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Early intervention is important in order to improve mental health outcomes for young people. Given the recent rise in mobile phone ownership among adolescents, an innovative means of delivering such intervention is through the use of mobile phone applications (apps).
The aim of this study was to evaluate the feasibility of “CopeSmart”, a telemental health app developed to foster positive mental health in adolescents through emotional self-monitoring and the promotion of positive coping strategies.
Forty-three adolescents (88% female) aged 15-17 years downloaded the app and used it over a one-week period. They then completed self-report questionnaires containing both open-ended and closed-ended questions about their experiences of using the app. The app itself captured data related to user engagement.
On average participants engaged with the app on 4 of the 7 days within the intervention period. Feedback from users was reasonably positive, with 70% of participants reporting that they would use the app again and 70% reporting that they would recommend it to a friend. Thematic analysis of qualitative data identified themes pertaining to users’ experiences of the app, which were both positive (eg, easy to use, attractive layout, emotional self-monitoring, helpful information, notifications, unique) and negative (eg, content issues, did not make user feel better, mood rating issues, password entry, interface issues, engagement issues, technical fixes).
Overall findings suggest that telemental health apps have potential as a feasible medium for promoting positive mental health, with the majority of young people identifying such technologies as at least somewhat useful and displaying a moderate level of engagement with them. Future research should aim to evaluate the efficacy of such technologies as tools for improving mental health outcomes in young people.
Adolescence has consistently been identified as a critical period for the development of mental health difficulties [
Recent years have seen dramatic increases in smartphone ownership, with approximately 69-84% of adolescents in the developed world now owning smartphones [
Over the coming years, it is predicted that the use of mobile technologies in mental health contexts will continue to rapidly increase [
As rigorously designed evaluations often require the investment of significant resources, not all interventions can be tested for efficacy and effectiveness. Feasibility studies play an important role in identifying potentially efficacious interventions and ensuring they are prioritized for comprehensive evaluation [
Whittaker et al [
The objective of the present study was to evaluate the feasibility of a telemental health app, which aimed to foster positive mental health, for use by adolescents on their personal mobile phones. This study expands on previous research [
The app in the present study was designed and programed for use on android and iOS mobile devices, following focus group consultation with adolescents in relation to their needs from mental health mobile technologies [
The app was branded “CopeSmart” and contains five main sections (see
CopeSmart app screenshots.
Participants were 43 adolescents (88% female) aged 15-17 years with a mean of 16.0 years (SD 0.724), in possession of Android or iOS mobile phone devices.
Approval for this study was granted by the Human Research Ethics Committee in University College Dublin. Initially, emails were sent to six schools in the East of the Republic of Ireland detailing the nature of the study. Four of these schools agreed to participate (three urban, one rural). None of the schools were considered socially or economically disadvantaged under nationally established governmental criteria [
Initially, over 250 young people were approached and of these 215 returned parental consent and were eligible to participate. Of these eligible participants, 114 did not download the app, primarily due to unforeseen technical delays which meant the app was unavailable on iOS or a number of Android devices for a period of time. Consequently, many eligible participants from the first two schools and the one-day university program were unable to download the app. Of the 101 participants who downloaded the app, 43% completed follow-up questionnaires and these individuals made up the final sample used in the present study. The low follow-up rate was mainly due to restrictions on when the researchers could access schools, which meant that a significant number of students were absent on the day of questionnaire completion due to either exam prep or involvement in extracurricular activities.
The 43 participants who comprised the final sample downloaded and installed the app on their personal mobile phones during school hours. Participants were asked to engage with the app and rate their mood on a regular basis over a brief one-week period (as is common in feasibility studies which generally have shorter follow-up periods than larger scale trials [
Descriptive statistics were used to present quantitative data. Thematic analysis [
Participants’ usefulness ratings.
|
Very useful | Somewhat useful | Not useful |
|
n (%) | n (%) | n (%) |
Overall | 3 (7%) | 31 (72%) | 9 (21%) |
Mood ratinga | 15 (35%) | 18 (42%) | 7 (16%) |
Coping tipsb | 8 (19%) | 23 (54%) | 10 (23%) |
Resourcesc | 5 (12%) | 20 (40%) | 17 (40%) |
amissing data for mood rating n=3; bmissing data for coping tips n=2; cmissing data for resources n=1
Qualitative feedback from participants.
