving mental health outcomes is the realignment of tertiary mental health education and research in a way which places strategic value on experience-driven involvement in mental health and addiction-related care. One of the most widely recognized ways of achieving this is by increasing representation of individuals with first-hand experience of mental health and addiction distress (also known or referred to as Experts by Experience or EBE) within the tertiary sector. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Benefits of tertiary EBE representation such as improving student's preparedness for practice and the empowerment of mental health consumers are consistently reported throughout the literature. In striving towards these outcomes, it is crucial we remain mindful of relevant and often-reported hurdles such as stigma and improper implementation. By using Aotearoa New Zealand as a case study, the need for approaches to increasing EBE representation which is conscious of diverse cultural contexts, perspectives and identities is highlighted. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This review draws together a broad range of factors associated with improving clinical practice. These include the potential for EBE representation to improve outcomes for trainee clinicians, and the incorporation of consumer-driven perspectives into evidence-based practice. This review further highlights the need for EBE representation to be implemented in a way which is responsive to the cultural needs and nuances of mental health education and practice in Aotearoa New Zealand, and, similarly in other countries. ABSTRACT: Introduction There is potential value in increasing representation of expert by experience (EBE) involvement in mental health education sectors. This approach to improving mental health outcomes is here explored in the context of Aotearoa New Zealand's tertiary education sector. Aim/Question This review sought to identify potential outcomes, benefits and barriers associated with EBE representation in tertiary institutions, whilst critically analysing these strategies in the context of Aotearoa New Zealand's mental health education sector. Method Data retrieved from electronic databases were subjected to critical appraisal and thematic analysis. The integrative review drew from a final data set of 113 articles. Results An integrative review of our search results indicated that moving towards a tertiary mental health model in which lived experience plays a central role has the potential to benefit both teaching and research in the tertiary sector. Discussion The interplay between contemporary perspectives on tertiary EBE representation and the cultural needs and nuances of Aotearoa New Zealand's tertiary sector highlights the need for critical and careful approaches to EBE representation. Implications for clinical practice Findings surrounding tertiary EBE representation have direct implications for the training of mental health practitioners and the evaluation and development of clinical practice outcomes and procedures.

Digital Overload among College Students: Implications for Mental Health App Use

Mental health phone applications (apps) provide cost-effective, easily accessible support for college students, yet long-term engagement is often low. Digital overload, defined as information burden from technological devices, may contribute to disengagement from mental health apps. This study aimed to explore the influence of digital overload and phone use preferences on mental health app use among college students, with the goal of informing how notifications could be designed to improve engagement in mental health apps for this population. A semi-structured interview guide was developed to collect quantitative data on phone use and notifications as well as qualitative data on digital overload and preferences for notifications and phone use. Interview transcripts from 12 college students were analyzed using thematic analysis. Participants had high daily phone use and received large quantities of notifications. They employed organization and management strategies to filter information and mitigate the negative effects of digital overload. Digital overload was not cited as a primary barrier to mental health app engagement, but participants ignored notifications for other reasons. Findings suggest that adding notifications to mental health apps may not substantially improve engagement unless additional factors are considered, such as users’ motivation and preferences.

Bonded design in the virtual environment: the transition of a participatory design methodology

Purpose

This paper examines how bonded design (BD), a participatory design methodology, was influenced by the transition to working in a virtual environment necessitated by the coronavirus disease 2019 (COVID-19) pandemic.

Design/methodology/approach

Abiding by the participatory design tenets of creativity, learning-by-doing and mutual learning, the BD methodology was created for the specific purpose of fostering meaningful communication and interaction between two disparate groups. Previous iterations of BD are discussed, including its naissance with intergenerational teams, its adaptation to provide a framework for a university-wide initiative, the Faculty Information Technology (IT) Liaison Program that brought together faculty members and IT professional staff, and its current use in helping public librarians to develop with older adults, targeted library programming and services.

Findings

Analysis of the findings from the assessment of the BD methodology in different physical contexts demonstrates that the flexibility in the makeup and order of design techniques (discussion, evaluation, brainstorming, prototyping, consensus-building) makes BD potentially adaptable to online spaces. Recommendations for implementing the BD methodology online are outlined. It is argued that BD’s adaptability makes it an ideal method for creating meaningful and productive collaborations within both physical and virtual environments.

Originality/value

The proposed iteration of the BD methodology responds to a need for innovative practices to foster collaborative work in a virtual environment. BD is a unique, inclusive and cost-effective methodology to encourage meaningful interaction and communication between disparate groups in physical or online contexts.

A School-Based Mobile App Intervention for Enhancing Emotion Regulation in Children: Exploratory Trial

BACKGROUND

Most mental health disorders are first experienced in childhood. The rising rates of mental health difficulties in children highlight the need for innovative approaches to supporting children and preventing these difficulties. School-based digital interventions that address shared risk factors and symptoms, such as emotion dysregulation, present exciting opportunities to enhance mental health support for children on a larger scale.

OBJECTIVE

This study investigates the use of a new app-based intervention designed to support children's emotion regulation in schools. The aim is to optimize the usability, acceptability, and utility of the app and explore its scope for implementation with the target user in the school context.

