BackgroundNew Zealand youth, especially those of Māori and Pacific descent, have high rates of depression, anxiety, and self-harm, but have low rates of help-seeking from mental health professionals. Apps, computerized therapy, and other digital tools can be effective, highly scalable treatments for anxiety and depression. Co-design processes are often used to foster engagement with end users, but this does not always lead to high levels of engagement.ObjectiveWe aimed to carry out preliminary scoping to understand adolescents’ current internet use and diversity of preferences to inform a planned co-design process for creating digital mental health tools for teenagers.MethodsInteractive workshops and focus groups were held with young people. Data were analyzed using a general inductive approach.ResultsParticipants (N=58) engaged in 2 whānau (extended family) focus groups (n=4 and n=5), 2 school- or community-based focus groups (n=9 each), and 2 workshops (n=11 and n=20). The authors identified 3 overarching themes: (1) Digital mental health tools are unlikely to be successful if they rely solely on youth help-seeking. (2) A single approach is unlikely to appeal to all. Participants had diverse, noncompatible preferences in terms of look or feel of an app or digital tool. The authors identified 4 user groups players or gamers, engagers, sceptics, and straight-talkers. These groups differed by age and degree of current mental health need and preferred gamified or fun approaches, were open to a range of approaches, were generally disinterested, or preferred direct-to-the-point, serious approaches, respectively. (3) Digital mental health tools should provide an immediate response to a range of different issues and challenges that a young person may face.ConclusionsDefining the preferences of different groups of users may be important for increasing engagement with digital therapies even within specific population and mental health–need groups. This study demonstrates the importance of scoping possible user needs to inform design processes.

The harm associated with use of synthetic cannabinoids has had a direct impact on the utilisation of specialist alcohol and drug services in Auckland, New Zealand. Many clients with synthetic cannabinoid withdrawal symptoms required intensive support including medication and admission to an inpatient detoxification unit. Clients withdrawing from synthetic cannabinoids were the third largest group of clients admitted to inpatient detoxification services in Auckland, New Zealand, between May 2013 and May 2014.

mHealth interventions promise the economic delivery of evidence-based mental health treatments like cognitive behavioural therapy (CBT) to populations that struggle to access health services, such as adolescents and in New Zealand, Māori and Pasifika youth. Unfortunately engagement with digital therapies is poor; modularisation and gamification have potential to increase their appeal. Gamifying CBT involves selecting suitable interventions, adapting them to a digital format while applying gamification principles. We describe the design and development of Quest - Te Whitianga, an app that encourages the user to learn CBT skills via a series of activities and games. A variety of approaches including consultation with clinicians, reference to best-practice literature, focus groups and interactive workshops with youth were used to inform the co-design process. Clinicians worked iteratively with experienced game designers to co-create a youth CBT digital intervention. The Quest modular app is set on an ocean and the user travels between islands to learn six evidence-based skills. These include a relaxation/mindfulness activity, activity planning, a gratitude journal plus problem solving and communication skills training. We describe the theoretical and design aspects of each module detailing the gamified features that aim to increase user engagement. In the near future we will be testing the app and the principles discussed in this paper via a randomised-controlled trial.

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The SACS is a simple AOD instrument that is reliable, valid and acceptable to young people. It has utility in screening and measuring outcome and should enhance the identification and treatment of AOD difficulties in adolescents across a range of health settings.