JMIR Publications

ABSTRACT

Background:

Common challenges in the youth mental health system include low access, poor uptake, poor adherence, and limited overall effectiveness. Digital mental health services (DMHS) such as Moderated Online Social Therapy (MOST) have shown potential to help solve some of these problems. Theory of Change (ToC) is a comprehensive framework recommended for outlining how and why a complex intervention or service works.

Objective:

To develop a ToC for MOST in order to guide platform improvements and later evaluation.

Methods:

A ToC specific to MOST was developed using a number of synthesized knowledge sources gathered over its 12 year history, which included over 1000 consultation and co-design sessions with young people and clinicians, a review of randomized controlled trials and pilot studies conducted by the group, a review of the qualitative studies conducted by the group, a review of other ToC frameworks, a review of the digital mental health literature, and an internal expert review of the final ToC.

Results:

The final ToC was produced in both narrative and table form. It outlined 3 assumptions, 4 contextual factors, 16 stakeholder problem statements, 4 guiding theories, 13 mechanisms, 10 outputs, 10 short term measurable outcomes and 6 medium- and long-term outcomes.

Conclusions:

The ToC highlighted a number of gaps in the current model that will become the target of further development, as then guiding its evaluation. These include a focus on transdiagnostic mechanisms in the therapeutic content, use of specific behavior change techniques by human supporters and platform content derived from Self Determination Theory (SDT), and the application of comprehensive implementation frameworks to integrate MOST into clinical practice.