METHODS

As part of an interdisciplinary development framework, the app is being evaluated in a 3-month trial across 4 primary schools. In total, 144 children (aged 10-12 years) took part and accessed the intervention app in the classroom or at home. Outcomes regarding usability, acceptability, and implementation opportunities were assessed through digital user data, self-report questionnaires (132/144, 91.6%), and semistructured interviews with children (19/144, 13.2%) and teachers (6/8, 75%).

RESULTS

The app usage data showed that 30% (128/426) of the users were returning users. Self-report data indicated that 40.1% (53/132) of the children had not used the app, whereas 57.5% (76/132) had used it once or more. Of the children who had used the app, 67% (51/76) reported that the app was helpful. Interviews with children and teachers suggested positive experiences with the app and that it helped them to calm down and relax. Children reported that they perceived the app as acceptable, usable, and helpful. In terms of the intervention's usability, most features functioned well; however, certain technical issues were reported, which may have led to reduced engagement levels. Teachers not only reported overall positive experiences but also discussed access difficulties and reported a lack of content as one of the main barriers to implementing the app. Having a web-based app significantly enhanced accessibility across devices and settings and provided teachers with more opportunities to use it. We identified the need for new, activating app features in addition to the existing, primarily relaxing ones. The findings indicated that it is possible to use and evaluate an app intervention in the school context and that the app could help enhance children's emotion regulation. We discuss areas for improvement regarding the app, study design, and future implementation strategies.

CONCLUSIONS

We share important insights with regard to the development, implementation, and evaluation of a new app for supporting children's emotion regulation in schools. Our results demonstrate that mental health apps represent a promising means to facilitate effective mental health service provision in and outside of the school context. Important lessons learned are shared to support other researchers and clinicians on similar journeys.

A Systematic Review of Design Workshops for Health Information Technologies

Background: Design workshops offer effective methods in eliciting end-user participation from design inception to completion. Workshops unite stakeholders in the utilization of participatory methods, coalescing in the best possible creative solutions. Objective: This systematic review aimed to identify design approaches whilst providing guidance to health information technology designers/researchers in devising and organizing workshops. Methods: A systematic literature search was conducted in five medical/library databases identifying 568 articles. The initial duplication removal resulted in 562 articles. A criteria-based screening of the title field, abstracts, and pre-full-texts reviews resulted in 72 records for full-text review. The final review resulted in 10 article exclusions. Results: 62 publications were included in the review. These studies focused on consumer facing and clinical health information technologies. The studied technologies involved both clinician and patients and encompassed an array of health conditions. Diverse workshop activities and deliverables were reported. Only seven publications reported workshop evaluation data. Discussion: This systematic review focused on workshops as a design and research activity in the health informatics domain. Our review revealed three themes: (1) There are a variety of ways of conducting design workshops; (2) Workshops are effective design and research approaches; (3) Various levels of workshop details were reported.

Involvement of Indigenous young people in the design and evaluation of digital mental health interventions: a scoping review protocol

BACKGROUND

Indigenous young people worldwide are at greater risk of developing mental health concerns due to ongoing inequity and disadvantage. Digital mental health (dMH) interventions are identified as a potential approach to improving access to mental health treatment for Indigenous youth. Although involvement in the development and evaluation of dMH resources is widely recommended, there is limited evidence to guide engagement of Indigenous young people in these processes. This scoping review aims to examine the methods used to involve Indigenous young people in the development or evaluation of dMH interventions.

METHODS

Articles published in English, involving Indigenous young people (aged 10-24 years) in the development or evaluation of dMH interventions, originating from Australia, New Zealand, Canada and the USA will be eligible for inclusion. PubMed, Scopus and EBSCOhost databases (Academic Search Premiere, Computer and Applied Science complete, CINAHL, MEDLINE, APA PsychArticles, Psychology and Behavioural Sciences collection, APA PsychInfo) will be searched to identify eligible articles (from January 1990 onwards). Infomit and Google Scholar (limited to 200 results) will be searched for grey literature. Two reviewers will independently screen citations, abstracts and full-text articles. Study methods, methodologies, dMH intervention details, participant information and engagement, and dissemination methods will be extracted, analysed (utilising content analysis), and qualitatively assessed for alignment with best practice ethical guidelines for undertaking Indigenous health research. A narrative summary of findings will be presented. Reporting will follow the Consolidated Criteria for Strengthening Reporting of Health Research involving Indigenous peoples (CONSIDER) and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) guidelines.

DISCUSSION

To date, there are no reviews which analyse engagement of Indigenous young people in the development and evaluation of dMH interventions. This review will appraise alignment of current practice with best practice guidelines to inform future research. It will highlight appropriate methods for the engagement of young people in study processes, providing guidance for health practitioners, policy makers, and researchers working in the field of Indigenous youth and dMH.

SYSTEMATIC REVIEW REGISTRATION

Open Science Framework ( osf.io/2nkc6 ).

Participatory Design of an Activities-Based Collective Mentoring Program in After-School Care Settings: Connect, Promote, and Protect Program

BACKGROUND

Out of school hours care (OSHC) services provide a unique opportunity to deliver early intervention programs to enhance primary school-aged children's social, emotional, physical, and cognitive well-being; however, such programs are currently lacking.

