Feasibility and Acceptability of the Aboriginal and Islander Mental Health Initiative for Youth App: Nonrandomized Pilot With First Nations Young People

Co-design methodologies to develop mental health interventions with young people: a systematic review

Co-design methodologies are increasingly being used to develop mental health interventions with young people (aged 10-24 years), but the adoption of this participatory approach has been accompanied by concerns around quality, reporting, and participation. We aimed to identify and critically assess the characteristics, quality, outcomes, barriers, and facilitators of co-design methodologies used to develop mental health interventions with young people. We searched MEDLINE, PubMed, PsycINFO, SCOPUS, and Web of Science for articles published from database inception to Feb 6, 2024. We included articles describing empirical studies that used co-design in the development of a mental health intervention with young people, and identified 41 unique co-design studies. Our systematic review revealed that the use of co-design methodologies to develop mental health interventions has expanded substantially over the past 5 years. We also found that the application of co-design terms, frameworks, and methods varied across the studies, and most co-designed interventions had not been evaluated. A third of the studies evaluating the co-design process were assessed as being low quality, and two-thirds had a low degree of participation of young people in the co-design process. In the future, this area should be guided by clearer terms and frameworks, higher quality and degree of participation, and greater evaluation of co-designed programmes.

Personalization variables in digital mental health interventions for depression and anxiety in adolescents and youth: a scoping review

Introduction

The impact of personalization on user engagement and adherence in digital mental health interventions (DMHIs) has been widely explored. However, there is a lack of clarity regarding the prevalence of its application, as well as the dimensions and mechanisms of personalization within DMHIs for adolescents and youth.

Methods

To understand how personalization has been applied in DMHIs for adolescents and young people, a scoping review was conducted. Empirical studies on DMHIs for adolescents and youth with depression and anxiety, published between 2013 and July 2024, were extracted from PubMed and Scopus. A total of 67 studies were included in the review. Additionally, we expanded an existing personalization framework, which originally classified personalization into four dimensions (content, order, guidance, and communication) and four mechanisms (user choice, provider choice, rule-based, and machine learning), by incorporating non-therapeutic elements.

Results

The adapted framework includes therapeutic and non-therapeutic content, order, guidance, therapeutic and non-therapeutic communication, interfaces (customization of non-therapeutic visual or interactive components), and interactivity (personalization of user preferences), while retaining the original mechanisms. Half of the interventions studied used only one personalization dimension (51%), and more than two-thirds used only one personalization mechanism. This review found that personalization of therapeutic content (51% of the interventions) and interfaces (25%) were favored. User choice was the most prevalent personalization mechanism, present in 60% of interventions. Additionally, machine learning mechanisms were employed in a substantial number of cases (30%), but there were no instances of generative artificial intelligence (AI) among the included studies.

Discussion

The findings of the review suggest that although personalization elements of the interventions are reported in the articles, their impact on younger people's experience with DMHIs and adherence to mental health protocols is not thoroughly addressed. Future interventions may benefit from incorporating generative AI, while adhering to standard clinical research practices, to further personalize user experiences.

Facilitators and Barriers to Digital Mental Health Interventions for Depression, Anxiety, and Stress in Adolescents and Young Adults: Scoping Review

BACKGROUND

Digital mental health interventions (DMHIs) offer unique strengths as emerging services with practical applications for adolescents and young adults (AYAs) experiencing depression, anxiety, and stress. Although promising, acceptance and participation in DMHIs vary across interventions, participants, and contexts. It is essential to delineate and synthesize the factors that promote or hinder DMHI use.

OBJECTIVE

This review aims to assess and synthesize the facilitators and barriers to accessing DMHIs for depression, anxiety, and stress in AYAs through a scoping review.

METHODS

A comprehensive search was conducted across multiple databases, including PubMed, Web of Science, PsycINFO, CNKI, OpenGrey, and APA PsycExtra, up to October 31, 2023. Articles examining facilitators and barriers to DMHIs among AYAs with disorders or symptoms of depression, anxiety, and stress were included. Data synthesis and analysis involved quality assessment, thematic analysis, and relative frequency meta-analysis.

RESULTS

A total of 27 records met the eligibility criteria, and 14 facilitators and 13 barriers were identified across the external, intervention, and individual levels. The relative frequency meta-analysis indicated that factors influencing AYAs' use of DMHIs varied based on delivery modes. Among these factors, "quality and effect" emerged as the predominant theme-high quality and effect served as the primary facilitator, while low quality and effect acted as a barrier across both portable and nonportable devices, as well as single and multiple platforms.

