JMIR Publications

ABSTRACT

Background:

Early intervention can reduce the risk of mental health disorder in young people. Given the burden on services, schools often provide frontline support, but with few resources. School-hosted mHealth is a novel option which could meet young people’s needs for privacy in mental health intervention and schools’ need for evidence-based resources.

Objective:

We aimed to co-design and feasibility test a self-help, school hosted, digital intervention for symptomatic adolescents in UK high schools.

Methods:

Extensive co-design processes integrated user and stakeholder design and implementation preferences with evidence, theory and treatment guidelines with. We conducted co-design workshops (n=14) and iterative content development reviews (n=40) with youth, parents/carers, teachers, mental health professionals and software engineers. Co-design determined the intervention aim, content, user features, implementation and evaluation protocol, and led to the production of a web-app 'MindMate2U' as well as to a low-intensity parent component ‘Partner2U’ (email psychoeducation and support). Feasibility was tested in school-selected year groups in four UK high schools where young people opted in to use MindMate2U. We specified rules for progression to an effectiveness randomised controlled trial, tested two candidate primary outcome measures (SDQ and WEMWBS) and conducted an exploratory cost-effectiveness analysis

Results:

MindMate2U is an evidence-based, six-week, self-help program targeting risk and protective factors for mental health with content released weekly to a young person’s smartphone. It met high standards of clinical safety, privacy needs and user testing before trial. Four large UK urban secondary schools opted into the study and committed to low intensity teacher training on MindMate2U, creating individual web-app accounts for participating young people, a teacher being ‘on standby’ for users and assessing any post-intervention needs. Thirty-one adolescents (15-17y) opted to use MindMate2U. Most scored in sub-clinical or clinical ranges. User ratings (n=19) and post-intervention interviews (n=6) showed acceptability of the resource. We met our recruitment, retention and pre-post measure completion targets and identified the SDQ as the most sensitive outcome measure. Young people designed release of the parent component to be under their control. Only one young person opted for this. Improvements and design parameters for an effectiveness trial were identified.

Conclusions:

This study established the feasibility of a co-designed mental health app as a low-burden, school-hosted resource for symptomatic young people and opens up new possibilities for the integration of mHealth in schools. There is scope to consider how MindMate2U could operate within schools as an adjunct to school counselling. Support via schools to parents of symptomatic young people may need to be universal rather than targeted to protect young people’s needs for autonomy and privacy. Following some development of MM2U, a subsequent phase 2 randomized controlled trial is warranted to test its effectiveness in reducing clinical risk among symptomatic young people.