OBJECTIVE

This study aims to address the lack of well-being programs for children accessing OSHC services in the research literature by using participatory design (PD) to collaboratively develop and test an OSHC well-being program-the connect, promote, and protect program (CP3).

METHODS

The study employed methods of PD, user (acceptance) testing, and iterative knowledge translation to develop a novel well-being program framework-CP3-with key stakeholders (eg, children, OSHC staff, volunteers, families, clinicians, educators, and researchers). Thematic techniques were used to interpret and translate the qualitative information obtained during the research and design cycles.

RESULTS

The co-design process generated the CP3 model, which comprises a group-based mentoring approach to facilitate enhanced activities in OSHC settings. Activities are underpinned by 4 key principles of program delivery: build well-being and resilience, broaden horizons, inspire and engage, and connect communities.

CONCLUSIONS

To our knowledge, the CP3 program is the first co-designed well-being program developed specifically for OSHC services. This co-design process is key to ensuring local community needs-particularly those of young people accessing OSHC-are met and that these individuals are meaningfully and actively involved in all stages of the research and design process, from conception to implementation, evaluation, and continuous improvement.

Recommendations for Implementing Gamification for Mental Health and Wellbeing

Gamification is increasingly being proposed as a strategy to increase engagement for mental health and wellbeing technologies. However, its implementation has been criticized as atheoretical, particularly in relation to behavior change theory and game studies theories. Definitions of the term “gamification” vary, sometimes widely, between and within academic fields and the effectiveness of gamification is yet to be empirically established. Despite this, enthusiasm for developing gamified mental health technologies, such as interventions, continues to grow. There is a need to examine how best to implement gamification in mental health and wellbeing technologies in a way that takes quick production cycles into account while still emphasizing empirical investigation and building a rigorous evidence base. With reference to game studies and the medical (eHealth/mHealth) literature, this article interrogates gamification for mental health and wellbeing by examining core properties of the game form. It then explores how gamification can best be conceptualized and implemented for mental health and wellbeing goals from conceptualization through to iterative co-development and evaluation that accommodates software development schedules. Finally, it summarizes its conceptual analysis into recommendations for researchers and designers looking to do so. These recommendations are: (1) assess suitability, (2) implement to support, (3) assess acceptability, (4) evaluate impact, and (5) document comprehensively. These recommendations aim to encourage clear language, unified terminology, the application and evaluation of theory, comprehensive and constant documentation, and transparent evaluation of outcomes.

Youth Participatory Approaches and Health Equity: Conceptualization and Integrative Review

There is an array of youth participatory approaches relevant to health equity efforts in community psychology, adolescent health, youth development, and education. While they share some commonalities, they also reflect important distinctions regarding key processes and intended level of impact. Here, we consider the following: (a) youth-led participatory action research (YPAR), (b) youth organizing (YO), (c) youth-led planning, (d) human-centered design, (e) participatory arts, and (f) youth advisory boards. Informed by community psychology theories on empowerment and levels of change and social epidemiology frameworks that focus on the social determinants of health inequities, we aim to promote greater clarity in the conceptualization, implementation, and evaluation of youth participatory approaches; frame the "landscape" of youth participatory approaches and their similarities and differences; present an integrative review of the evidence regarding the impact of youth participatory approaches; and describe several illustrative cases so as to consider more deeply how some youth participatory approaches aim to influence the social determinants of health that lead to the physical embodiment of health inequities. We conclude by identifying areas of future policy- and practice-relevant research for advancing youth participation and health equity.

Development of a Web-Based Acceptance and Commitment Therapy Intervention to Support Lifestyle Behavior Change and Well-Being in Health Care Staff: Participatory Design Study

Background

Positive emotional well-being is associated with healthier lifestyle choices and overall health function, whereas poor mental health is associated with significant economic and psychological costs. Thus, the development of effective interventions that improve emotional well-being is crucial to address the worldwide burden of disease.

Objective

This study aims to develop a web-based emotional well-being intervention for use by health care staff using participatory design to consider adherence and engagement from a user perspective.

Methods

A 3-staged iterative participatory design process was followed, including multiple stakeholders: researchers, computer scientists, mental health experts, and health care staff. Stage 1 used document analyses, direct observation, and welcome interviews; stage 2 used focus group discussions, rapid prototyping, and usability tasks; and stage 3 evaluated a high-fidelity prototype.

Results

Different health care staff (N=38) participated during a sustained period. A structured, sequential, automated, 12-week, web-based emotional well-being intervention based on acceptance and commitment therapy was developed. Freely navigated psychoeducational resources were also included.

Conclusions

The iterative and collaborative participatory design process successfully met its objectives. It generated an in-depth understanding of well-being within the workplace and identified barriers to access. The 3-staged process ensured that participants had the opportunity to explore and articulate criteria relevant to their roles over time and reflect on decisions made at each stage.

