The Acceptability, Engagement, and Feasibility of Mental Health Apps for Marginalized and Underserved Young People: Systematic Review and Qualitative Study.

BACKGROUND: Smartphone apps may provide an opportunity to deliver mental health resources and interventions in a scalable and cost-effective manner. However, young people from marginalized and underserved groups face numerous and unique challenges to accessing, engaging with, and benefiting from these apps. OBJECTIVE: This study aims to better understand the acceptability (ie, perceived usefulness and satisfaction with an app) and feasibility (ie, the extent to which an app was successfully used) of mental health apps for underserved young people. A secondary aim was to establish whether adaptations can be made to increase the accessibility and inclusivity of apps for these groups. METHODS: We conducted 2 sequential studies, consisting of a systematic literature review of mental health apps for underserved populations followed by a qualitative study with underserved young male participants (n=20; age: mean 19). Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, an electronic search of 5 databases was conducted in 2021. The search yielded 18,687 results, of which 14 articles met the eligibility criteria. RESULTS: The included studies comprised a range of groups, including those affected by homelessness, having physical health conditions, living in low- and middle-income countries, and those with sexual and gender minority identities. Establishing and maintaining user engagement was a pervasive challenge across mental health apps and populations, and dropout was a reported problem among nearly all the included studies. Positive subjective reports of usability, satisfaction, and acceptability were insufficient to determine users' objective engagement. CONCLUSIONS: Despite the significant amount of funding directed to the development of mental health apps, juxtaposed with only limited empirical evidence to support their effectiveness, few apps have been deliberately developed or adapted to meet the heterogeneous needs of marginalized and underserved young people. Before mental health apps are scaled up, a greater understanding is needed of the types of services that more at-risk young people and those in limited-resource settings prefer (eg, standard vs digital) followed by more rigorous and consistent demonstrations of acceptability, effectiveness, and cost-effectiveness. Adopting an iterative participatory approach by involving young people in the development and evaluation process is an essential step in enhancing the adoption of any intervention, including apps, in "real-world" settings and will support future implementation and sustainability efforts to ensure that marginalized and underserved groups are reached. TRIAL REGISTRATION: PROSPERO CRD42021254241; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=254241.

Does socioeconomic position and gender affect human-nature interactions?

Aim: The growing number of mental health problems worldwide is alarming. Encouraging human-nature interactions (HNIs) could help to tackle this issue. For this reason, the aim of the present research was to investigate certain components that promote HNI in two groups of students with different socioeconomic positions (SEPs) in Mexico. HNIs describe the direct relationship between humans and nature. HNIs are composed of elements such as connectedness to nature (CN) and commitment to the environment (CE), and are beneficial to both physical and mental health. However, the impact of CN and CE on people's lives seems to depend on their SEP, which has been investigated mainly in developed countries where SEP is less salient compared with developing countries. Methods: A survey was sent to students from two universities representing each group. A total of 210 surveys was collected. Results: The results showed no differences in CN (p = .480) and CE (p = .421) regarding SEP. However, gender differences were found with females from a low SEP showing higher levels of CN than men (p = .015) from the same SEP. For high SEP, no differences were found. In addition, men showed a higher CE than women, regardless of their SEP. Conclusion: Given the high vulnerability of women to mental health problems, it is of major importance to conduct more research considering the relationship between gender, HNI, SEP, and health in developing countries.