Barriers and enablers to young people’s posting, responding and reading behaviours on mental health forums using the Behaviour Change Wheel

Background: Web-based mental health forums have the potential to play a significant role in providing accessible support to young people, supplementing in-person services and positively contributing to their mental wellbeing. However, lack of engagement often limits their impact and effectiveness in supporting young people. Objective: Using the Behaviour Change Wheel framework, this qualitative study explores the barriers and facilitators to young people’s engagement with web-based mental health forums; focusing on the behaviours of creating a new post, responding to posts, and reading posts; behaviour change techniques (BCTs) are identified to tackle the barriers. Methods: Semi-structured interviews with 13 young people, ranging from 17 to 25 years, who use UK-based youth mental health forums were conducted. Three self-identified as men, eight as women, one as non-binary, and one did not wish to disclose their gender. Transcripts were coded using the Theoretical Domains Framework (TDF), then inductive themes were generated. TDF Barriers were mapped to BCTs to suggest intervention strategies. Results: Thematic analysis revealed 10 inductive themes within 5 TDF domains. Of these, three were enablers, two barriers and five that were both an enabler and barrier. The findings indicated that skills, beliefs about consequences, emotions, and the social and physical environment are important influences on young people’s engagement with web-based mental health forums. Positive emotions felt after using mental health forums was an enabler to posting, responding and reading behaviours, while enablers to more active participation (i.e. posting and responding) included anonymity and positive interactions with other users. The presence of moderators was also an enabler to all three behaviours through enabling a safe environment but acted as a barrier to posting due to potentially limiting the content of users’ posts. While the ability to access forum content on mobile phones facilitated posting, responding and reading, when the layout is not optimised, it acted as a barrier to typing and reading on the go. Conclusions: The present study adds to the existing knowledge base by examining the different ways that young people engage with youth mental health forums. Different strategies may be prioritised and adopted depending on whether forum providers are looking to increase more active forms of engagement (e.g., posting and responding can be encouraged by increasing positive interactions with other users) or overall engagement (e.g., having clear rules of engagement and optimising webpage content to access on mobile can benefit all forms of engagement). These insights can help to improve the delivery of youth mental health forums and create a positive ecosystem of support for young people.