Development of the Niggle App for Supporting Young People on Their Dynamic Journey to Well-being: Co-design and Qualitative Research Study

Abstract

Background Adolescence is a life stage characterized by intense development and increased vulnerability. Yet, young people rarely seek help for mental health, often due to stigma and embarrassment. Alarmingly, even those who do seek help may not be able to receive it. Interventions focused on well-being offer a protective factor against adversity. Highly effective, innovative, theoretically sound, accessible, and engaging mobile health (mHealth) interventions that can be used to look beyond mental ill-health and toward mental well-being are urgently needed. Objective We aimed to explore how young Australians conceptualize and construct recovery journeys from feeling unwell to being well in order to inform the conceptual design of a youth-led information-, resource-, and support-focused mHealth intervention. Methods A sample of young people, grouped by age (12-15 years, 16-19 years, and 20-25 years), took part in 3 in-person participatory design workshops (per group). Young people’s understanding and representation of well-being, feeling unwell, and the recovery journey were investigated using visual and linguistic data collection methods: photo elicitation and journey mapping. A social constructionist perspective was used for thematic analysis to produce a conceptual model of the recovery journey. A mobile app was co-designed and all app functions were mapped through iterative development and testing by young people and a team of psychology, research, design and information technology experts. Results Young people (n=25) described a 6-stage journey with specific barriers and coping strategies. The findings, when situated within the personal recovery framework in mental health, emphasize the cyclic and iterative model of change. Through co-design, the new app—Niggle—was conceptualized as a visual representation of an amorphous problem, which can be addressed through app functions corresponding to the most helpful strategies that young people used to progress through the stages of their recovery journey. Conclusions Niggle is available to offer support to young people for a range of problems and provides a hot link to counseling services in Australia. This paper elaborates on the process of in-depth qualitative data collection through visual, linguistic, and co-design methods. The findings of this study give insight into young people’s understanding of well-being and recovery. This paper could aid the development of high-quality personalized mHealth interventions and support resources.

A cognitive behavioural therapy smartphone app for adolescent depression and anxiety: co-design of ClearlyMe

“…The findings from our co-design process are largely consistent with what has been found by other research groups regarding youth design preferences (Jeminiwa et al, 2019;Kenny et al, 2016;Stoyanov et al, 2021;Werner-Seidler et al, 2017). However, in contrast to the design of other adolescent CBT interventions that utilise smartphone technology, such as Sleep Ninja (Werner-Seidler et al, 2017) and Pesky gNATs (Chapman et al, 2016), adolescents in the current study did not endorse gamification, a chatbot feature, or calming images and colours.…”

“…Interventions that have resulted from co-design processes show some degree of consistency regarding the needs and preferences of youth (Kenny et al, 2016;Stoyanov et al, 2021;Werner-Seidler et al, 2017). Specifically, young people's feedback on digital mental health prototypes has consistently indicated that they endorse aspects such as trustworthy design and content, engaging and interactive features, gamification, ease of use, personalisation and customisability, security and privacy, ability to access and use independently, social interaction, and visual appeal (Kenny et al, 2016;Stoyanov et al, 2021;Werner-Seidler et al, 2017). However, to capitalise on the potential of digital health interventions in addressing treatment gaps, it is critical to also include those supporting adolescent care in the co-design process.…”

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“…Participants mentioned learning to empower themselves to gain mental resilience and maintaining a self-care routine to support their mental well-being. It is important to note that these described journeys overlapped across personas and could be experienced nonlinearly instead of being necessarily sequential [ 49 , 50 ].…”

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“…However, they found that the use of these strategies was limited in apps available for youth, with social connectivity being the most used but with few examples of interactive multimedia experiences. Several studies have worked with youth to co-design digital mental health interventions [32][33][34][35], including MHapps, but these studies have often resulted in early-stage ideas or functional prototypes that, although sometimes are evaluated, rarely make it to app stores or other places where youth could access them. Finally, many studies have focused on trying to understand MHapps from app store user reviews [36,37].…”