Youth Codesign of a Mobile Phone App to Facilitate Self-Monitoring and Management of Mood Symptoms in Young People With Major Depression, Suicidal Ideation, and Self-Harm

Abstract

BackgroundEffective treatment of depression in young people is critical, given its prevalence, impacts, and link to suicide. Clinical practice guidelines point to the need for regular monitoring of depression symptom severity and the emergence of suicidal ideation to track treatment progress and guide intervention delivery. Yet, this is seldom integrated in clinical practice.ObjectiveThe objective of this study was to address the gap between guidelines about monitoring and real-world practice by codesigning an app with young people that allows for self-monitoring of mood and communication of this monitoring with a clinician.MethodsWe engaged young people aged 18 to 25 years who had experienced depression, suicidal ideation including those who self-harm, as well as clinicians in a codesign process. We used a human-centered codesign design studio methodology where young people designed the features of the app first individually and then as a group. This resulted in a minimal viable product design, represented through low-fidelity hand-drawn wireframes. Clinicians were engaged throughout the process via focus groups.ResultsThe app incorporated a mood monitoring feature with innovative design aspects that allowed customization, and was named a “well-being tracker” in response to the need for a positive approach to this function. Brief personalized interventions designed to support young people in the intervals between face-to-face appointments were embedded in the app and were immediately available via pop-ups generated by a back-end algorithm within the well-being tracker. Issues regarding the safe incorporation of alerts generated by the app into face-to-face clinical services were raised by clinicians (ie, responding in a timely manner) and will need to be addressed during the full implementation of the app into clinical services.ConclusionsThe potential to improve outcomes for young people via technology-based enhancement to interventions is enormous. Enhancing communication between young people and their clinicians about symptoms and treatment progress and increasing access to timely and evidence-based interventions are desirable outcomes. To achieve positive outcomes for young people using technology- (app) based interventions, it is critical to understand and incorporate, in a meaningful way, the expectations and motivations of both young people and clinicians.

Informing the Development of an E-Platform for Monitoring Wellbeing in Schools: Involving Young People in a Co-Design Process.

“…This study provided an opportunity to explore key features of a successful e-platform for monitoring mental health and wellbeing within a school setting for young people 16+. Findings support some existing literature, highlighting the importance of design and customisation on e-platform uptake and retention (31), and provides novel insight into young people's expectations and preferences for digital health. Very few studies have reported the process of co-design with young people in wellbeing digital technologies.…”

“…While forms of PPI are increasingly prevalent in health research, there are concerns that the power dynamic between 'research community' and 'public' limits the impact of meaningful and effective collaboration (29). To address such concerns, previous adolescent e-health research has employed a collaborative co-design approach with young people throughout web-development processes (30,31). There are various roles a young person can occupy in a co-design collaboration, including a user, tester, informant or design partner (32).…”

Strategies to Engage Adolescents in Digital Health Interventions for Obesity Prevention and Management

“…Available frameworks [ 51 ] and findings from co-design research in adolescent mental health and primary care can guide the development of digital health interventions to address effective engagement with adolescent obesity prevention and management interventions. Two recent Australian research studies have described a co-design process to develop apps to improve young people’s experience of seeing their general practitioner [ 54 ] and for self-monitoring and management mood symptoms in adolescents with depression [ 55 ]. A similarity of both studies throughout the co-design process was the identification of contrasting needs, motivations and intentions for the apps between researchers, clinicians, and adolescents [ 54 , 55 ].…”

Development and Long-Term Acceptability of ExPRESS, a Mobile Phone App to Monitor Basic Symptoms and Early Signs of Psychosis Relapse (Preprint)

“…In contrast with clinicians' hypothetical views [40,57,58], most participants were happy with a clinician having automatic access to their responses. The absence of difficulties while using ExPRESS, which automatically uploads data to the researcher, may have allayed concerns about automatic uploads in our sample.…”