The five resulting themes from across the YPAG sessions are summarised below.
Theme 1. Perception of young People’s mental health
Throughout the sessions, group members discussed the importance of understanding the specific needs and context surrounding young people’s mental health. Participants wanted health related issues to be taken seriously, validated and respected by supporting adults. There were concerns around disclosing information and being dismissed.
“We should always believe when someone says something to us, like confides in us. You just don’t know what they’re going through.” (G2).
There were additional comments around the desire for non-judgemental support and advice around risky health behaviours that influence on mental and physical health (such as alcohol/drug consumption, sexual activities and excessive social media use).
“Teachers always blame it on you though, like, if you feel bad because you’ve been smoking or drinking, they’ll just be like that’s because of you.” (G1).
Members also felt positivity towards embracing new technology in mental health and wellbeing measurement, however commented on the potential reluctance to adopt these methodologies in some populations.
“The older generation always say phones are making us all have mental health issues, and I think it maybe has impacted us in some ways … but I think it can also be a way to help.” (G3).
Group members also recognised a spectrum of mental health and wellbeing needs.
“If you look back, mental health support and stuff has come a long way and I think people are beginning to realise that we all have wellbeing needs” (G1).
The group also discussed the need for supporting networks to understand life stressors specific to contemporary adolescents when identifying and treating wellbeing needs.
“I mean life can be stressful with like exams and school and social media pressures and stuff.” (G4).
Theme 2. Trust
The YPAGs discussed the importance of transparency and protection of young people’s data and its use - including willingness to share data, anonymity and fear of data misuse.
“There a feeling of ‘what are you doing with our data’, because lots of places give it to like third parties. I don’t want to have my life recorded if I don’t know what’s going to happen with that information.” (G3).
Group members agreed that clear and transparent data policies would make individuals more likely to use and trust an e-platform.
“As long as they tell you like honestly what they are doing with your information, I wouldn’t mind sharing with researchers.” (G4).
Young people felt it was important to trust the team behind the web development and expressed scepticism around corporate companies’ intentions. Group members felt that an e-platform would be legitimised if it was promoted through a trusted source, such as school or a health care provider.
“I want to use something that was built by people that care, like actual humans, not just companies trying to get money and data from you. It would be good if teachers could suggest it to students.” (G1).
It was felt that flexibility should be incorporated into the data policies to allow individual users to control the use of their data. Most group members reported willingness to share data at group or cohort level but remained reluctant to share identifiable data with schools and researchers.
“If it’s really and truly anonymous, then under no circumstances should that be broken.” (G2).
Theme 3. Accessibility
The participants felt that any platform developed should optimise accessibility to all students. During the group sessions, general barriers and enables of help seeking behaviour were discussed (including factors for accessing e-support). It was felt that the stigma of mental health influenced individual help seeking, as well as the choice of mobile phone application or website accessed.
“The title of it needs to be subtle, because if it’s literally something like ‘mental health help’, then they are going to try and hide it and won’t want it on their phone.” (G2).
Furthermore, individual differences and issues around diversity and inclusion were discussed in relation to accessing and adhering to health programmes.
“There’s definitely issues with toxic masculinity … Plus it’s harder to access therapy and stuff if your family don’t talk about this or maybe just can’t afford it.” (G1).
“If your parents don’t necessarily know what you’re going through, you can’t really go up to them and get them to pay a £15-a-month subscription.” (G4).
The groups highlighted that the ease of accessing (i.e. downloading, signing up to and beginning to use) an e-platform would be an important factor for individuals showing initial interest. This also included practical issues with data usage, storage capacity and battery demand of the platform. The participants also discussed the accessibility of content on the platform, with developers ensuring that the level of information is appropriate for the age category intended.
“Don’t put the information in a long, boring agreement thing because nobody reads that.” (G3).
Theme 4. Support
The groups felt that an effective and engaging e-platform would provide an appropriate level of information and support to facilitate positive mental health and wellbeing. Participants discussed the ability for young people to engage in self-help, and frustrations around patronising approaches to mental health support.
