JMIR Publications

ABSTRACT

Background:

Mental health digital interventions (MHDIs) are increasingly viewed as promising support in university counseling centers. Yet many remain stand-alone and poorly integrated into counseling practice, leading to lower engagement. Little is known about how digital support should be integrated across counseling stages or how counselors and students with counseling experience perceive their role in hybrid care.

Objective:

This study aimed to examine counselors’ and students’ perspectives on how digital interventions could be integrated across the counseling journey in university counseling centers and to derive stakeholder-informed strategies for hybrid care.

Methods:

We conducted semi-structured interviews with 18 counselors and 24 university students with prior counseling experience. Participants provided answers on counseling-stage vignette scenarios and prototype features representing major MHDIs functions, including their expectations, concerns, and implementation strategies. Data were analyzed using framework analysis, combining a primary stage-based analysis of counseling experiences with a secondary function-based analysis of digital intervention needs and implementation requirements.

Results:

Across the counseling journey, participants viewed digital support as useful for promoting reflection before counseling, facilitating disclosure during intake, maintaining behavioral engagement between sessions, and supporting self-regulation after counseling. Students with counseling experience emphasized emotional safety, motivation, and self-understanding, whereas counselors emphasized interpretability, moral responsibility, and implementation feasibility. Integration was also perceived as requiring personalization according to students’ distress, readiness to engage, and understanding of the counseling process, while also supporting counselors’ professional responsibilities related to data interpretation, risk management, and alignment with existing therapeutic approaches. Participants suggested that implementation should proceed in phased ways, beginning with lower-burden functions and clearer role boundaries, while distinguishing student-facing supportive uses from counselor-facing interpretive uses

Conclusions:

This study identified how different digital intervention modalities and functions may be integrated across the offline in-person counseling journey, and how their roles vary according to counseling stage and user context. Successful implementation may depend not only on user engagement, but also on counselors’ concerns regarding moral burden and integration into existing therapeutic practice. The findings highlight the need for staged and personalized implementation strategies based on psychotherapeutic literacy and level of distress and readiness to engage. This study provides a stakeholder-informed strategic framework for service-level decisions about when, how, and for whom digital intervention components may be integrated within real-world counseling settings.