CONCLUSIONS

The uptake of DMHIs among AYAs is influenced by a complex interplay of facilitators and barriers, particularly those related to quality and effect. Our syntheses provide crucial guidance for intervention designers, emphasizing the importance of user-centered approaches that balance scientific rigor with engaging and adaptive features. Enhancing the alignment of DMHIs with adolescent needs can improve both adoption and real-world mental health impact.

TRIAL REGISTRATION

PROSPERO CRD42023479880; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023479880.

Determining the cultural safety of chronic disease interventions for Aboriginal and Torres Strait Islander Australians: a scoping review

Objectives

To assess how the cultural safety of primary care-based chronic disease interventions for Aboriginal and Torres Strait Islander Australians is determined.

Methods

Scoping review of peer-reviewed evaluations of chronic disease interventions for Aboriginal and Torres Strait Islander patients, in which cultural safety is an outcome. Searches included Scopus, Informit, OVID Medline, Emcare and CINAHL including all articles published until September 2023.

Results

Searches identified 2,225 articles. 1,854 articles underwent title and abstract screening, with 97 progressing to full text review. Twenty articles met the inclusion criteria. 75% (n = 15) of articles determined cultural safety based solely on Aboriginal and Torres Strait Islander peoples' perspectives, with community acceptance as the most common means of determining cultural safety. In the analysed studies, elements contributing to cultural safety included practitioner behaviour (n = 15), knowledge (n = 6), skills (n = 1) and attitudes (n = 4), partnership with community (n = 4) and culturally safe services (n = 5), and graphics and artwork (n = 6). The inconsistent terminology and lack of definitions made comparison of studies challenging.

Conclusion

This review underscores the importance of adopting the Australian Health Practitioner Regulation Agency (AHPRA) definition of cultural safety to standardise terminology and explore the many elements of cultural safety. It is recommended that cultural safety is defined by the community targeted by the intervention. Identification of elements of cultural safety will guide future interventions and reduce reliance on community acceptance as an indirect measure of cultural safety. If chronic diseases interventions are to effectively impact health equity, it is vital to understand cultural safety within these settings.

Population attributable fractions of depression and anxiety among Aboriginal and Torres Strait Islander peoples: a population-based study

Background

Aboriginal and Torres Strait Islander peoples face an increased risk of common mental disorders, which may be associated with underlying socio-economic challenges, racism, and discrimination. This is the first study to calculate the population attributable fractions (PAFs) for depression and anxiety attributed to potentially modifiable risk factors such as health behaviour, social and cultural characteristics, and past adverse events among Aboriginal and Torres Strait Islander peoples aged ≥15 years.

Methods

This cross-sectional study examined the 2018-19 National Aboriginal and Torres Strait Islander Health Survey conducted by the Australian Bureau of Statistics. Logistic regression models were used to compute odds ratios (ORs). PAFs adjusted for communality were calculated using adjusted ORs and prevalence estimates for each risk factor.

Findings

This study included a weighted sample of 5362 individuals, with a mean age of 40.8 years (SD = ±17.2). Personal income below the national average (PAF = 13.4%; 95% CI: 12.4, 14.5), severed access to Indigenous cultural affiliations (PAF = 12.8%; 95% CI: 11.8, 13.8), central obesity (PAF = 7.2%; 95% CI: 6.4, 8.0), daily smoking (PAF = 5.9%; 95% CI: 5.2, 6.7) and severed access to Indigenous knowledge (PAF = 5.2%; 95% CI: 4.5, 5.8) were associated with 45% of depression cases. Personal income below the national average (PAF = 10.7%; 95% CI: 9.8, 11.7), limited access to Aboriginal Community Controlled Health Services (PAF = 10.6%; 95% CI: 9.7, 11.6), central obesity (PAF = 7.1%; 95% CI: 6.3, 7.9), severed access to Indigenous knowledge (PAF = 5.7%; 95% CI: 4.9, 6.4) and the experience of discrimination in the last 12 months (PAF = 4.7%; 95% CI: 4.0, 5.3) were associated with 39% of anxiety cases.

Interpretation

To reduce the burden of depression and anxiety disorder among Aboriginal and Torres Strait Islander peoples, addressing socio-economic and cultural harms that constrain healthy connections to people/kin, their rights, languages, land, and healthy food sources should be a priority.

