Perceptions of mHealth Interventions for the Prevention of Mental Disorders in Adolescents: A Qualitative Study

Background and Purpose: The COVID-19 pandemic drew renewed attention to the extent and severity of the mental health crisis affecting adolescents while also opening up an entry point for innovative methods in service delivery. With the mental health system fragmented and under unprecedented strain, the application of personalized mobile health (mHealth) methodologies, such as smartwatches and mental health apps, is emerging to fill the service gap. However, there is limited evidence on adolescent attitudes and perceptions (e.g., perceived problems, benefits, opportunities) of digital mental health approaches. The purpose of this paper was to explore youth perspectives on psychosocial support through the Ilumivu mobile app and smartwatch. As part of responsible digital research and innovation where user needs are supported, the needs and concerns of adolescents in this study are critical to inform the future development of youth-oriented mental health apps.

Methods: The sample consisted of adolescent-aged participants (13-18 years) in New York City as part of a 28-day real-time monitoring study examining daily patterns of adolescent anxiety, depression, and stress by a wearable smartwatch and daily diary surveys on the Ilumivu app. Semi-structured interviews (n=39) were conducted remotely via phone or video calls under COVID-19 restrictions. Participants were asked for their perspectives on perceived problems, benefits, and opportunities of smartwatch and mobile app use to inform future interventions. Transcripts of the interviews were coded using thematic analysis conducted via NVivo. This method was selected for the study as it generated in-depth insights into the perceptions of adolescents.

Results: Analyses revealed most adolescents favored the smartwatch and found the Ilumivu app less helpful. Adolescents reported specific personalized features, such as the daily survey, step count, heart rate monitor, stress level tracker, and statistics reports, as desired functionalities. Some reported the smartwatch led to behavior changes such as exercise and coping skills through mindful breathing. However, adolescents also reported frequent notifications were distracting, they disliked the increased screen time and some experienced technical challenges with the app that decreased usability. Participants offered recommendations, including adding other personalized features, such as a mood tracker, therapeutic “mindfulness” techniques, features to improve focus, an emergency button connecting to individualized therapy or crisis intervention, and reliable mental health education.

Conclusions and Implications: Overall, findings highlight adolescents felt mHealth technology was acceptable and useful, but there were some features and technical challenges that decreased usability. Adolescents also had recommendations for additional features to increase appeal and usefulness. These recommendations can guide the design and development of new digital interventions. As new mHealth technologies are being developed at a rapid pace, it is important to ensure that adolescent feedback is considered at all stages of the mHealth development process – planning, design, delivery, and evaluation – ensuring that the technologies developed are accessible to, acceptable by, and appropriate for adolescents and youth.