Attitudes Towards Digital Health Interventions in Germany: Findings From a Population-Based Representative Survey.

Adolescents with type 1 diabetes (T1D) experience higher rates of psychological disorders compared with their healthy peers. As poor psychological health has been associated with suboptimal glycaemic control and more frequent complications, there is an urgent need to develop more 'clinically usable' interventions. Digital mental health interventions offer unique advantages compared with in-person interventions; however, what adolescents with T1D want in terms of content and functionality is poorly understood. Accordingly, the current study conducted focus groups to examine the views of adolescents with T1D regarding digital mental health interventions. Four focus groups were conducted, including 16 adolescents with T1D, ranging from 13 to 17years in age (69% female). Transcripts were analysed using directed content analysis to examine (1) 'what adolescents dislike about existing digital mental health interventions?' and (2) 'what adolescents want in future digital mental health interventions?'. Findings provide a preliminary understanding of what adolescents dislike and also the type of content and functional features, which may be important to include in digital mental health programs for this population, such as a peer support feature (reported by 16 of 16), emotion and diabetes check-in feature (11 of 16) and diabetes-relevant content (12 of 16). Early data suggest that digital mental health interventions should include a significant peer support element, diabetes-relevant content and examples, and check-in on their mental health and diabetes self-management regularly, while avoiding fixed responses or modules and non-age-appropriate content. Based on these findings, a digital intervention is currently being developed.

BACKGROUND Racialized immigrant youth face a multitude of challenges that heighten their vulnerability to mental illness. Digital mental health has increasingly been recognized as an effective method to improve accessibility to mental health services for communities with limited access to inclusive care, particularly among youth. However, despite the growing emphasis on cultural inclusivity in interventions targeting racialized and marginalized populations, there remains a gap in empirical evidence regarding how culturally inclusive elements are integrated into digital mental health practices and their impact on the effectiveness of these interventions. OBJECTIVE Focusing on Asian immigrant youth in Canada, this protocol outlines our community-engaged project, which aims to assess whether current digital mental health interventions provide effective and culturally accessible support, and how we can collaboratively develop a framework for creating innovative, inclusive, and effective digital interventions to promote youth mental health. METHODS A two-phase community-engaged approach will be used to involve Asian immigrant youth facing mental health challenges, youth leaders, service providers, and stakeholders from East, Southeast, and South Asian communities. Phase one includes scoping reviews on the technology, access, and cultural inclusivity of digital mental health interventions for Asian and racialized newcomer youth in Canada. In phase two, 15 diverse Asian youth leaders and 15 service providers will participate in a 3.5-hour online session to discuss the need for effective digital mental health interventions, share results from the reviews, co-identify key elements of an inclusive and innovative intervention, and outline next steps for forming a community-campus research partnership focused on mental health promotion for Asian immigrant youth. RESULTS This project is expected to yield a co-developed framework outlining key elements of culturally inclusive and effective digital mental health interventions for Asian immigrant youth in Canada. Anticipated outcomes include enhanced understanding of cultural accessibility gaps in existing digital interventions and strengthened community-campus partnerships to support youth mental health. CONCLUSIONS This research aims to improve access to culturally safe and effective digital mental health interventions for Asian immigrant youth. Benefits include enhanced mental health support for this population, increased awareness of mental health issues among stakeholders, and the development of a framework for culturally inclusive mental health services

Purpose: This review aimed to investigate the effectiveness of digital school-based mental health interventions for adolescents in Sub-Saharan Africa. Method: The authors conducted a comprehensive search of digital school-based mental health interventions to identify studies conducted in Sub-Saharan Africa targeting adolescents between the ages of (10–19) years. Peer-reviewed studies published in English between 2009 and May 2023 were obtained through electronic bibliographic databases. Result: Only one study met the full inclusion criteria for this review. The included study tested a digital mental health intervention (“Shamiri Digital”) for treating depression, anxiety, and well-being in adolescents. The “Shamiri Digital” intervention demonstrated positive outcomes on depressive symptoms within the full sample. Discussion: The dearth of studies investigating digital mental health solutions for adolescents in low-income countries demonstrates a critical gap in intervention and research for adolescent mental health in resource constrictive settings

