Understanding the Digital Divide: Exploring Digital Mental Health Service Use Decision-Making and the Role of Intersecting Identities Among Canadian Youth

Background and Purpose: One in four youth experience a mental health issue each year, but only 20% access services. Youth voices are integral to determining what youth need from digital mental health resources, with a common concern among youth being how to navigate online health information to make informed decisions for their well-being. However, oftentimes youth voices are not considered when developing tools/resources nor in the research process. Furthermore, research suggests that gender and race disparities in mental health services exists, and yet there is a dearth of research exploring service use experiences of diverse youth, including those that identify as LGBTQ2IA+, racialized, and Indigenous. This qualitative study seeks to understand how youth aged 12-24 make decisions about accessing digital mental health technology (DMHT), and how their identities (e.g. gender, ability, race) intersect with these decisions about service use.

Methods: Using purposeful sampling and multiple methods of recruitment, youth aged 12-24 were invited to participate in 1-2 hour long virtual qualitative interviews conducted by four youth research assistants in the Summer and Fall of 2020. Questions were developed based on the ten constructs (e.g. beliefs, social norms, emotions, self-efficacy, social image, knowledge, environment, habits, cues, split-second decision-making) from the Unified Theory of Behavior (UTB) (Jaccard et al, 2002), a decision-making framework. Youth were also asked questions related to how their identities, and the pandemic influenced their services use experiences. For example, interviewers asked the question, “Are there aspects of your own personal identity (examples: gender, race, ethnicity, ability, student and housing status, or SES) that you feel makes a difference in your experiences of accessing digital mental health technology?” Graduate students and youth research assistants engaged in content analysis, using constant comparison and developing a taxonomy of the most salient responses for each question.

Results: Forty-five youth aged 12-24 were interviewed, with a mean age 19 (SD=3.3). Our sample gender distribution included: 31% Female, 33% Male, and 38% Two-spirit and Non-Binary. Of those youth 38% were Transgender. Our sample race distribution included: 42% White, 18% Chinese, 13% Mixed ethnicity, 11% Indigenous, 2% Filipino, and 2% South Asian. Youth discussed their beliefs about services (advantages and disadvantages of DMHT), who in their social networks approved or disapproved them seeking DMHT, their emotions related to accessing DMHT, and skills and strategies required to access DMHT. They also discussed how their access to digital services increased during Covid-19. Finally, they discussed how their identities (e.g. gender, race, ability) impacted (impeded and/facilitated) accessing DMHT. For example, one youth stated, “I'm a white cisgender male who comes from a privileged family. All those things play a huge role and a reality in the level of access I am able to have and the stigma I might now have compared to other people from different identity categorizations.”

Conclusion and Implications: Findings from this study can be applied in the creation of DMHT tools to help support youth in the decision-making process. Considering the role of identity is critical when designing DMHT tailored to diverse youth.