Acceptability and Feasibility of “Village,” a Digital Communication App for Young People Experiencing Low Mood, Thoughts of Self-harm, and Suicidal Ideation to Obtain Support From Family and Friends: Mixed Methods Pilot Open Trial

Abstract

BACKGROUND: Young people experiencing low mood, thoughts related to self-harm, and suicidal ideation often struggle to communicate their emotions and receive timely support from family and friends. Technologically delivered support interventions may be useful in addressing this need. OBJECTIVE: This paper aimed to evaluate the acceptability and feasibility of "Village," a communication app co-designed with young people and their family and friends from New Zealand. METHODS: A mixed methods pilot open trial design was adopted. Participants were primarily recruited via social media advertisements and clinicians in specialist mental health services over an 8-month period. The primary outcomes were acceptability of the app (via thematically analyzed qualitative feedback and retention rates) and feasibility of conducting a larger randomized controlled trial gauged via effectiveness of recruitment methods, completion of chosen outcome measures, and occurrence of unanticipated operational issues. Secondary outcomes were app usability, safety, and changes in symptoms of depression (via the Patient Health Questionnaire-9 modified for adolescents), suicidal ideation (on the Suicidal Ideation Questionnaire), and functioning (using the World Health Organization Disability Assessment Schedule 2.0 or Child and Youth version). RESULTS: A total of 26 young people ("users") were enrolled in the trial, of which 21 recruited friends and family members ("buddies") and completed quantitative outcome measures at baseline, 4 weeks, and 3 months. Furthermore, 13 users and 12 buddies also provided qualitative feedback about the app, identifying the key themes of appeal of app features and layout, usefulness of its content, and technological challenges (primarily with onboarding and notifications). Users gave Village a mean rating of 3.8 (range 2.7-4.6) out of 5 on a 5-point scale for app quality and an overall star rating of 3.4 out of 5 for subjective quality. Within this limited sample, users reported a clinically significant reduction in depressive symptoms (P=.007), but nonsignificant changes in suicidal ideation and functioning. The embedded risk detection software was activated on 3 occasions, and no additional support was required for users. CONCLUSIONS: During this open trial, Village was found to be acceptable, usable, and safe. The feasibility of a larger randomized controlled trial was also confirmed after some modifications to the recruitment strategy and app. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Network Registry ACTRN12620000241932p; https://tinyurl.com/ya6t4fx2.

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