Primary prevention of overweight and obesity in adolescents: An overview of systematic reviews

The aim of this overview of systematic reviews was to summarize evidence from up-to-date reviews of the effectiveness of interventions aimed at preventing overweight and obesity in adolescents aged 10 to 19 years. We searched nine databases for systematic reviews published between January 2008 and November 2019. We used A Measurement Tool to Assess Systematic Reviews (AMSTAR) 2 to assess the quality of reviews, excluding those of critically low quality, and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) tool to grade the certainty of included evidence. We included 13 reviews. Three reviews focused on dietary behaviour, six on physical activity, and four on both types of behaviours. Individual-oriented and school-based interventions dominated. Results across reviews showed little or no effect on body mass index, or physical activity levels of adolescents, whereas results from a couple of reviews suggest possibly beneficial effects of public health interventions on dietary behaviours (i.e., consumption of sugar-sweetened beverages). The certainty of evidence was low to very low for all outcomes. Overall, the evidence base for the effect of primary interventions to prevent overweight and obesity in adolescents is weak. In particular, there is a lack of reviews assessing the impact of environmental interventions targeting adolescents, and reviews addressing social inequality are virtually absent from this body of literature.

Effects of a Mobile and Web App (Thought Spot) on Mental Health Help-Seeking Among College and University Students: Randomized Controlled Trial

Background

Mental health disorders are the most prevalent health issues among postsecondary students, yet few solutions to this emerging crisis exist. While mobile health technologies are touted as promising solutions for the unmet mental health needs of these students, the efficacy of these tools remains unclear. In response to these gaps, this study evaluates Thought Spot, a mobile and web app created through participatory design research.

Objective

The goal of the research is to examine the impact of Thought Spot on mental health and wellness help-seeking intentions, behaviors, attitudes, self-stigma, and self-efficacy among postsecondary students in Canada.

Methods

A 2-armed randomized controlled trial involving students from three postsecondary institutions was conducted. Students were eligible if they were aged 17 to 29 years, enrolled in full-time or part-time studies, functionally competent in English, and had access to a compatible digital device. The usual care group received a mental health services information pamphlet. The intervention group received the Thought Spot app on their digital device. Thought Spot is a standalone app that allows users to add, review, and search crowdsourced information about nearby mental health and wellness services. Users can also track their mood on the app. Outcomes were self-assessed through questionnaires collected at baseline and 3 and 6 months. The primary outcome was change in formal help-seeking intentions from baseline to 6 months, measured by the General Help-Seeking Questionnaire. A mixed-effects model was used to compare the impact of usual care and intervention on the primary outcome (formal help-seeking intentions). Secondary outcomes included changes in informal help-seeking intentions and help-seeking behaviors, help-seeking attitudes, self-stigma, and self-efficacy.

Results

A total of 481 students were randomized into two groups: 240 to usual care, and 241 to the intervention group. There were no significant differences in help-seeking intentions between the usual care and intervention groups over 6 months (F2,877=0.85; P=.43, f=0.04). Both groups demonstrated similar increases in formal help-seeking intentions at 3 and 6 months (F2,877=23.52; P<.001, f=0.21). Compared with males, females sought more help from formal resources (OR 1.86; 95% CI 1.22 to 2.83, P=.001). Females were less likely to seek help from informal sources than males (OR 0.80; 95% CI 0.22 to 0.73, P<.001).

Conclusions

Prompting postsecondary students about mental health and help-seeking appears to increase help-seeking intentions. mHealth interventions may be as effective as information pamphlets in increasing formal help-seeking but may confer a small advantage in driving help-seeking from informal sources. Although there is enthusiasm, developers and health policy experts should exercise caution and thoroughly evaluate these types of digital tools. Future studies should explore the cost-effectiveness of digital interventions and develop strategies for improving their efficacy.

Trial Registration

ClinicalTrials.gov NCT03412461; https://clinicaltrials.gov/ct2/show/NCT03412461

International Registered Report Identifier (IRRID)

RR2-10.2196/resprot.6446

Effects of a Mobile and Web App (Thought Spot) on Mental Health Help-Seeking Among College and University Students: Randomized Controlled Trial

Background

Mental health disorders are the most prevalent health issues among postsecondary students, yet few solutions to this emerging crisis exist. While mobile health technologies are touted as promising solutions for the unmet mental health needs of these students, the efficacy of these tools remains unclear. In response to these gaps, this study evaluates Thought Spot, a mobile and web app created through participatory design research.

Objective

The goal of the research is to examine the impact of Thought Spot on mental health and wellness help-seeking intentions, behaviors, attitudes, self-stigma, and self-efficacy among postsecondary students in Canada.

Methods

A 2-armed randomized controlled trial involving students from three postsecondary institutions was conducted. Students were eligible if they were aged 17 to 29 years, enrolled in full-time or part-time studies, functionally competent in English, and had access to a compatible digital device. The usual care group received a mental health services information pamphlet. The intervention group received the Thought Spot app on their digital device. Thought Spot is a standalone app that allows users to add, review, and search crowdsourced information about nearby mental health and wellness services. Users can also track their mood on the app. Outcomes were self-assessed through questionnaires collected at baseline and 3 and 6 months. The primary outcome was change in formal help-seeking intentions from baseline to 6 months, measured by the General Help-Seeking Questionnaire. A mixed-effects model was used to compare the impact of usual care and intervention on the primary outcome (formal help-seeking intentions). Secondary outcomes included changes in informal help-seeking intentions and help-seeking behaviors, help-seeking attitudes, self-stigma, and self-efficacy.

