JMIR Publications

ABSTRACT

Background:

Adolescence is a critical period for preventive mental health care, yet many young people experience barriers to seeking help, including stigma, low mental health literacy, and limited service availability. Digital mental health interventions (DMHIs) hold promise as low-threshold, scalable solutions, but their uptake and engagement remain low. Moreover, much of the existing research has relied on quantitative approaches with forced-choice responses, insufficiently considering adolescents’ perspectives and needs. To enhance the design, relevance, and effectiveness of preventive DMHIs, it is essential to systematically explore, integrate, and evaluate young people’s perspectives through co-design methodologies.

Objective:

This study explored factors influencing adolescents’ uptake and engagement with preventive transdiagnostic DMHIs across person, intervention and system levels using a qualitative, co-design approach.

Methods:

Participants were recruited through voluntary response sampling. A qualitative study with single-interview design was employed. The semi-structured interviews were recorded, transcribed verbatim and analyzed through structured qualitative content analysis.

Results:

The sample consisted of 48 participants (mean age=16.52; 35 female). Seven main topics across the three levels were identified: (1) facilitating factors in the awareness phase of help-seeking and (2) beliefs about uptake and engagement with DMHIs at the person level, (3) required features of the DMHI, (4) expected support and (5) preferences regarding the presentation of intervention content that influence uptake and enhance engagement at the intervention level and (6) suggestions of adolescents about the integration of DMHIs into existing mental health services to ensure uptake and engagement at the system level. Furthermore, (7) several discrepancies between adolescents’ expectations and implementation possibilities were identified. This resulted in a final overview outlining implementation suggestions of these identified factors to enhance uptake and engagement at all three levels.

Conclusions:

Enhancing uptake and engagement at the person level could be achieved by providing clear and transparent information on the DMHI’s purpose, its developers, data security, and expected benefits before and during registration. Testimonials, peer-exchange functions and personalization and individualization options may enhance uptake and engagement at the intervention level. At the system level, integrating low-threshold, adaptive DMHIs into existing mental health services could facilitate broader accessibility and sustained engagement. These findings emphasize the importance of incorporating adolescents’ perspectives into DMHI development by exploring how and why uptake and engagement occurs to use these insights to develop new or to optimize existing preventive DMHIs.