Adding JoyPopTM: evaluating an e-mental health app as a complementary tool alongside treatment for youth using the RE-AIM Framework

Abstract

Given the growing rates of mental health concerns and the need for accessible support tools among youth (ages 12-24), mobile health (mHealth) apps offer an avenue to support youth. Little research has determined where mHealth apps can be implemented as complementary tools alongside traditional mental healthcare, including youth and staff perspectives and support recommendations in utilizing such tools. One mHealth app, JoyPopTM, is an evidence-based tool that supports youth emotion regulation and coping skill development. The current study assessed the utility of the JoyPopTM app as a complementary support tool that may help to promote mental health and wellness outcomes among youth clients (ages 12-18) receiving services at a local children’s mental health organization in Northwestern Ontario (Children’s Centre Thunder Bay). The study used an implementation science approach via the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework to support the transferability of study findings and inform the implementation of similar mHealth tools. This as done through the combination of qualitative and quantitative methodologies in line with the frameworks’ dimensions to answer the following research questions: 1) how adding the JoyPopTM app affects youth treatment outcomes across four months (effectiveness), 2) to what extent youth use the JoyPopTM app alongside services and reasoning for trends (reach, implementation), 3) to what extent staff support using the JoyPopTM app as a tool throughout services and reasons for these trends (adoption, implementation) 4) youth client perspectives on maintaining JoyPopTM app use alongside treatment (maintenance), and 5) staff perspectives of maintaining their support of JoyPopTM app use alongside services (maintenance). Specifically, youth participants (n = 40, 60% female; Mage = 15.03, SD = 1.79) were given access to the JoyPopTM app at the beginning of their treatment and completed self-report assessments of their therapeutic progress in comparison to a subset of youth clients who did not receive the JoyPopTM app (n = 59, 64% female; Mage = 15.03, SD = 2.12) using a routine outcome monitoring measure (Partners for Change Outcome Management System, PCOMS). Youth and staff completed semi-structured interviews of their JoyPopTM app use and integration, respectively, after one and four months. Linear mixed modelling and interview findings were used to assess research question one and effectiveness. Descriptive analyses, back-end app use data, and interview findings were used to assess research questions two and three, as well as reach, adoption, and implementation. Research questions four and five were assessed using interview data. Interview categories were derived via deductive and inductive content analysis. Regarding research question one and effectiveness, results indicated that while both JoyPopTM and the non-user comparison group showed significant improvements in their PCOMS scores over time, they did not significantly differ from each other in this improvement. Additionally, most youth and staff perceived the app to have a positive impact on youth treatment (e.g., improving mood, adjunct tool). For research question two regarding reach and youth implementations, results indicated the success of the study’s reach via recruitment strategies. Additionally, successful youth implementation of the app was primarily outside of sessions, with facilitators (e.g., being easy to use) and barriers (e.g., forgetting to use). Similarly for research question three, staff support and adoption of the app were moderately successful based on recruitment support. Additionally, implementation success outside of sessions was moderate, with facilitators (e.g., JoyPopTM coordinator role) and barriers (e.g., busy sessions and organization expectations). For research questions four and five, results indicated successful maintenance of continued app use and support with consideration of youth contingencies and recommendations (e.g., as a calming tool, with feature improvements or additions), as well as staff ones (e.g., if they know more about the app, with youth accessibility considerations and more training), to support ongoing use. Overall, results supported the relative success of the JoyPopTM app as a clinical tool through its consideration of the RE-AIM dimensions, with important insight into the necessary conditions to support uptake and use of a youth-oriented mHealth app alongside mental healthcare services for youth. Findings emphasized the important role that mHealth tools can play as adjunct resources to support youth wellness outcomes and the necessary parameters for their successful integration among youth clients and staff. Notably, digital tools may require ongoing internal support within the organization (e.g., app coordinator, management support). Youth and staff recommendations can also inform app development to enhance JoyPopTM’s potential to support youth service delivery and mental health outcomes among other future organizations. Keywords: JoyPopTM, Youth, mHealth, RE-AIM, Community-Based Research