1. The Acceptability, Engagement, and Feasibility of Mental Health Apps for Marginalized and Underserved Young People: Systematic Review and Qualitative Study
- Author
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Bear, Holly Alice, Nunes, Lara Ayala, Ramos, Giovanni, Manchanda, Tanya, Fernandes, Blossom, Chabursky, Sophia, Walper, Sabine, Watkins, Edward, and Fazel, Mina
- Subjects
Health Services and Systems ,Public Health ,Health Sciences ,Social Determinants of Health ,Health Disparities ,Health Services ,Behavioral and Social Science ,Clinical Research ,Clinical Trials and Supportive Activities ,Mental Health ,7.1 Individual care needs ,3.1 Primary prevention interventions to modify behaviours or promote wellbeing ,Mental health ,Generic health relevance ,Good Health and Well Being ,Humans ,Mobile Applications ,Male ,Qualitative Research ,Young Adult ,Adolescent ,Feasibility Studies ,Vulnerable Populations ,Adult ,Mental Health Services ,Patient Acceptance of Health Care ,Smartphone ,Female ,adolescent mental health ,marginalized groups ,smartphone apps ,engagement ,implementation science ,mobile app ,smartphone ,mobile health ,mHealth ,mental health ,challenges ,acceptability ,young ,effectiveness ,mobile phone ,Information and Computing Sciences ,Medical and Health Sciences ,Psychology and Cognitive Sciences ,Medical Informatics ,Health services and systems - Abstract
BackgroundSmartphone apps may provide an opportunity to deliver mental health resources and interventions in a scalable and cost-effective manner. However, young people from marginalized and underserved groups face numerous and unique challenges to accessing, engaging with, and benefiting from these apps.ObjectiveThis study aims to better understand the acceptability (ie, perceived usefulness and satisfaction with an app) and feasibility (ie, the 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 the accessibility and inclusivity of apps for these groups.MethodsWe conducted 2 sequential studies, consisting of a systematic literature review of mental health apps for underserved populations followed by a qualitative study with underserved young male participants (n=20; age: mean 19). Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, an electronic search of 5 databases was conducted in 2021. The search yielded 18,687 results, of which 14 articles met the eligibility criteria.ResultsThe included studies comprised a range of groups, including those affected by homelessness, having 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.ConclusionsDespite the significant amount of funding directed to the development of mental health apps, juxtaposed with only limited empirical evidence to support their effectiveness, few apps have been deliberately developed or adapted to meet the heterogeneous needs of marginalized and underserved young people. Before mental health apps are scaled up, a greater understanding is needed of the types of services that more at-risk young people and those in limited-resource settings prefer (eg, 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 that marginalized and underserved groups are reached.Trial registrationPROSPERO CRD42021254241; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=254241.
- Published
- 2024