Aspects of the app participants liked/reasons they or other young people would use it in future or recommend it to a friend. | ||
Theme | Example | na |
Easy to use |
“ |
9 |
Attractive layout |
“ |
6 |
Mood rating was generally helpful | “ |
17 |
Mood rating helped increase emotional self-awareness |
“ |
16 |
Mood rating was useful as alternate emotional outlet | “ |
2 |
Information on app was helpful |
“ |
15 |
Notifications were useful |
“ |
5 |
Uniqueness of app | “ |
3 |
Needs more information |
“ |
8 |
Needs less information |
“ |
2 |
Needs to be more personalized |
“ |
4 |
Information provided was not useful |
“ |
6 |
Did not make user feel better | “ |
7 |
Needs more moods to rate | “ |
6 |
Mood charts were confusing |
“ |
5 |
Should have option to input text |
“ |
4 |
Password entry is annoying |
“ |
6 |
Interface issues |
“ |
9 |
More activities |
” |
6 |
Uninterested in app/do not need it |
“ |
7 |
Technical fixes | “ |
4 |
an=number of participants who identified this theme
Usage data were obtained from 30 participants, as it was not possible to obtain usage data from all participants due to differing security settings across mobile devices. On average, participants engaged with the app on 4 of the days within the 7-day usage period (SD 1.75). As illustrated in
Average number of days within the usage period on which participants engaged with different sections of the app (within 1 standard deviation).
Average number of days within the usage period on which participants engaged with the app during specific time periods (within 1 standard deviation).
Overall, participants’ responses to the app were reasonably positive, with 79% of participants reporting they found it at least somewhat useful and 93% reporting that they found it easy to use. Nearly three-quarters of participants reported that they would use the app in the future and would recommend it to a friend. User engagement levels were moderate, with participants on average engaging with the app on 4 of the 7 days within the intervention period. These findings suggest this type of app has potential as a feasible means of promoting positive youth mental health.
Participants identified “Rate My Mood” as the most useful section, and most frequently engaged with this component. As in Reid et al’s study [
Participants’ engagement levels with the “Coping Tips” and “Resources” components of the app were low, and 23% and 40% of participants respectively reported that they did not find these sections helpful. Their main reasons were that they felt they did not need this information or that it did not help them to feel better. This corresponds to the primary reasons given by participants in Whittaker et al’s text message-based intervention as to why they did not find the intervention content useful [
Six participants reported that having to enter a password every time they accessed the app acted as a barrier to engagement. As privacy has been identified as essential for adolescents in these types of interventions [
The high levels of participant variability in terms of engagement with different sections of the app and the times at which the app was used, indicates that young people engaged with the app in different ways and to different extents. Similarly, there was variability and some level of contradiction in terms of qualitative feedback obtained; for example, some participants reported that they wanted more coping information and some reported that they wanted less. A challenge faced by future researchers will be how to reconcile such contradictory feedback and a key focus going forward should be to identify characteristics associated with different levels of app engagement and specific users’ needs (ie, how do needs differ for different types of users, what types of users are most likely to engage with such technologies, and under what circumstances). This will help to identify patterns of engagement with, and individual user needs from such technologies, so that telemental health interventions can be tailored and personalized to target specific types of users. Indeed, this is in line with the comments of four participants in the present study who specifically reported a desire for more personalized content in the app.
A limitation of this study was the gender imbalance of the sample, which meant statistical analysis could not be conducted to explore gender differences in participants’ responses. As research suggests males are less likely to show interest in technology-based mental health interventions [
Overall findings suggest that telemental health apps have potential as a feasible medium for promoting positive youth mental health, with the majority of young people identifying such technologies as at least somewhat useful and displaying a moderate level of engagement with them. Future research should aim to evaluate the effectiveness of such technologies as tools for improving mental health outcomes, using rigorously controlled research designs. This piece of research was conducted as part of a larger study, the next phase of which will be to evaluate the efficacy of the app as a tool for fostering positive mental health in adolescents via emotional self-monitoring and the promotion of positive coping strategies. This will be done using a large sample of young people and with a randomized controlled design methodology.
Self-Report Questionnaire.
This study was conducted as part of a PhD thesis funded by the Irish Research Council.
None declared.