Results

A total of 481 students were randomized into two groups: 240 to usual care, and 241 to the intervention group. There were no significant differences in help-seeking intentions between the usual care and intervention groups over 6 months (F_2,877=0.85; P=.43, f=0.04). Both groups demonstrated similar increases in formal help-seeking intentions at 3 and 6 months (F_2,877=23.52; P<.001, f=0.21). Compared with males, females sought more help from formal resources (OR 1.86; 95% CI 1.22 to 2.83, P=.001). Females were less likely to seek help from informal sources than males (OR 0.80; 95% CI 0.22 to 0.73, P<.001).

Conclusions

Prompting postsecondary students about mental health and help-seeking appears to increase help-seeking intentions. mHealth interventions may be as effective as information pamphlets in increasing formal help-seeking but may confer a small advantage in driving help-seeking from informal sources. Although there is enthusiasm, developers and health policy experts should exercise caution and thoroughly evaluate these types of digital tools. Future studies should explore the cost-effectiveness of digital interventions and develop strategies for improving their efficacy.

Trial Registration

ClinicalTrials.gov NCT03412461; https://clinicaltrials.gov/ct2/show/NCT03412461

International Registered Report Identifier (IRRID)

RR2-10.2196/resprot.6446

Perspectives on an Acceptance and Commitment Therapy (ACT) based program for patients with inflammatory bowel disease and comorbid anxiety and/or depressive symptoms

Background and aim: Individuals with inflammatory bowel disease (IBD) suffer higher rates of anxiety and depression than the general population, however, few psychological interventions are designed for this population. Acceptance and Commitment Therapy (ACT), aimed to increase psychological flexibility, may be useful to address the unique concerns of IBD sufferers. This study aimed to explore stakeholder perspectives on an ACT-based intervention prototype tailored to people with IBD and comorbid anxiety and/or depressive symptoms.Methods: An Intervention Mapping methodology guided intervention design. A qualitative exploratory design was used to investigate the perspectives of stakeholders. Focus groups or interviews obtained feedback from IBD patients of a major regional hospital, and health providers to IBD patients Australia-wide.Results: Findings were analysed using template analysis. Data saturation was reached at 19 participants (11 patients and 8 health professionals). Participants' perspectives on the ACT-based intervention were distributed across four themes: (1) Barriers to access and participation; (2) Timing in the illness trajectory; (3) ACT is useful for IBD; and (4) The more support, the better.Conclusion: The findings suggest that an ACT modality and blended delivery design is well received by patients and health professionals, providing recommendations to future researchers and clinicians on intervention design.

Communication Technology Use by Caregivers of Adolescents With Mental Health Issues: Systematic Review

Background

Caregivers of adolescents with mental health issues experience challenges that may result in the caregivers having a variety of unmet needs. There is a growing need to support these caregivers. Effective support to strengthen positive caregiving behavior in caregivers may address their challenges. Communication technologies offer novel opportunities to assist these caregivers and may contribute to strengthening caregiver behavior. However, little is known about the use of communication technologies among caregivers of adolescents with mental health issues.

Objective

The study aimed to answer the question: “What is the best evidence available to strengthen positive behavior of caregivers of adolescents with mental health issues using communication technology.”

Methods

A systematic review of articles published between January 2007 and August 2018 was conducted. Searches included articles of multiple study designs from EBSCO Host and Scopus platforms with prespecified eligibility criteria. Methodological quality was evaluated using the applicable Critical Appraisal Skills Programme and Joanna Briggs Institute assessment tools.

Results

The search yielded 1746 articles. Altogether, 5 articles met the eligibility criteria and were included in the review for data synthesis. Data analysis and synthesis identified three thematic conclusions reflecting the types of communication technologies used, caregivers as the target population, and strengthening of positive behavior through determinants of the Integrated Model of Behavior Prediction.

Conclusions

The review reported the usefulness of communication technology by caregivers. Caregivers also demonstrated improvement in self-efficacy, knowledge, parent-child communication, and parental skills reflecting positive behavior. Although the use of communication technology is expanding as a supportive intervention to address caregivers’ needs, the evidence for usefulness among caregivers of adolescents with mental health issues is still scarce. More research and information related to preferred methods of communication delivery among caregivers of adolescents is still needed.

Practitioner review: Co-design of digital mental health technologies with children and young people

BACKGROUND

There is increasing interest in digital technologies to help improve children and young people's mental health, and the evidence for the effectiveness for these approaches is rising. However, there is concern regarding levels of user engagement, uptake and adherence. Key guidance regarding digital health interventions stress the importance of early user input in the development, evaluation and implementation of technologies to help ensure they are engaging, feasible, acceptable and potentially effective. Co-design is a process of active involvement of stakeholders, requiring a change from the traditional approaches to intervention development. However, there is a lack of literature to inform the co-design of digital technologies to help child and adolescent mental health.

METHODS

We reviewed the literature and practice in the co-design of digital mental health technologies with children and young people. We searched Medline, PsycInfo and Web of Science databases, guidelines, reviews and reference lists, contacted key authors for relevant studies, and extracted key themes on aspects of co-design relevant to practice. We supplemented this with case studies and methods reported by researchers working in the field.

