Coproduction of accessible digital mental health supports in partnership with young people from marginalised backgrounds: a scoping review protocol

There is increasing evidence that some digital mental health supports may improve the accessibility of mental health services and support for young people, including marginalised young people with mental health needs who would otherwise find it difficult to seek help.1 Guidelines with regard to digital mental health interventions highlight the importance of early user input in the development, implementation and evaluation of technologies to ensure that they are engaging, feasible, acceptable and potentially effective.2 However, there is a lack of guidance concerning the most appropriate coproduction processes for engaging young people in the different stages of assessing digital mental health technologies, especially with regard to those who are disadvantaged, vulnerable and/or marginalised.3–5

Focusing on the innovative digital mental health approaches led by young people, this review will consider coproduction in the design, development, implementation and evaluation phases of digital mental health supports for marginalised young people, as well as overall evaluations of coproduction processes in this context. The review is part of a larger project called ‘Atlantic Futures’.6 One of the work packages (Research Stream 4) within this project explores the accessible digital supports and blended services to promote the mental health of youth on a shared island basis in Ireland and Northern Ireland. This is to be achieved through engaging with young people (aged 16–25), including those who are marginalised, and the staff who support them in health, youth and community services.

Marginalisation

This scoping review focuses on young people categorised as ‘marginalised’ in the digital mental health support context. A briefing paper produced by UNICEF’s Office of Research defines ‘disadvantaged, vulnerable and/or marginalised adolescents as individuals aged 10–19, who are excluded from social, economic and/or educational opportunities enjoyed by other adolescents in their community due to numerous factors beyond their control’.7 These factors include those operating at the social level (such as economic inequality, violence, stigma, racism and migration), family level (including neglect and abuse) and individual level (eg, disability and ethnicity). Examples of disadvantaged, vulnerable and/or marginalised young people include immigrants, refugees, orphans and those who belong to stigmatised indigenous, ethnic or religious groups. They also include individuals who belong to sexual minorities (eg, gay, lesbian, bisexual and queer) or gender minorities (eg, transgender and gender diverse).

Previous reviews on coproduction in digital mental health interventions have highlighted either an under-representation of young people with learning disabilities and specific difficulties3 or a marked absence of young people including, but not limited to those who are migrants, asylum seekers and refugees, those experiencing homelessness but also those from socioeconomically deprived backgrounds.8

In the context of digital mental health technologies, the concept of digital marginalisation is also highly relevant, and this typically refers to people who do not have or use the internet, who lack access to fast and reliable internet connection (eg, people living in rural areas) and who lack the skills or access to developing skills for using the internet.8 Many marginalised groups face barriers in accessing the online services, which can further perpetuate the ‘digital divide’, a technology-based form of social inequality that can increase marginalisation in other areas of their lives.9

Considering the above, the project seeks to take into account the specific needs of young people who are disadvantaged, vulnerable and/or marginalised from a socioeconomic, cultural and digital perspective.

Thus, in order to investigate coproduction and marginalisation, the scoping review will include, but not be limited to, the following groups of young people who have been identified as marginalised in the Irish context

  • Living in isolated rural areas10

  • Socioeconomically deprived

  • Unemployed

  • Not in education, employment or training

  • Immigrants

  • Asylum seekers

  • Refugees

  • Travelling community

  • Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) community

  • Living with a disability

  • Homeless

This scoping review intends to explore the most appropriate coproduction processes for engaging young people in the different stages of designing, developing, implementing and evaluating digital mental health technologies, especially with regard to those who are marginalised. Due to the exploratory nature of this research question, a scoping review approach has been selected to explore the breadth and depth of the extant literature on coproduction processes with marginalised young people in the context of digital mental health supports, ranging from mental health promotion and primary prevention to targeted interventions. This includes all types of digital interventions, such as websites and apps but not studies that report on digital delivery of services that are typically administered face-to-face such as remote counselling. The review aims to map and summarise the evidence, inform the overall research project, as well as identify and address the knowledge gaps.11

This post was originally published on https://bmjopen.bmj.com