Understanding Meaningful Engagement in mHealth Access in Integrated Youth Service

Background: Digital solution is one of the major pillars of integrated care. However, as a form of digital health, current mobile health (mHealth) tools and interventions for youth mental health are highly unregulated and lack engagement in the design, development, and implementation stages. Evidence suggests that most mHealth tools and interventions are expensive to develop and have a short shelf life. To date, limited research exists to understand how youth, mHealth developers, and health providers design tools and interventions for application within an integrated health service. The objective of this study was to describe the value of meaningful engagement of diverse stakeholders in the development, implementation, and scaling of mHealth tools and interventions for youth mental health services through a case study at an integrated youth services (IYS) initiative. Methods: To understand stakeholder perception on how can youth be meaningfully engaged within the different stages of mHealth service delivery in an integrated system, our team recruited three types of participants, mHealth developers, service providers, and youth users. Participants were recruited at Foundry, is an integrated youth services (IYS) initiative based in British Columbia which creates a single point of access to care for youth ages 12-24. In 2020, Foundry launched its provincial virtual service, along with the Foundry BC app, to support youth with health care access during the COVID-19 pandemic. App development is ongoing and requires input from multiple stakeholders. We conducted semi-structured interviews via Zoom. All interviews were recorded and we used thematic analysis to understand the common and unique themes amongst the three groups. Results: Currently, data continue to be collected to achieve saturation within the three groups and gain the perspectives of more diverse participants. Preliminary results suggest that integrating mHealth services into an IYS system is value-added to in-person services, and a key component of success is systematic collaboration with diverse stakeholders. Three main themes have emerged: 1) utilizing co-design efforts to ensure first-time impressions of the service are intriguing to youth and continuously fresh; 2) clearly defining roles throughout the ongoing processes of development, refinement, and scaling; and 3) building ongoing processes to ensure meaningful and ongoing participation of new youth and families. Across all three groups, participants suggested the term “engagement” be constantly examined to ensure the values are applied and participants are not tokenized. Conclusion: Preliminary results suggest the value of engagement in mHealth development, but also the extensive effort needed to ensure it is done well in a rapidly functioning team working to meet the needs of youth. The results of the study are fundamental to establishing a guideline for collaborative engagement when developing integrated mHealth products and interventions that are sustainable and fit for purpose for the evolving needs of youth. What we are learning from this study can serve as an example for international partners to consider mHealth integration to current systems of and methods to engage youth at different stages of co-designing, testing, and scaling new mHealth interventions that are designed to last and have an impact.