Diversity, equity and inclusion considerations in the design of digital mental health interventions for psychosis: A scoping review

Digital mental health interventions (DMHIs) are increasingly used to support people with psychosis. However, little is known about how diversity, equity, and inclusion (DEI) are considered in their design. In this review, DEI was operationalised as design considerations relating to access, content, appearance, and stakeholder involvement, employed to support development of equitable and inclusive DMHI, and evaluated using an adapted Culturally Informed Design Framework. While stakeholder engagement is frequently reported, the extent to which design processes systematically address DEI domains remains unclear. This scoping review examines what design approaches have been used, the nature of stakeholder involvement, and the DEI domains considered in DMHI development for psychosis. A systematic search across six databases identified 167 eligible studies, describing 55 DMHIs. Data were extracted and synthesised. Thirteen interventions (23.6%) explicitly named a design approach, with user-, person-, or human-centred design most frequently reported. Thirty-one interventions (56.4%) reported some level of stakeholder engagement in design, most commonly involving people with lived experience of psychosis and clinicians. Forty-three interventions (78.2%) were reported as addressing at least one DEI-related feature. At the subdomain level, literacy (n = 15), system requirements (n = 16), psychosis-specific adaptations (n = 14), and diverse visual representation (n = 13) were among the most frequently reported considerations, whereas cultural adaptation (n = 3), availability in languages beyond English (n = 3), and environmental tailoring (n = 5) were rarely reported. Interventions characterised by sustained stakeholder engagement across multiple stages of development tended to demonstrate broader DEI coverage, although inclusion was rarely articulated as an explicit design goal. These findings highlight that while participatory design approaches are commonly employed, published reports indicated limited and uneven integration of DEI considerations in DMHI design. To support equity and inclusion, DMHI development should adopt a theoretically-informed design approach with stakeholder involvement throughout and comprehensive targeting of DEI domains.