BackgroundCollege students are increasingly reporting common mental health problems, such as depression and anxiety, and they frequently encounter barriers to seeking traditional mental health treatments. Digital mental health interventions, such as those delivered via the Web and apps, offer the potential to improve access to mental health treatment.ObjectiveThis study aimed to review the literature on digital mental health interventions focused on depression, anxiety, and enhancement of psychological well-being among samples of college students to identify the effectiveness, usability, acceptability, uptake, and adoption of such programs.MethodsWe conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (registration number CRD42018092800), and the search strategy was conducted by a medical research librarian in the following databases: MEDLINE (Ovid), EMBASE (Elsevier), PsycINFO (EbscoHost), the Cochrane Library (Wiley), and Web of Science (Thomson Reuters) from the date of inception to April 2019. Data were synthesized using a systematic narrative synthesis framework, and formal quality assessments were conducted to address the risk of bias.ResultsA total of 89 studies met the inclusion criteria. The majority of interventions (71/89, 80%) were delivered via a website, and the most common intervention was internet-based cognitive behavioral therapy (28, 31%). Many programs (33, 37%) featured human support in the form of coaching. The majority of programs were either effective (42, 47%) or partially effective (30, 34%) in producing beneficial changes in the main psychological outcome variables. Approximately half of the studies (45, 51%) did not present any usability or acceptability outcomes, and few studies (4, 4%) examined a broad implementation of digital mental health interventions on college campuses. Quality assessments revealed a moderate-to-severe risk of bias in many of the studies.ConclusionsResults suggest that digital mental health interventions can be effective for improving depression, anxiety, and psychological well-being among college students, but more rigorous studies are needed to ascertain the effective elements of these interventions. Continued research on improving the user experience of, and thus user engagement with, these programs appears vital for the sustainable implementation of digital mental health interventions on college campuses.

BackgroundLow- and middle-income countries (LMICs), which bear a larger proportion of the global mental illness burden, have been disproportionately impacted by the COVID-19 pandemic due to preexisting mental health care system deficiencies. The pandemic has also led to a considerable increase in care delivered through digital mental health interventions (DMHIs), many of which have been adapted from in-person formats. Thus, there is a need to examine their fidelity to the original format along with issues regarding usability and other challenges to and facilitators of their uptake in LMICs. As most DMHIs have been developed in high-income countries, examining their cultural adaptation to LMIC settings is also critical.ObjectiveThe purpose of this research was to conduct a rapid scoping review of the available evidence on DMHIs for depression and anxiety, two of the most common mental disorders, in LMICs.MethodsA rapid scoping review was conducted following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) and processes for rapid reviews by Tricco et al. The PubMed and PsycINFO databases were searched for records published between January 2020 (when COVID-19 was declared a public health emergency) and January 2025 using a search strategy developed in consultation with a liaison librarian. The pandemic accelerated the development and application of DMHIs, and this time frame was used to capture the recent literature that may have incorporated new methods of application. The search strategy was developed across three domains: (1) digital health interventions, (2) depression or anxiety, and (3) LMICs. Data were charted from the final records according to (1) intervention type; (2) discussions on fidelity, usability, and cultural adaptation; and (3) challenges to and facilitators of their uptake in LMICs.ResultsA total of 80 records were included in the final analysis, with reasons for exclusion (eg, focused on mental health in general, not being a DMHI, or not focused on LMICs) reported. Six DMHI platforms were identified: (1) mobile app, (2) the web, (3) virtual reality, (4) videoconferencing, (5) telemedicine, and (6) social media. Less than half of the records referenced fidelity (16/80, 20%), usability (29/80, 36%), and cultural adaptation (31/80, 39%). Challenges pertained to the technological system, engagement issues, structural barriers, and concerns regarding privacy and confidentiality. Facilitators included widespread mobile phone use, built-in supervision and training features, and convenience.ConclusionsDespite the opportunities that DMHIs offer for reducing the mental health treatment gap, further work examining and improving their fidelity, usability, and cultural adaptation is required. In addition, various challenges to the uptake of DMHIs in LMICs, including contextual issues, structural barriers, and privacy concerns, must be mitigated to avoid contributing further to the digital divide.

