A Scoping Review Exploring the Barriers and Facilitators That Youth Experience Accessing Digital Mental Health Technology: Developing a Roadmap to Design Accessible Digital Mental Health Technology for Youth

Background and Purpose: Research shows that 75% of mental health disorders develop by age 25, and the rates of mental health challenges are increasing in youth due to the pandemic. In Canada, nearly all youth aged 12-24 years use the internet to access health information. With the widespread availability of technology, and knowing that youth are savvy with technology, the focus becomes how to connect youth to digital mental health technology (DMHT). This study was part of a larger scoping review summarizing the current available literature on the digital divide for youth accessing DMHT. The digital divide refers to the separation between those who have access to digital information and communication technologies and those who do not. The purpose of this scoping review was to understand what are barriers and facilitators youth experience when accessing DMHT. We were also interested in exploring how many studies engaged youth in the research process, and how many focused on diverse populations.

Methods: The review was conducted in accordance with the Arksey and O’Malley framework. The research team led by Drs. Ben-David and Barbic, youth research ambassadors, graduate level students, and the help of a UBC librarian performed a thorough search of Medline, EMBASE, CINAHL, PsycINFO, and Cochrane databases. Researchers screened 11,811 studies, and 335 met criteria. Articles were included if published in the last ten years, and sampled youth that were accessing DMHT. Researchers then set out to review all of the qualitative and mixed methods articles (78 articles) in order to understand what are the facilitators and barriers youth experience when accessing DMHT. After reviewing these articles, 33 were removed. The final sample included 45 articles. Study findings were pulled and categorized into facilitators and barriers to accessing DMHT.

Results: Seven facilitator categories emerged: design (e.g. interactive, easy to navigate, and allows for personalization), safety and trustworthiness, content (e.g. concise, variety), improves wellbeing, accessibility, connecting to others (e.g. peers), and links to resources and professionals. Five barrier categories emerged: external barriers (e.g. access), internal barriers (e.g. mental state), design issues, problems with content being unengaging or triggering, and privacy concerns. Twenty percent of the articles engaged youth in the research process, ranging from consultation roles to youth being part of the research team. Twenty-two percent of the articles focused specifically on diverse populations including: Indigenous youth, LGBTQIA2S+ youth, racialized youth, and youth experiencing homelessness. Specific findings emerged for these groups including having content tailored to the needs of these populations, inclusive language and non-binary options, culturally competent resources available in different languages, DMHT tools that strengthen intergenerational relationships and build a positive sense of self and community, privacy, peer support, and accessibility.

Conclusion and Implications: The barriers and facilitators that emerged provide a roadmap for designing DMHT to increase youth accessibility. Future research should recruit diverse youth in their studies in order to understand their specific DMHT experiences and needs. Research should also prioritize engaging youth in the research process, to help shape the direction of the research and development of DMHT.