Designing for Safety and Trust to Optimize Engagement in Digital Mental Health Resources for Sexual and Gender Minority Consumers

Background and Purpose: Sexual and gender minority (SGM) populations are disproportionately impacted by mental health concerns, while also reporting unmet service needs due to barriers to care. Digital mental health (DMH) resources offer promising solutions by broadening access to acceptable mental health care. However, limited tailored content and suboptimal engagement reduce their effectiveness for SGM users. In partnership with Mental Health America (MHA), a non-profit offering free, evidence-based screenings and online DMH tools, the QT-Digital Mental Health Engagement (QT-DIME) Study used human-centered design approaches to co-create tailored strategies to optimize DMH engagement among SGM users. The current study explores safety and trust as prerequisites to DMH engagement and identifies design features that communicate these values to SGM consumers.

Methods: We conducted six asynchronous online focus groups with 54 participants. Each focus group required participation over 16-18 days with new sets of research questions posted every 2-3 days. Questions explored SGM-specific needs, barriers, and preferences for DMH, including motivations and desired features. Participants were recruited from MHA’s website and social media advertisements, and groups were stratified by age (youth; adults) and recruitment source. Participants ranged in age from 14 to 75 (M=28.5; SD=12.3); 35% identified as bisexual, 60% as cisgender women, and nearly 20% were trans or nonbinary. Transcripts were qualitatively coded; parent nodes were identified based on existing theory (Health Action Process Approach) and a stable set of codes were developed based on individual and collective transcript processing. An audit trail was used to enhance the quality and credibility of the analysis. Synthesis of focus group data identified modifiable mechanisms of engagement and tailored content that were translated into prototype strategies for engaging DMH consumers.

Results: Safety and trust emerged as salient barriers to DMH engagement. Concerns included privacy and data security, especially related to family and workplace discovering their SGM identity or DMH activity. Participants preferred anonymous platforms and avoided resources requiring names. Trust was further undermined by generic content and unclear data practices. Participants recommended that tools be transparent about privacy policies, include user feedback options, and highlight lived experience in content development. Specific suggestions included use of testimonies demonstrating DMH effectiveness for SGM users, representative imagery, and access to tools that reflect SGM populations’ community-oriented values. Early-stage users indicated a need for welcoming, clear, and supportive onboarding. More experienced users described needing deeper and varied content, and opportunities to engage with community-based, collaborative tools.

Conclusions and Implications: Designing for safety and trust is critical to improving DMH engagement among SGM users. Resources should prioritize anonymity and privacy, transparently communicate data use, and clearly signal that they are created for (and ideally, by) SGM people. Tailoring content to reflect SGM identities, values, and lived experiences may foster trust, safety, and ultimately motivation. Intuitive, affirming, and customizable tools were directly suggested by participants and informed the design of prototype engagement strategies that can be implemented through MHA’s messaging or content.