Digital mental health: a potential opportunity to improve health equity in China

Youth experiencing early psychosis in West Africa often face delays in accessing evidence-based treatment. Digital mental health interventions may offer an acceptable and scalable approach to improve access to early psychosis care in West Africa; however, few data exist on the experiences and perspectives of patients with early psychosis and their caregivers to inform digital intervention development. This study aims to explore current experiences of early psychosis care, identify barriers and facilitators to in-person early psychosis care within health facilities, and identify opportunities for digital interventions to support patients with early psychosis and caregivers in Ghana. We conducted qualitative focus group discussions among patients with early psychosis, their caregivers, and their mental health care providers recruited at Accra Psychiatric Hospital in Accra, Ghana. Trained qualitative researchers facilitated discussions using a structured qualitative interview guide, exploring current care practices for early psychosis in Ghana, barriers and facilitators to facility-based care, and perceptions of digital mental health interventions. Transcripts were translated, transcribed, and analyzed thematically using a hybrid inductive and deductive approach grounded in the theoretical framework of acceptability. Overall, we conducted 4 focus group discussions (N=31) among 7 patients with early psychosis (median age 28, IQR 21-41 years), 6 caregivers (median age 58, IQR 29-34 years), and 18 clinicians (median age 30, IQR 29-34 years). Participants described current early psychosis care practices in Ghana, including seeking spiritual and traditional healing, the dearth of information and resources about psychosis, and the integral role of caregivers in facilitating treatment engagement and continuation (often at the cost of caregiver mental distress and burnout). Common barriers to facility-based mental health care included stigma associated with mental illness, lack of prior knowledge about early psychosis and treatment options, and practical constraints (eg, financial, logistical, and health care system limitations). Motivating factors for facility-based care included success stories from community members and strong rapport and trust in mental health clinicians. Technology (eg, mobile phones, laptops, radio, and television) was commonly used among participants in typical daily tasks, health information seeking, and stress reduction. Participants expressed support for digital tools that could deliver psychoeducation about early psychosis, support treatment adherence, and extend patient-provider communication between clinic visits. Digital mental health interventions have the potential to complement facility-based early psychosis services in Ghana by addressing misinformation, reducing access barriers, and supporting caregiver roles. These qualitative findings inform potential integration points, content, attributes, and strengths of digital modalities that could be leveraged to support patients with early psychosis and their caregivers in Ghana.

School teachers face the paradox of being in a privileged position to act in youth mental health prevention, but in a vulnerable position for not receiving adequate training and personal support. Digital interventions can provide unexpensive tools and narrow this gap in a large scale without major structural changes. We aimed to synthesize the evidence for digital mental health interventions for school teachers. Studies published from any date until August 2022 were identified through a literature search of the MEDLINE, Embase, ScIELO, and Cochrane Central databases. The studies included evaluated digital interventions targeting school teachers to deal with their own mental health or to assist them in the management of students' mental health. Studies that addressed school-based digital mental health interventions, but directly targeted students, parents, or specifically other professionals were not included. The literature search retrieved 5626 hits and several interventions were described, but only 11 studies fulfilled the inclusion criteria, none of which focused on teachers' mental health. There was some evidence that these interventions improved knowledge about general or specific topics in mental health, and most studies also reported gains in preparedness, confidence, and attitudes towards mental health. The studies identified in this review provide initial support for teacher-focused mental health digital interventions. However, we discuss limitations regarding study designs and data quality. We also discuss barriers, challenges, and the need for effective evidence-based interventions.