“I think teachers and parents can sometimes not give us enough credit of being able to deal with things on our own … like we are more independent at this age and I think we should be able to have access to information that we can use to help ourselves without necessarily adults being involved.” (G3).
However young people also acknowledged the variety of support needed for each user and highlighted the need to provide emergency responses when needed.
“I think there needs to be a kind of safeguarding system for when people are in danger or might hurt themselves.” (G4).
The groups also discussed the current lack of wellbeing support for young people who don’t present to mental health services or have a clinical diagnosis.
“It feels like you either have to wait to get to the point of being so bad that you’re on medication, or it’s no input and you can just deal with it yourself” (G3).
Young people identified choice in mental health support was important, and an e-platform should provide options in the services and self-help available to give individuals ownership in their help seeking.
“It’s best to give the information on services available and give people the choice of whether to access them or not.” (G1).
Theme 5. Design
Young people stressed the importance of design in the acceptability and feasibility of a mental health e-platform. Participants discussed design preferences with reference to existing mental health phone applications and websites known to them.
“It needs to be designed well. If it looks like it’s made in 2000, I’m not using it … I mean I will literally think ‘can I really trust it if it looks like that.’” (G1).
Furthermore, the layout and presentation of questions was thought to be an important factor in young people’s responses and level of engagement.
“We don’t like being boxed and like categorised, maybe even something like a slider so you don’t have to say, ‘I’m this’ or ‘I’m that’.” (G3).
Having the ability to customise and personalise profile settings was discussed as a favourable feature in an e-platform. This included comments on personalised colour palettes, icons and notification reminders. Individuals also expressed an interest in having a feedback function for reviewing entries.
“People want to get results. if you’re putting in information you want an answer to that. So, I guess it’s helpful to get some kind of feedback in that way.” (G2).
Example co-design informant input
Impact on e-platform
Young People’s Mental Health
Acknowledge the specific contexts which young people face mental health challenges.
When documenting life-events, the e-platform presents the user with categories, including school, to contextualise their experiences.
Allow autonomy in help-seeking and health management.
The platform provides feedback graphs to the user to allow for reflection on mood variation across time and place. It also provides help-seeking resources.
Minimise the focus on ‘mental health’ problems.
The title and icon of the app are not associated with mental health. Questions asked are addressing wellbeing and life-events rather than clinical outcome measures.
Provide a space to document thoughts and feelings without fear of information being shared.
The platform promises anonymity to the user. The only instances in which this is broken, is if the user was in immediate danger to themselves or others.
Clear and concise information on how the data is handled.
Ability to contact the web-developers and others involved.
Contact information for the web-development company and researchers involved are provided to all users, and feedback on app stores regularly checked for queries.
Inclusivity in every character used.
The platform uses an avatar character which is inclusive of race, age and gender.
Do not charge for app or in-app features.
The platform is a free service provided for schools, no individual user or school will be charged to access its features.
Make information understandable and digestible.
The platform has tried to minimise ‘words per page’ and has provided a break-down of information on the research which is accessible at all times in an embedded PDF document.
Having a clear safeguarding procedure for at-risk users.
The platform has clinical advisors that will assist in risk screening of any inputting of free-text boxes.
Offering support services for those in need.
Embedded as part of the app, there is a ‘support’ tab which lists a range of local and national support resources. Hyperlinks to webpages, phone numbers and app downloads are built in.
Transparency of therapeutic ability and scope.
As part of the sign-up process, the platform outlines the limits of its therapeutic ability – including the frequency of risk screening and the lack of immediate support for users.
Do not box responses into categories.
Most responses on the app are collected through a ‘sliding scale’ to offer flexibility. In sections where this is not possible, an ‘other’ option or free-text box is provided.
Avoid using triggering colours.
The app does not use ‘red’ or ‘green’ colours to reflect ‘good’ and ‘bad’. The colour scheme is pastel, and the avatar character is purple, which users felt was gender neutral.
Flexibility in the nature and frequency of notifications.
The app allows the user to determine when notifications are set, with setting preferences at the sign-up process as well as complete flexibility to change this in user settings throughout engagement.