Funding

This work was funded by a grant from the Commonwealth of Australia, represented by the Department of Health and Aged Care (Grant Activity 4-DGEJZ1O/4-CW7UT14).

Navigating the cultural adaptation of a US-based online mental health and social support program for use with young Aboriginal and Torres Strait Islander males in the Northern Territory, Australia: Processes, outcomes, and lessons

BACKGROUND

Despite disproportionate rates of mental ill-health compared with non-Indigenous populations, few programs have been tailored to the unique health, social, and cultural needs and preferences of young Aboriginal and Torres Strait Islander males. This paper describes the process of culturally adapting the US-based Young Black Men, Masculinities, and Mental Health (YBMen) Project to suit the needs, preferences, culture, and circumstances of Aboriginal and Torres Strait Islander males aged 16-25 years in the Northern Territory, Australia. YBMen is an evidence-based social media-based education and support program designed to promote mental health, expand understandings of gender and cultural identities, and enhance social support in college-aged Black men.

METHODS

Our adaptation followed an Extended Stages of Cultural Adaptation model. First, we established a rationale for adaptation that included assessing the appropriateness of YBMen's core components for the target population. We then investigated important and appropriate models to underpin the adapted program and conducted a non-linear, iterative process of gathering information from key sources, including young Aboriginal and Torres Strait Islander males, to inform program curriculum and delivery.

RESULTS

To maintain program fidelity, we retained the core curriculum components of mental health, healthy masculinities, and social connection and kept the small cohort, private social media group delivery but developed two models: 'online only' (the original online delivery format) and 'hybrid in-person/online' (combining online delivery with weekly in-person group sessions). Adaptations made included using an overarching Aboriginal and Torres Strait Islander social and emotional wellbeing framework and socio-cultural strengths-based approach; inclusion of modules on health and wellbeing, positive Indigenous masculinities, and respectful relationships; use of Indigenous designs and colours; and prominent placement of images of Aboriginal and Torres Strait Islander male sportspeople, musicians, activists, and local role models.

CONCLUSIONS

This process resulted in a culturally responsive mental health, masculinities, and social support health promotion program for young Aboriginal and Torres Strait Islander males. Next steps will involve pilot testing to investigate the adapted program's acceptability and feasibility and inform further refinement.

An emerging framework for digital mental health design with Indigenous young people: a scoping review of the involvement of Indigenous young people in the design and evaluation of digital mental health interventions

BACKGROUND

Indigenous young people worldwide possess unique protective factors that support wellbeing. However, they experience mental illness at higher rates than their non-indigenous counterparts. Digital mental health (dMH) resources can increase access to structured, timely, and culturally tailored mental health interventions by reducing structural and attitudinal barriers to accessing treatment. The involvement of Indigenous young people in dMH resource development is recommended, however, no guidelines exist on how this can best be facilitated.

METHODS

A scoping review examining processes to involve Indigenous young people in developing or evaluating dMH interventions was conducted. Studies reported between 1990 and 2023 involving Indigenous young people aged 12-24 years, originating from Canada, the USA, New Zealand, and Australia, in the development or evaluation of dMH interventions were eligible for inclusion. Following a three-step search process, four electronic databases were searched. Data were extracted, synthesized, and described under three categories: dMH intervention attributes, study design, and alignment with research best practice. Best practice recommendations for Indigenous research and participatory design principles derived from the literature were identified and synthesised. Included studies were assessed against these recommendations. Consultation with two Senior Indigenous Research Officers ensured Indigenous worldviews informed analysis.

RESULTS

Twenty-four studies describing eleven dMH interventions met inclusion criteria. Studies included formative, design, pilot, and efficacy studies. Overall, most included studies demonstrated a high degree of Indigenous governance, capacity building, and community benefit. All studies adapted their research processes to ensure that local community protocols were followed and most aligned these within an Indigenous research paradigm. Formal agreements regarding existing and created intellectual property and implementation evaluations were rare. Outcomes were the primary focus of reporting, with limited detailed descriptions of governance and decision-making processes or strategies for managing predictable tensions between co-design stakeholders.

CONCLUSIONS

This study identified recommendations for undertaking participatory design with Indigenous young people and evaluated the current literature against these criteria. Common gaps were evident in the reporting of study processes. Consistent, in-depth reporting is needed to allow assessment of approaches for this hard-to-reach population. An emergent framework, informed by our findings, for guiding the involvement of Indigenous young people in the design and evaluation of dMH tools is presented.

TRIAL REGISTRATION

Available via osf.io/2nkc6.