The opportunities technology offers for improving mental health have led to a surge in digital interventions. A pivotal step in the development of such interventions involves translating theoretical intervention techniques into specific technological features. However, practical guidelines on how to approach this translation are currently underdeveloped. To support efforts to develop digital mental health interventions, from theoretical inception to an actual digital intervention, we present the Digital Intervention Development Guide (DID-Guide). The DID-Guide is structured into two distinct phases. Phase 1 establishes the intervention's theoretical foundation, outlining the steps for developing a theoretical intervention framework. Phase 2 translates this theoretical framework into actionable technological features, that make up the intervention. We break down the DID-Guide's two phases into a series of actionable steps, accompanied by concrete examples from a recent intervention that can be delivered through both a smartphone app and Virtual Reality. The DID-Guide serves as a comprehensive resource for creating impactful digital mental health interventions, while also facilitating collaboration and communication among a diverse range of stakeholders, including researchers, clinicians, and software developers.

Individuals enrolling in the Veterans Health Administration frequently report symptoms consistent with insomnia disorder. Cognitive behavioral therapy for insomnia (CBT-I) is a gold standard treatment for insomnia disorder. While the Veterans Health Administration has successfully implemented a large dissemination effort to train providers in CBT-I, the limited number of trained CBT-I providers continues to restrict the number of individuals who can receive CBT-I. Digital mental health intervention adaptations of CBT-I have been found to have similar efficacy as traditional CBT-I. To help address the unmet need for insomnia disorder treatment, the VA commissioned the creation of a freely available, internet-delivered digital mental health intervention adaptation of CBT-I known as Path to Better Sleep (PTBS). We aimed to describe the use of evaluation panels composed of veterans and spouses of veterans during the development of PTBS. Specifically, we report on the methods used to conduct the panels, the feedback they provided on elements of the course relevant to user engagement, and how their feedback influenced the design and content of PTBS. A communications firm was contracted to recruit 3 veteran (n=27) and 2 spouse of veteran (n=18) panels and convene them for three 1-hour meetings. Members of the VA team identified key questions for the panels, and the communications firm prepared facilitator guides to elicit feedback on these key questions. The guides provided a script for facilitators to follow while convening the panels. The panels were telephonically conducted, with visual content displayed via remote presentation software. The communications firm prepared reports summarizing the panelists' feedback during each panel meeting. The qualitative feedback described in these reports served as the raw material for this study. The panel members provided markedly consistent feedback on several elements of PTBS, including recommendations to emphasize the efficacy of CBT-I techniques; clarify and simplify written content as much as possible; and ensure that content is consistent with the lived experiences of veterans. Their feedback was congruent with previous studies on the factors influencing user engagement with digital mental health interventions. Panelist feedback influenced multiple course design decisions, including reducing the effort required to use the course's sleep diary function, making written content more concise, and selecting veteran testimonial videos that emphasized the benefits of treating chronic insomnia symptoms. The veteran and spouse evaluation panels provided useful feedback during the design of PTBS. This feedback was used to make concrete revisions and design decisions consistent with existing research on improving user engagement with digital mental health interventions. We believe that many of the key feedback messages provided by these evaluation panels could prove useful to other digital mental health intervention designers.

U.S. health care systems are tasked with alleviating the burden of mental health, but are frequently underprepared and lack workforce and resource capacity to deliver services to all in need. Digital mental health interventions (DMHIs) can increase access to evidence-based mental health care. However, DMHIs commonly do not fit into the day-to-day activities of the people who engage with them, resulting in a research-to-practice gap for DMHI implementation. For health care settings, differences between digital and traditional mental health services make alignment and integration challenging. Specialized attention is needed to improve the implementation of DMHIs in health care settings so that these services yield high uptake, engagement, and sustainment. The purpose of this article is to enhance efforts to integrate DMHIs in health care settings by proposing implementation strategies, selected and operationalized based on the discrete strategies established in the Expert Recommendations for Implementing Change project, that align to DMHI-specific barriers in these settings. Guidance is offered in how these strategies can be applied to DMHI implementation across four phases commonly distinguished in implementation science using the Exploration, Preparation, Implementation, Sustainment Framework. Next steps to advance research in this area and improve the research-to-practice gap for implementing DMHIs are recommended. Applying implementation strategies to DMHI implementation will enable psychologists to systematically evaluate this process, which can yield an enhanced understanding of the factors that facilitate implementation success and improve the translation of DMHIs from controlled trials to real-world settings. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