RESULTS

We identified 25 original articles and 30 digital mental health technologies that were designed/developed with children and young people. The themes identified were as follows: principles of co-design (including potential stakeholders and stages of involvement), methods of involving and engaging the range of users, co-designing the prototype and the challenges of co-design.

CONCLUSIONS

Co-design involves all relevant stakeholders throughout the life and research cycle of the programme. This review helps to inform practitioners and researchers interested in the development of digital health technologies for children and young people. Future work in this field will need to consider the changing face of technology, methods of engaging with the diversity in the user group, and the evaluation of the co-design process and its impact on the technology.

What makes it work? Exploring experiences of patient research partners and researchers involved in a long-term co-creative research collaboration

BACKGROUND

Exchanging experiences of patient and public involvement (PPI) can bring insights into why, how and when PPI is most effective. The aim of this study was to explore the experiences of patient research partners (PRPs) and researchers engaged in a co-creative long-term collaboration in cancer research.

METHODS

The aim and procedures of this study were jointly decided upon by PRPs and researchers. The PRPs included former patients treated for cancer and significant others of the same target group. The participants (11 PRPs, 6 researchers) took part in semi-structured telephone interviews. The interviews were analysed using qualitative content analysis by a researcher who had no prior relationships with the participants.

RESULTS

Five overarching categories were identified: Reasons for investing in a long-term collaboration, Benefits of participating, Improving the research, Elements of success and Challenges and ways to improve. Reasons for investing in the collaboration included the desire to improve cancer care and to make use of own negative experiences. Benefits of participating included a positive impact on the PRPs' psychosocial adjustment to the illness. Moreover, the researchers highlighted that working together with the PRPs made the research feel more meaningful. The participants reported that the collaboration improved the relevance and acceptability of the research. Having a shared goal, a clear but yet accommodating structure, as well as an open and trustful working atmosphere were recognised as elements of success. The PRPs furthermore emphasized the importance of seeing that their input mattered. Among the few challenges raised were the distance to the meeting venues for some PRPs and a limited diversity among participants.

CONCLUSIONS

This study identified factors essential to researchers and clinicians attempting to engage the public in research. Our results suggest that for successful patient involvement, the purpose and format of the collaboration should be clear to both PRPs and researchers. A clear but yet accommodating structure and keen leadership emerged as key factors to create a sense of stability and a trustful atmosphere. Furthermore, providing regular feedback on how PRPs input is implemented is important for PRPs to stay committed over time.

A review of reviews on principles, strategies, outcomes and impacts of research partnerships approaches: a first step in synthesising the research partnership literature

Background

Conducting research in partnership with stakeholders (e.g. policy-makers, practitioners, organisations, patients) is a promising and popular approach to improving the implementation of research findings in policy and practice. This study aimed to identify the principles, strategies, outcomes and impacts reported in different types of reviews of research partnerships in order to obtain a better understanding of the scope of the research partnership literature.

Methods

This review of reviews is part of a Coordinated Multicenter Team approach to synthesise the research partnership literature with five conceptually linked literature reviews. The main research question was ‘What principles, strategies, outcomes and impacts are reported in different types of research partnership approaches?’. We included articles describing a literature review of research partnerships using a systematic search strategy. We used an adapted version of the Revised Assessment of Multiple Systematic Reviews tool to assess quality. Nine electronic databases were searched from inception to April 2018. Principles, strategies, outcomes and impacts were extracted from the included reviews and analysed using direct content analysis.

Results

We included 86 reviews using terms describing several research partnership approaches (e.g. community-based participatory research, participatory research, integrated knowledge translation). After the analyses, we synthesised 17 overarching principles and 11 overarching strategies and grouped them into one of the following subcategories: relationship between partners; co-production of knowledge; meaningful stakeholder engagement; capacity-building, support and resources; communication process; and ethical issues related to the collaborative research activities. Similarly, we synthesised 20 overarching outcomes and impacts on researchers, stakeholders, the community or society, and the research process.

Conclusions

This review of reviews is the first that presents overarching principles, strategies, outcomes and impacts of research partnerships. This review is unique in scope as we synthesised literature across multiple research areas, involving different stakeholder groups. Our findings can be used as a first step to guide the initiation and maintenance of research partnerships and to create a classification system of the key domains of research partnerships, which may improve reporting consistency in the research partnership literature.

Trial registration

This study is registered via Open Science Framework: 10.17605/OSF.IO/GVR7Y.

Drafting the Aboriginal and Islander Mental Health Initiative for Youth (AIMhi-Y) App: Results of a formative mixed methods study

BACKGROUND

Culturally responsive, strengths-based early-intervention mental health treatment programs are considered most appropriate to influence the high rates of psychological distress and suicide experienced by Aboriginal and Torres Strait Islander youth. Few early intervention services effectively bridge the socio-cultural and geographic challenges of providing sufficient and culturally relevant services in rural and remote Australia. Mental Health apps provide an opportunity to bridge current gaps in service access if co-designed with Aboriginal and Torres Strait Islander youth to meet their needs.

AIMS

This paper reports the results of the formative stage of the AIMhi-Y App development process which engaged Aboriginal and Torres Strait Islander youth in the co-design of the new culturally informed AIMhi-Y App.

