Introduction: In a recent child health research priority setting exercise conducted in Alberta (CA), youth identified mental health as a priority topic. Specifically, youth were interested in understanding what the early signs and symptoms of anxiety were, and when they should seek help. Objective: The objective of this study was to understand what information is currently available online for Canadian youth about the signs and symptoms of anxiety, what resources are available for self-assessment, and what are youths behaviors, experiences and information needs around seeking help for anxiety. Methods: We conducted a systematic environmental scan of Internet resources and academic literature. Internet and literature search results (Information Sources) were screened by one reviewer and verified by another. Relevant information (e.g., self-assessment resource features and population characteristics such as age, presence of anxiety, and education) were then extracted and verified. Information Sources were categorized relating to the research concepts regarding; signs and symptoms, self-assessments, information needs and experiences. We complimented our environmental scan with youth consultations to understand how anxiety resources are perceived by youth, and what if anything, could be improved about the information they are receiving. Consultations were conducted over Zoom with three Canadian Youth Advisory Groups (2 provincial, 1 national) and took a semi-structured focus group format. Results: A total of 99 Information Sources (62 addressing signs and symptoms, 18 self-assessment resources, and 19 reporting on information and help-seeking behaviors) met the inclusion criteria. The majority of Information Sources on signs and symptoms were webpage-based articles, and 36 (58%) specifically stated that they were targeting youth. 72% of anxiety self-assessment resources were provided by private institutions. The resources varied markedly in the post-assessment support provided to youth according to their source (i.e. private, academic, governmental). Regarding information and help-seeking preferences, three main themes were apparent and related to 1) obtaining in-person professional help, 2) searching for online help, and 3) stigma associated with seeking help for anxiety disorders. The Youth Group consultations identified several areas that need to be considered when developing resources for youth. The key considerations highlighted by youth across the consultations suggested resources needed to be; youth friendly, align with a credible institute (e.g. University, Health Institution), and provide useful resources post online assessment and tangible action items to support help seeking. Conclusion: Awareness of the information and resources available to youth, coupled with an understanding of their help-seeking behaviors and information needs can help support the development and dissemination of appropriate knowledge translation tools around youth anxiety.

BACKGROUND Chatbots have been increasingly considered for applications in the health and social care fields. Currently, it remains unclear how a chatbot could engage users coping with complex health needs, such as parents of individuals with neurodevelopmental disorders (NDDs), who often need frequent and ongoing support. One approach to enhancing user engagement is the use of game elements in non-game contexts, known as gamification. To be effective, gamification needs to be tailored to users. OBJECTIVE We sought to identify which gamification elements would be the most useful in a chatbot that focuses on supporting families of children and youths with NDDs. METHODS We performed a narrative literature review of gamification elements and their current implementation. We then used a qualitative approach, which included a series of focus groups and interviews with caregivers of individuals with NDDs (N = 21) to identify potential gamification elements that could be well-suited for a chatbot focused on NDDs. Transcripts were analyzed for emerging themes. RESULTS From our 21 participants, we identified 3 main themes: 1) parents of individuals with NDDs were familiar and had positive experiences with gamification; 2) specific gamification element (goal setting) was considered an important feature for a chatbot for NDDs, whereas others (customization, rewards, and unlockable content) received more mixed opinions; and 3) although social networking was viewed positively, it is a complex feature to implement due to the pertaining issue of medical fact-checking. CONCLUSIONS We show for the first time that prospective users (parents of individuals with NDDs) support the use of gamification in a chatbot for NDDs. Our study illustrates the importance of adopting a user-centred design when deciding which gamification elements to include, as some commonly used elements were perceived negatively by this specific group of users.

Background Chatbots have been increasingly considered for applications in the health care field. However, it remains unclear how a chatbot can assist users with complex health needs, such as parents of children with neurodevelopmental disorders (NDDs) who need ongoing support. Often, this population must deal with complex and overwhelming health information, which can make parents less likely to use a software that may be very helpful. An approach to enhance user engagement is incorporating game elements in nongame contexts, known as gamification. Gamification needs to be tailored to users; however, there has been no previous assessment of gamification use in chatbots for NDDs. Objective We sought to examine how gamification elements are perceived and whether their implementation in chatbots will be well received among parents of children with NDDs. We have discussed some elements in detail as the initial step of the project. Methods We performed a narrative literature review of gamification elements, specifically those used in health and education. Among the elements identified in the literature, our health and social science experts in NDDs prioritized five elements for in-depth discussion: goal setting, customization, rewards, social networking, and unlockable content. We used a qualitative approach, which included focus groups and interviews with parents of children with NDDs (N=21), to assess the acceptability of the potential implementation of these elements in an NDD-focused chatbot. Parents were asked about their opinions on the 5 elements and to rate them. Video and audio recordings were transcribed and summarized for emerging themes, using deductive and inductive thematic approaches. Results From the responses obtained from 21 participants, we identified three main themes: parents of children with NDDs were familiar with and had positive experiences with gamification; a specific element (goal setting) was important to all parents, whereas others (customization, rewards, and unlockable content) received mixed opinions; and the social networking element received positive feedback, but concerns about information accuracy were raised. Conclusions We showed for the first time that parents of children with NDDs support gamification use in a chatbot for NDDs. Our study illustrates the need for a user-centered design in the medical domain and provides a foundation for researchers interested in developing chatbots for populations that are medically vulnerable. Future studies exploring wide range of gamification elements with large number of potential users are needed to understand the impact of gamification elements in enhancing knowledge mobilization.