JMIR Publications

ABSTRACT

Background:

Smartphone applications (‘apps’) may provide an opportunity to deliver mental health resources and interventions in a scalable and cost-effective manner. However, young people from marginalised and underserved groups face numerous and unique challenges to accessing, engaging with, and benefitting from these apps.

Objective:

To better understand the acceptability (i.e., perceived usefulness and satisfaction with an app) and feasibility (i.e., extent to which an app was successfully used) of mental health apps for underserved young people. A secondary aim was to establish whether adaptations can be made to increase accessibility and inclusivity apps for these groups.

Methods:

We conducted two sequential studies, consisting of a systematic literature review of mental health apps for underserved populations, followed by a qualitative study with underserved young males (n = 20, mean age = 19 years). Following the PRISMA guidelines, an electronic search of five databases was conducted in 2021. The search yielded 11,539 results of which 11 articles met eligibility criteria.

Results:

Included studies comprised a range of groups, including those affected by homelessness, physical health conditions, living in low- and middle-income countries, and those with sexual and gender minority identities. Establishing and maintaining user engagement was a pervasive challenge across mental health apps and populations, and dropout was a reported problem among nearly all the included studies. Positive subjective reports of usability, satisfaction, and acceptability were insufficient to determine users’ objective engagement.

Conclusions:

Despite the significant amount of funding directed to the development of mental health apps, juxtaposed with only limited empirical evidence to support their effectiveness; few have been deliberately developed or adapted to meet the heterogeneous needs of marginalised and underserved young people. Before mental health apps are scaled-up, greater understanding is needed of the types of services more vulnerable young people and those in limited resource settings prefer (e.g., standard vs. digital) followed by more rigorous and consistent demonstrations of acceptability, effectiveness, and cost-effectiveness. Adopting an iterative participatory approach by involving young people in the development and evaluation process is an essential step in enhancing the adoption of any intervention, including apps, in ‘real world’ settings and will support future implementation and sustainability efforts to ensure marginalised and underserved groups are reached.