<p><b>Background: High rates of mental distress are reported among adolescents. Emerging evidence suggests that digital mental health interventions, such as computerised psychotherapy, informative websites, and non-clinical helplines, may help. However, it is unclear whether these resources are reaching those who experience distress in real-world settings. </b></p><p>Aim: The aim of this research is to explore adolescent uptake of digital mental health interventions offered via a comprehensive youth health survey, with a particular focus on adolescents experiencing probable mental distress. </p><p>Methods: Data were drawn from the Youth19 Rangatahi Smart Survey. At the end of the survey participants were provided the opportunity to opt-in to receive digital health resources. Participants’ opt-in and access to these digital health resources, as well as if they accessed the specific mental health resources, was remotely monitored. We compare opt-in and access among participants with and without probable mental distress. </p><p>Results: Of those who completed the Youth19 survey (n = 7721), a substantial minority of participants opted-in to receive the digital health resources (n = 1720). However, of those who opted-in, access was low (n = 187). Participants with probable mental distress were more likely than their non-distressed counterparts to opt-in and access the digital health resources, although these differences were small. Importantly, only seven participants went on to access digital </p><p>mental health interventions. </p><p>Discussion: The moderate number of participants to opt-in to receive Youth19 digital health resources suggests that digital resources may be a valuable component of supporting diverse groups of adolescents. The high attrition, however, indicates that adolescents may be experiencing barriers to accessing these interventions. Smart design to increase appeal, addressing barriers that limit access, and providing multiple options for different groups could </p><p>increase adolescents’ engagement with digital mental health interventions.</p>

Background“Digital public health” has emerged from an interest in integrating digital technologies into public health. However, significant challenges which limit the scale and extent of this digital integration in various public health domains have been described. We summarized the literature about these challenges and identified strategies to overcome them.MethodsWe adopted Arksey and O’Malley's framework (2005) integrating adaptations by Levac et al. (2010). OVID Medline, Embase, Google Scholar, and 14 government and intergovernmental agency websites were searched using terms related to “digital” and “public health.” We included conceptual and explicit descriptions of digital technologies in public health published in English between 2000 and June 2020. We excluded primary research articles about digital health interventions. Data were extracted using a codebook created using the European Public Health Association's conceptual framework for digital public health.Results and analysisOverall, 163 publications were included from 6953 retrieved articles with the majority (64%, n = 105) published between 2015 and June 2020. Nontechnical challenges to digital integration in public health concerned ethics, policy and governance, health equity, resource gaps, and quality of evidence. Technical challenges included fragmented and unsustainable systems, lack of clear standards, unreliability of available data, infrastructure gaps, and workforce capacity gaps. Identified strategies included securing political commitment, intersectoral collaboration, economic investments, standardized ethical, legal, and regulatory frameworks, adaptive research and evaluation, health workforce capacity building, and transparent communication and public engagement.ConclusionDeveloping and implementing digital public health interventions requires efforts that leverage identified strategies to overcome diverse challenges encountered in integrating digital technologies in public health.

