ABSTRACT
BACKGROUND: In March 2020, New Zealand was plunged into its first nationwide lockdown to halt the spread of COVID-19. Our team rapidly adapted our existing chatbot platform to create Aroha, a well-being chatbot intended to address the stress experienced by young people aged 13 to 24 years in the early phase of the pandemic. Aroha was made available nationally within 2 weeks of the lockdown and continued to be available throughout 2020. OBJECTIVE: In this study, we aimed to evaluate the acceptability and relevance of the chatbot format and Aroha's content in young adults and to identify areas for improvement. METHODS: We conducted qualitative in-depth and semistructured interviews with young adults as well as in situ demonstrations of Aroha to elicit immediate feedback. Interviews were recorded, transcribed, and analyzed using thematic analysis assisted by NVivo (version 12; QSR International). RESULTS: A total of 15 young adults (age in years: median 20; mean 20.07, SD 3.17; female students: n=13, 87%; male students: n=2, 13%; all tertiary students) were interviewed in person. Participants spoke of the challenges of living during the lockdown, including social isolation, loss of motivation, and the demands of remote work or study, although some were able to find silver linings. Aroha was well liked for sounding like a "real person" and peer with its friendly local "Kiwi" communication style, rather than an authoritative adult or counselor. The chatbot was praised for including content that went beyond traditional mental health advice. Participants particularly enjoyed the modules on gratitude, being active, anger management, job seeking, and how to deal with alcohol and drugs. Aroha was described as being more accessible than traditional mental health counseling and resources. It was an appealing option for those who did not want to talk to someone in person for fear of the stigma associated with mental health. However, participants disliked the software bugs. They also wanted a more sophisticated conversational interface where they could express themselves and "vent" in free text. There were several suggestions for making Aroha more relevant to a diverse range of users, including developing content on navigating relationships and diverse chatbot avatars. CONCLUSIONS: Chatbots are an acceptable format for scaling up the delivery of public mental health and well-being-enhancing strategies. We make the following recommendations for others interested in designing and rolling out mental health chatbots to better support young people: make the chatbot relatable to its target audience by working with them to develop an authentic and relevant communication style; consider including holistic health and lifestyle content beyond traditional "mental health" support; and focus on developing features that make users feel heard, understood, and empowered.
ABSTRACT
AIMS: To investigate whether tamariki Maori screened for attention-deficit/hyperactivity disorder (ADHD) concerns in the B4 School Check (B4SC) between 2011 to 2018 are as likely to receive ADHD medication as non-Maori children. METHODS: Using population-level data from the Integrated Data Infrastructure, we investigated whether ADHD medication dispensing differed for tamariki Maori screened for ADHD concerns relative to non-Maori children. Analyses were also stratified by area-level deprivation and urban/rural profile of residence. RESULTS: In our cohort of 414,171 children, 2.8% of Maori and 1.6% of non-Maori were screened as showing ADHD concerns. Among those with ADHD concerns, tamariki Maori had a lower likelihood of ADHD medication dispensing following the B4SC (10.8%) relative to non-Maori children (14.9%), but this effect was only significant among those living in the most deprived quintile and outside of major urban areas. CONCLUSION: Our study indicates that inequities to accessing ADHD treatment may exist for tamariki Maori living in highly deprived neighbourhoods or outside of major urban areas. Further research is needed to understand what the specific barriers may be to accessing ADHD medication treatment for Maori in these areas.
