Joint Adaptation of a Digital Mental Health Intervention for University Students: Inductive Qualitative Analysis.

Background: Digital mental health interventions (DMHIs) can be particularly effective for young people, who live more of their lives online than older generations. Co-designing mental health support with young people can combat the challenges of a lack of engagement and sustained use. While this is increasingly common, there are often budget and timeline restraints in research settings that limit true co-design. As part of the Nurture-U project exploring a whole-university approach to student mental health, we coadapted an existing digital platform, i-Spero (P1Vital), with university students. This paper is a reflection on the impact that our student advisors had on the end product, and where the guidance of the young people was implemented, and not implemented, within the existing research parameters. Objective: This study aims to present an inductive analysis of meeting notes and recordings of the co-design process, in order to highlight what aspects of DMHIs our advisors valued and what, as a research team, we were able to implement. The hope is that this will inform future mental health interventions in this age group. Methods: The i-Spero digital well-being platform was developed over an iterative process with multiple rounds of feedback from student advisors in 2022-2024. An inductive qualitative analysis approach was implemented by 2 authors (NA and JD) on the detailed feedback reports and meeting summaries of this process to generate categories and themes from the student advisors' feedback. Results: Three themes were created: "Relevance and Usefulness," highlighting the importance of comprehensive features linking in with all aspects university life, while treating young people as adults; "Simplicity and Clarity," with student advisors suggesting edits that removed burden from the user and eased access to support; and "Acceptability and Inclusiveness," ensuring awareness of the needs of students from different backgrounds, and what young people with mental health difficulties may be able to access in times of need. Conclusions: There are some challenges in ensuring that DMHIs are both comprehensive and simple. These can be met by ensuring the aesthetic design and platform structure are consistent and clear. Co-design and development are crucial due to the difficulty in ensuring that online interventions are relevant to specific audiences in the constantly evolving digital landscape. The structures surrounding our joint adaptation of an existing intervention meant that not all the changes suggested could be implemented. Future work should explore the impact of different participation frameworks when coproducing interventions with young people.