Blended digital mental health interventions combining technology with human support are more effective than stand-alone treatments. However, limited research has examined how to train and supervise personnel delivering human support components. The Kuamsha app, a gamified digital intervention for adolescent depression based on behavioral activation, was designed to be paired with low-intensity telephone-based peer support. A structured training and supervision program for peer supporters was codeveloped through workshops with mental health professionals and youth with lived experience of mental health challenges in South Africa and Uganda. To the best of our knowledge, this is the first study to evaluate a structured peer mentor model within a digital mental health intervention in low- and middle-income countries. This study assessed the feasibility, acceptability, and fidelity of a training and supervision program for peer supporters delivering a digital mental health intervention in South Africa and Uganda. We conducted a mixed methods evaluation of the peer mentor program. Quantitative metrics assessed the feasibility of recruitment, retention, and attendance among peer mentors (n=13, South Africa; n=4, Uganda), as well as training acceptability. Fidelity, adherence, and competence were scored at the session level and converted to percentages of the maximum possible score. Linear mixed-effects regression models with a random intercept for provider and site estimated adjusted marginal means (95% CI). In-depth interviews and focus group discussions explored program acceptability and implementation factors. The peer mentor training and supervision program was feasible and acceptable in both settings, with high recruitment (South Africa: n=13/19, 68%; Uganda: 4/4, 100%), retention (South Africa: 9/13, 69%; Uganda: 4/4, 100%), and training attendance rates (89%-92% in South Africa and 100% in Uganda), alongside qualitative reports of high satisfaction. All peer mentors met a minimum posttraining competency threshold (≥50%), with median competency scores of 70.7% (IQR 45.8%-78.2%) in South Africa and 75.4% (IQR 73.8%-77.3%) in Uganda. Independent ratings of recorded calls indicated high overall fidelity in South Africa (84.7%, 95% CI 80.3%-89.0%) and Uganda (87.7%, 95% CI 83.4%-92.1%). Adherence was higher in Uganda than South Africa (adjusted mean difference [AMD] 13.30 percentage points, 95% CI 8.99-17.61; P<.001), as was competence (AMD 4.88 percentage points, 95% CI 1.23-8.53; P=.009). The AMD in overall fidelity (3.06 percentage points, 95% CI -0.98 to 7.10) was not statistically significant (P=.14). The qualitative findings emphasized the value of ongoing supervision and capacity development, interactive training approaches, and blended delivery models. Locally adapted training and supervision models can strengthen peer mentor capabilities to support digital interventions. Adequate supervisory capacity and incentive structures are critical to sustain engagement, retention, and fidelity. In settings with frequent network disruptions, periodic in-person contact between peer mentors and supervisors may enhance fidelity. Future research should examine how peer mentor fidelity influences user engagement and mental health outcomes.

BACKGROUND Mental ill health is a leading cause of disability worldwide, but access to evidence-based support remains limited. Digital mental health interventions offer a timely and low-cost solution. However, improvements in clinical outcomes are reliant on user engagement, which can be low for digital interventions. User characteristics, including demographics and personality traits, could be used to tailor platforms to promote longer-term engagement and improved outcomes. OBJECTIVE This study aimed to investigate how character strengths, a set of positive personality traits, influence engagement patterns with Moderated Online Social Therapy (MOST), a national digital mental health platform offering individualised, evidence-based online mental health treatment for young people aged 12-25. METHODS Data from 6967 young people who enrolled with MOST between August 2021 and July 2023 were analysed. Longitudinal analyses were used to investigate whether scores on three character strength dimensions (‘Social Harmony’, ‘Positive Determination’, and ‘Courage and Creativity’) were associated with (1) an accelerated or decelerated rate of dropout from the platform, and (2) patterns of engagement over the first 12 weeks following onboarding. Engagement metrics were time spent on the platform, number of sessions on the platform, use of the embedded social network, and messages with the clinical team. RESULTS On average, young people used the platform for 72.64 days (SD = 106.64). The three character strengths were associated with distinct engagement patterns during this time. Individuals scoring higher on ‘Social Harmony’ demonstrated an accelerated dropout rate (P = .008). Interestingly, higher scores on this character strength were associated with high rates of initial engagement but a more precipitous decline in platform use over the first 12 weeks, in terms of time spent on the platform (t = -5.05, P &lt; .001) and the number of sessions completed (t = -2.26, P = .02). In contrast, higher scores on ‘Positive Determination’ and ‘Courage and Creativity’ predicted more modest initial platform use but steadier engagement over time, in terms of time spent on the platform (Positive Determination: t = 4.05, P &lt; .001; Courage and Creativity: t = 2.66, P = .008). Contrary to our predictions, character strengths did not predict use of the embedded social network or the number of messages sent to the clinical team. CONCLUSIONS Our findings illustrate how character strengths predict distinct engagement trajectories on a digital mental health platform. Specifically, individuals higher on ‘Social Harmony’ showed high initial engagement that quickly declined, while those higher on ‘Positive Determination’ and ‘Courage and Creativity’ demonstrate lower initial engagement but a steadier use of the platform over time. The findings of this study demonstrate an opportunity for digital mental health interventions to be tailored to individual characteristics in a way that would promote greater initial and ongoing engagement.