METHODS

Using a participatory design research approach, a series of co-design workshops were held across three sites with five groups of young people. Workshops explored concepts, understanding, language, acceptability of electronic mental health tools (e-mental health) and identified important characteristics of the presented applications and websites, chosen for relevance to this group. An additional peer supported online survey explored use of technology, help seeking and e-mental health design elements which contribute to acceptability.

RESULTS

Forty-five, Aboriginal and Torres Strait Islander youth, aged 10-18 years, from three sites in the Northern Territory (NT) were involved in the workshops (n = 29). Although experiencing psychological distress, participants faced barriers to help seeking. Apps were perceived as a potential solution to overcome barriers by increasing mental health literacy, providing anonymity if desired, and linking young people with further help. Preferred app characteristics included a strength-based approach, mental health information, relatable content and a fun, appealing, easy to use interface which encouraged app progression. Findings informed the new AIMhi-Y App draft, which is a strengths-based early intervention wellbeing app for Aboriginal and Torres Strait Islander youth.

CONCLUSIONS

Research findings highlight the need, feasibility and potential of these types of tools, from the perspective of Aboriginal and Torres Strait Islander youth.

Project Synergy: co-designing technology-enabled solutions for Australian mental health services reform

Project Synergy aims to test the potential of new and emerging technologies to enhance the quality of mental health care provided by traditional face-to-face services. Specifically, it seeks to ensure that consumers get the right care, first time (delivery of effective mental health care early in the course of illness). Using co-design with affected individuals, Project Synergy has built, implemented and evaluated an online platform to assist the assessment, feedback, management and monitoring of people with mental disorders. It also promotes the maintenance of wellbeing by collating health and social information from consumers, their supportive others and health professionals. This information is reported back openly to consumers and their service providers to promote genuine collaborative care. The online platform does not provide stand-alone medical or health advice, risk assessment, clinical diagnosis or treatment; instead, it supports users to decide what may be suitable care options. Using an iterative cycle of research and development, the first four studies of Project Synergy (2014-2016) involved the development of different types of online prototypes for young people (i) attending university; (ii) in three disadvantaged communities in New South Wales; (iii) at risk of suicide; and (iv) attending five headspace centres. These contributed valuable information concerning the co-design, build, user testing and evaluation of prototypes, as well as staff experiences during development and service quality improvements following implementation. Through ongoing research and development (2017-2020), these prototypes underpin one online platform that aims to support better multidimensional mental health outcomes for consumers; more efficient, effective and appropriate use of health professional knowledge and clinical skills; and quality improvements in mental health service delivery.

Involving End Users in Adapting a Spanish Version of a Web-Based Mental Health Clinic for Young People in Colombia: Exploratory Study Using Participatory Design Methodologies

BACKGROUND

Health information technologies (HITs) hold enormous promise for improving access to and providing better quality of mental health care. However, despite the spread of such technologies in high-income countries, these technologies have not yet been commonly adopted in low- and middle-income countries. People living in these parts of the world are at risk of experiencing physical, technological, and social health inequalities. A possible solution is to utilize the currently available HITs developed in other counties.

OBJECTIVE

Using participatory design methodologies with Colombian end users (young people, their supportive others, and health professionals), this study aimed to conduct co-design workshops to culturally adapt a Web-based Mental Health eClinic (MHeC) for young people, perform one-on-one user-testing sessions to evaluate an alpha prototype of a Spanish version of the MHeC and adapt it to the Colombian context, and inform the development of a skeletal framework and alpha prototype for a Colombian version of the MHeC (MHeC-C).

METHODS

This study involved the utilization of a research and development (R&D) cycle including 4 iterative phases: co-design workshops; knowledge translation; tailoring to language, culture, and place (or context); and one-on-one user-testing sessions.

RESULTS

A total of 2 co-design workshops were held with 18 users-young people (n=7) and health professionals (n=11). Moreover, 10 users participated in one-on-one user-testing sessions-young people (n=5), supportive others (n=2), and health professionals (n=3). A total of 204 source documents were collected and 605 annotations were coded. A thematic analysis resulted in 6 themes (ie, opinions about the MHeC-C, Colombian context, functionality, content, user interface, and technology platforms). Participants liked the idea of having an MHeC designed and adapted for Colombian young people, and its 5 key elements were acceptable in this context (home page and triage system, self-report assessment, dashboard of results, booking and video-visit system, and personalized well-being plan). However, to be relevant in Colombia, participants stressed the need to develop additional functionality (eg, phone network backup; chat; geolocation; and integration with electronic medical records, apps, or electronic tools) as well as an adaptation of the self-report assessment. Importantly, the latter not only included language but also culture and context.

CONCLUSIONS

The application of an R&D cycle that also included processes for adaptation to Colombia (language, culture, and context) resulted in the development of an evidence-based, language-appropriate, culturally sensitive, and context-adapted HIT that is relevant, applicable, engaging, and usable in both the short and long term. The resultant R&D cycle allowed for the adaptation of an already available HIT (ie, MHeC) to the MHeC-C-a low-cost and scalable technology solution for low- and middle-income countries like Colombia, which has the potential to provide young people with accessible, available, affordable, and integrated mental health care at the right time.

