Webchat counselling is increasingly utilised to deliver mental health services to young people. Despite potential barriers to its delivery, a systematic investigation has not yet been conducted. This qualitative study examined barriers and enablers to the delivery of webchat counselling through text communication and identified possible strategies to tackle these, on behalf of counsellors volunteering for an online charity offering psychological support to young people aged below 25. The current investigation was conducted using the Behaviour Change Wheel, a validated and systematic framework employed to guide intervention development and optimisation. Qualitative interviews were carried out with eight volunteers. Thematic analysis identified 11 core themes. Barriers were lack of online communication skills, lack of training to work online with young people, technical difficulties, reduced technical supervision during out‐of‐office hours, duration of webchat counselling sessions, perceived level of effectiveness, perceived establishment of a therapeutic relationship and perceived confidence in delivering webchat counselling. Enablers were familiarity with technology, flexibility and the absence of physical characteristics. These themes were perceived by counsellors as barriers or enablers depending on factors such as experience with technology and work shifts. Using the Behaviour Change Wheel (BCW), intervention functions and behaviour change techniques to address these barriers and optimise the service were identified, such as providing counsellors with training to work online with young people, learning new presence techniques to foster emotional connectedness between counsellors and clients, adding time to sessions to compensate for time taken to complete questionnaires and increasing technical support and supervision during out‐of‐office hours.

Background Over the last decades, the neurosciences, behavioral sciences, and the social sciences have all seen a rapid development of innovative research methods. The field of bioethics, however, has trailed behind in methodological innovation. Despite the so-called “empirical turn” in bioethics, research methodology for project development, data collection and analysis, and dissemination has remained largely restricted to surveys, interviews, and research papers. We have previously argued for a “Design Bioethics” approach to empirical bioethics methodology, which develops purpose-built methods for investigation of bioethical concerns. In this paper we compare a research tool created using a design bioethics approach to a “methods-as-usual” approach in empirical bioethics. Methods Our study compared dimensions of engagement with a digital game we created, called “Tracing Tomorrow,” to a standard vignette survey. The two tools investigated the same subject matter, digital phenotyping for mental health, in a sample of 301 UK adolescents. Results Participants who played the game reported a greater sense of presence, emotional engagement, cognitive absorption, and mental health ethics insight, compared to participants who completed the vignette survey. Perceived authenticity and curiosity/motivation to learn more was equivalent for both methods. Conclusion The results of this study highlights the importance of purpose-built methodology for empirical bioethics research.

Young people's engagement with online counselling remains an endemic obstacle faced by mental health services. This study utilises the Behaviour Change Wheel (BCW) framework to systematically explore the barriers and facilitators of young people's behavioural engagement with online webchat counselling. The current study defines behavioural engagement as any observable or active contribution by the young person in the webchat sessions, such as written verbalisation and self‐expression. Semi‐structured interviews with counsellors (n = 8) and open‐ended questionnaire data from 43 young people (aged 18–25 years) were gathered and then coded. Nine core themes were identified including communication difficulties, the safety of the webchat environment, absence of face‐to‐face communication, ambiguity in messages or pauses, reaching goals, optimism about outcomes, pre‐existing anxieties, mood or well‐being and wanting/not wanting to attend. Using the BCW framework, these themes were mapped to broad intervention functions and behaviour change techniques (BCTs) to provide suggestions to optimise young people's engagement with online counselling. These include the application of persuasive design features, the use of social strategies, increased counsellor training and greater personalisation of the online therapeutic approach. Future research can determine the effectiveness of these proposed strategies and BCTs to enrich the emerging engagement strategy field and the wider digital and mental health behaviour change literature.