Defining Quality across Digital Mental Health Interventions in Canada: A Participatory Mixed Methods Study

The global burden of disease attributed to mental health and substance use disorders has grown at an alarming rate over the past 10-years, especially amongst youth. Like countries everywhere, Canada is experiencing a crisis in youth mental health service coverage in which service availability is unable to keep up with growing levels of youth mental health need and demand.

This crisis is driven in part by a shortage of youth mental health professionals, long wait times, poor youth mental health service accessibility, acceptability, and overall quality. Over the past few years, Digital Mental Health Interventions (DMHIs), defined as psychosocial interventions delivered via digital technology, have emerged as potential cost-effective and scalable solutions to challenges in youth mental healthcare availability, accessibility, and use.

While promising, important ethical and equity concerns have been raised regarding the evidence-base upon which DMHIs targeting youth are designed and the quality care that they deliver. Some of these concerns include data privacy and confidentiality, cross-cultural appropriateness, and clinical validation and have been linked to high patient mistrust, and treatment dropout rates.

Efforts have been made to develop quality frameworks that can be used to evaluate and guide the selection of youth DMHIs in Canada. However, few have incorporated youth perspectives or engaged youth in their design. The mental health needs of youth are especially complex and dynamic.

Engaging youth in clarifying these needs is necessary to develop a comprehensive and representative quality framework for youth DMHIs and evaluate their contribution to overall youth mental health service coverage in Canada. This study aims to engage a diverse group of Canadian youth in articulating their mental healthcare needs, care expectations, and related perceptions of DMHI quality across different cultural, socioeconomic, and other contexts.

To address this aim, this study employs a mixedmethods participatory research approach that involves the active engagement of youth throughout the research process from design to data analysis and interpretation. Evidence generated from a scoping review of the grey and published literature and semi-structured interviews of Canadian youth will be thematically analyzed and quantitatively compared to identify the priority dimensions of quality care delivered by DMHIs for youth.

The resulting priority dimensions will contribute to the development of a quality framework for DMHIs that can be used at a national level and inform efforts to improve their responsiveness and integration into diverse community mental health systems.

Diverse Canadian youth will be engaged in every step of the proposed DPhil project through a participatory action research approach and methodology. Virtual platforms can be leveraged to facilitate this process. However, I believe they are most effective when trusting relationships have been established between researcher and participant.

I hope to travel to Canada during the summer term of the first year of my DPhil to recruit youth to the study, build relationships, and gather input on the research design. I hope to remain in Canada during the fall term of the second year of my DPhil to conduct the first round of semi-structured interviews with youth. The relationships formed and data collected during my overseas fieldwork will be critical to fostering continued virtual engagement during the analysis stage of my DPhil and the development of a quality framework for youth-focused DMHIs in Canada.