Experts by Experience: Qualitative Evaluation of Adolescent Participation in the Development of a Technological Intervention to Prevent Youth Suicide in Chile

Adolescent suicide is a pressing problem in Chile that has not yet been sufficiently addressed, as suicide rates have stagnated in recent years. One possible explanation could be linked to the adult-centered paradigm that continues to prevail in relation to adolescent health initiatives. In light of this, programs that seek to promote youth mental health should consider incorporating adolescents in the design process using participatory methodologies, to ensure that these initiatives are well-suited for the population. In line with this recommendation, a group of seven adolescents, 13 to 20 years of age, were incorporated into a research team to actively guide the design, development, and validation of a technology-based intervention, known as Project Clan, which was piloted to reduce adolescent suicide in schools in Chile. This group was known as the "Group of Experts," in acknowledgment of their role as experts by experience on adolescence. A qualitative case study was conducted to explore their lived experiences, through semistructured individual in-depth interviews with six members of the group. Results showed that the adolescents had a high level of interest in mental health and had experienced problems of their own or accompanied friends who were struggling, which motivated their participation in the study. They had a critical view of the previous interventions they had received through educational institutions and valued their role in the promotion of their peers' mental health through the Group of Experts. They also highlighted the importance of creating tools that complement their daily lives and provide an alternative to existing social networks, by respecting their anonymity, providing a secure place for divulgation and self-expression, and facilitating access to professional support. We conclude that programs that address issues that affect adolescents should incorporate adolescents in the decision-making and design processes to ensure the acceptability and effectivity of their interventions.

Development of a Lived Experience-Based Digital Resource for a Digitally-Assisted Peer Support Program for Young People Experiencing Psychosis

This paper describes the creation of a web-based digital resource designed for tablet computer use during peer work sessions to structure discussion about recovery in early psychosis. The resource consisted of a series of videos featuring young people who have used early psychosis services discussing how they navigated issues in their own recovery. A participatory process was used to create the resource. Researchers held a series of collaborative development workshops with early psychosis service users, peer workers, other mental health practitioners, and academics. These were used to derive a framework of recovery processes relevant to young people experiencing psychosis, which was considered as useful areas of discussion within a peer work relationship. A semi-structured interview guide based on this framework was then used in video-recorded interviews with young people in recovery from psychosis. Footage was edited into 14 videos and organized into six final themes: My Journey, Self-Care, Connections, My Identity, Life, and Mental Health. The combined expertise of young mental health service users, peer support workers, mental health practitioners, and digital mental health researchers throughout the development process enabled the creation of tailored digital resource for peer work in an early psychosis service.

Formative Evaluation to Build an Online Parenting Skills and Youth Drug Prevention Program: Mixed Methods Study

Background

Family-based drug prevention programs that use group-based formats with trained facilitators, such as the Strengthening Families Program (SFP), are effective in preventing underage drinking and youth drug use. However, these programs are resource-intensive and have high costs and logistical demands. Tailoring them for Web-based delivery is more cost-effective and makes it easier to scale these programs for widespread dissemination. This requires the active involvement of all key stakeholders to determine content and delivery format.

Objective

The aim was to obtain consumer, agency stakeholder, and expert input into the design of a Web-based parenting skills training and youth drug prevention program.

Methods

We conducted 10 focus groups with 85 adults (range 4-10, average 8 per group), 20 stakeholder interviews with family services agency staff, and discussed critical design considerations with 10 prevention scientists and e-learning experts to determine the optimal program content and technology features for SFP Online. Focus group participants also answered survey questions on perceived barriers to use, desired navigational features, preferred course format, desired content, preferred reward structures, course length, interactive components, computer efficacy, and technology use. Descriptive statistics were used to examine consumer characteristics; linear regression was used to examine relations between SFP exposure and four continuous outcome measures, including desired program content, interactive technology, and concerns that may inhibit future use of SFP Online. Logistic regression was used as a binary measure of whether consumers desired fun games in the SFP Online program.

Results

Three broad thematic categories emerged from the qualitative interviews enumerating the importance of (1) lesson content, (2) logistics for program delivery, and (3) multimedia interactivity. Among the many significant relations, parents who viewed more SFP lessons reported more reasons to use an online program (beta=1.48, P=.03) and also wanted more interactivity (6 lessons: beta=3.72, P=.01; >6 lessons: beta=2.39, P=.01), parents with less interest in a mixed delivery format (class and online) reported fewer reasons to use the online program (beta=−3.93, P=.01), comfort using computers was negatively associated with concerns about the program (beta=−1.83, P=.01), having mobile phone access was related to fewer concerns about online programs (beta=−1.63, P=.02), willingness to view an online program using a mobile phone was positively associated with wanting more online components (beta=1.95, P=.02), and parents who wanted fun games wanted more interactivity (beta=2.28, P=.01).

Conclusions

Formative evaluation based on user-centered approaches can provide rich information that fuels development of an online program. The user-centered strategies in this study lay the foundation for improving SFP Online and provide a means to accommodate user interests and ensure the product serves as an effective prevention tool that is attractive to consumers, engaging, and can overcome some of the barriers to recruitment and retention that have previously affected program outcomes in family-based prevention.