The Importance of User Segmentation for Designing Digital Therapy for Adolescent Mental Health: Findings From Scoping Processes

Abstract

BackgroundNew Zealand youth, especially those of Māori and Pacific descent, have high rates of depression, anxiety, and self-harm, but have low rates of help-seeking from mental health professionals. Apps, computerized therapy, and other digital tools can be effective, highly scalable treatments for anxiety and depression. Co-design processes are often used to foster engagement with end users, but this does not always lead to high levels of engagement.ObjectiveWe aimed to carry out preliminary scoping to understand adolescents’ current internet use and diversity of preferences to inform a planned co-design process for creating digital mental health tools for teenagers.MethodsInteractive workshops and focus groups were held with young people. Data were analyzed using a general inductive approach.ResultsParticipants (N=58) engaged in 2 whānau (extended family) focus groups (n=4 and n=5), 2 school- or community-based focus groups (n=9 each), and 2 workshops (n=11 and n=20). The authors identified 3 overarching themes: (1) Digital mental health tools are unlikely to be successful if they rely solely on youth help-seeking. (2) A single approach is unlikely to appeal to all. Participants had diverse, noncompatible preferences in terms of look or feel of an app or digital tool. The authors identified 4 user groups players or gamers, engagers, sceptics, and straight-talkers. These groups differed by age and degree of current mental health need and preferred gamified or fun approaches, were open to a range of approaches, were generally disinterested, or preferred direct-to-the-point, serious approaches, respectively. (3) Digital mental health tools should provide an immediate response to a range of different issues and challenges that a young person may face.ConclusionsDefining the preferences of different groups of users may be important for increasing engagement with digital therapies even within specific population and mental health–need groups. This study demonstrates the importance of scoping possible user needs to inform design processes.

Multiple uses of app instead of using multiple apps – a case for rethinking the digital health technology toolbox

“…The lack of engagement with individual mental health apps, with recent data suggesting a 4% daily open rate (Baumel et al, 2019), highlights the challenges for even those apps featured highly on the commercial marketplaces. Reasons for the lack of engagement with these apps vary but include a lack of customisation (Fleming et al, 2019), skepticism of efficacy (Muse and Topol, 2019), concerns around privacy (Huckvale et al, 2019), challenges around usability (Sarkar et al, 2016), incompatibility with older or cheaper phones and lack of actionability (Torous et al, 2018). There are thousands of apps that offer functions such as mood tracking or mindfulnessbut those numbers decay to single digits when looking for safe, evidencebased and adaptable tools.…”

SPARX-R computerized therapy among adolescents in youth offenders' program: Step-wise cohort study

“…However, implementing face-to-face CBT in programs for youth offenders is challenging due to a shortage of therapists with the requisite skills. Computerized CBT (cCBT) has been shown to be effective and acceptable in adolescent populations (Ebert et al, 2015;Christensen et al, 2011;Merry et al, 2012), and could increase access to therapy among hard-to-reach groups (Fleming et al, 2019a). However, few cCBT programs for adolescents have been trialled outside of school or health care settings, and we found just one published trial of cCBT among youth offenders (Wannachaiyakul et al, 2017).…”

Revising Computerized Therapy for Wider Appeal Among Adolescents: Youth Perspectives on a Revised Version of SPARX

“…Gulliver, Griffiths, and Christensen (33) reviewed qualitative and quantitative studies, and found that adolescents identified the most significant barriers to help-seeking as: perceived stigma and embarrassment, difficulty recognizing symptoms (i.e., poor mental health literacy), and a preference for self-reliance. We have previously identified that even looking up a website "for depression" in private can be off putting for some adolescents (34). Computerized approaches that avoid the terminology linked to diagnostic categories may help to reduce the barriers associated with stigma and embarrassment, whether a young person is seeking help via a professional or on their own (e.g.…”