Adolescents’ Perspectives on Uptake, Engagement, and Implementation to Inform the Development of a Preventive Transdiagnostic Digital Mental Health Intervention: Qualitative Interview Study
Journal of Medical Internet Research ·
Background: Adolescence is a critical period for mental health prevention; yet, many young people face barriers to help-seeking, including stigma, limited mental health literacy, and restricted access to services. Preventive digital mental health interventions (DMHIs) offer a scalable, low-threshold approach to early support, but uptake and sustained engagement remain limited. Existing research has predominantly relied on quantitative methods and has only partly captured adolescents’ perspectives. Qualitative research is therefore needed to inform the design and implementation of preventive DMHIs. Objective: This study aimed to explore adolescents’ perspectives on factors influencing the anticipated uptake, expected engagement, and implementation of preventive transdiagnostic DMHIs across person, intervention, and system levels. Methods: This qualitative study was conducted in Switzerland using a single-interview design in the predesign phase of the development of a transdiagnostic preventive DMHI. Adolescents aged 12‐21 years were recruited through voluntary response sampling via social media and the project website. Semistructured interviews explored experiences with online help-seeking, factors influencing DMHI anticipated uptake and expected engagement, and recommendations for implementation. Interviews were conducted in person or via video call between January and June 2022, audio-recorded, transcribed verbatim, and analyzed using a hybrid deductive-inductive qualitative content analysis. Intercoder agreement was assessed using Cohen κ (κ=0.72). Results: A total of 48 adolescents (mean age 16.52, SD 2.67 years; 32/48, 72.9% female) participated. In total, 8 main topics and multiple subtopics were identified across person, intervention, system, and cross levels. Person-level factors highlighted the importance of mental health literacy, preuptake communication, and relevance of social networks. Intervention-level factors emphasized usability, personalization, and privacy, while system-level findings reflected expectations for adaptive, integrated, and low-threshold mental health services. Trust and support emerged as cross-level factors for engagement. In addition, participants described several discrepancies between desired intervention characteristics and practical implementation, particularly regarding personalization, anonymity, peer exchange, and human support. Conclusions: Adolescents’ perspectives highlight that successful implementation of preventive DMHIs requires attention beyond intervention design to preuptake communication strategies, mental health literacy promotion, and integration within adaptive care systems. The tension between adolescents’ desire for immediate human-delivered support and the self-guided nature of preventive DMHIs underscores the need for clear clinical boundaries and explicit escalation pathways.