reachout nextstep: co-designing an online help-seeking tool for young people
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PowerPoint Presentation
ReachOut NextStep: Co-designing an online help-seeking tool for young people
Victoria BlakeReachOut Australia
Today well be stepping you through a project weve been working on in partnership with the University of Melbourne and Young and Well CRC since 2012, to co-design an online help-seeking tool for young Australians.1
In case some of the audience arent familiar with ReachOut, well give a brief introduction on who we are. Were an online Youth Mental Health organisation with a mission to help young Australians be happy and well.
Information and support for young people aged 14-25 yearsFrom tough times through to wellbeingFactsheets and personal storiesEvidence based self help tools, resources and appsPeer support community where YP can have conversations with each other in a safe and moderated environment
Accessed by over 110,000 Australians each month
Focus on prevention and early intervention work in partnership with downstream organisations for YP that require additional support
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The problem
1 in 4 young Australians suffers from a mental health difficulty. ONLY 1/3 of them seek help.King et al.(2010)
As an early intervention service, one of our key areas of focus is on young people at the early stages of MH difficulties, or that havent previously sought help for their concerns.
The ABS survey on mental health and wellbeing from 2007 showed that 26% of Australians aged 16-24 years had experienced a mental health disorder in the previous 12 months.
We know that intervening early following the onset of symptoms can have significant benefits in reducing the duration and severity of a mental illness.
Yet only around 1/3 of young people that experience psychological distress seek professional help significant amount of unmet need.
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BarriersACCESSAUTONOMYAWARENESSCONFIDENTIALITYFEARVALIDATION
From help-seeking theory and also from qualitative research with young people we know that the following barriers prevent them from seeking help
ACCESSNot knowing where and how to access services; geographical barriers or inflexible service deliveryAUTONOMYWanting to fix it themselves / stigma around needing to seek helpAWARENESSLack of awareness about what's going on for themCONFIDENTIALITYConcerns about confidentiality, judgment, being a burdenFEARFear of the unknown, not knowing what to expectVALIDATIONUnsure about whether the issue is serious enough
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60%of first-time users to ReachOut report experiencing suicidal thoughts.51%have not accessed mental health care. 91%say that they got the information they needed.OUR IMPACT
54%of young people use the Internet for help about important issuesWhy online?
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Our Project
OBJECTIVEDevelop and evaluate of an online tool which supports young peoples mental health and wellbeing, and facilitates help-seeking through the Australian mental health landscape.
- Sought to address these issues as part of the YAW-CRC program- Brings together MH service providers, academics, government and industry to tackle big challenges
Partnered with the University of Melbourne and the Young and Well CRCWith the objective of - development and evaluation of an online tool which:Supports young peoples mental health and wellbeing; and Facilitates help-seeking through the Australian mental health landscape for young people (and those who care for them)6
User researchResearch and development process
Several stages to the project across 4 years:
Formative research and participatory design define the problem and potential solutions; formulate a working concept (at the same time as a systematic review of literature)
Develop Minimum Viable Product to test the concept a basic working model that included enough features and content to meet the concept definition outlined by users
Feasibility study small scale evaluation to test if the tool works and does no harm; also that the research methodology is appropriate and telling us what we need to know.
RCT
Use the findings to further develop the tool for the live environment
Ongoing evaluation and iterative improvement
User research and consultation with consumers was carried out across the whole lifecycle of the project
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Participatory Design
We used participatory design methodologies to partner with young people to design all aspects of the service.
It was an iterative process not one-off and not just at one stage. We harnessed the expertise of YP at all stages of the product development process from identifying the issue or problem to solve, designing and creating the product and using and testing it.
We also made sure our research was creative and fun where both the young people and the researchers were able to learn.8
Help-seeking workshopsMVP concept testingMVP prototype + UX testingAcademic pilot studyAcademic RCTFunctionality workshopsPhase 2 concept testingPhase 2 prototype and UX testingContent and multimedia workshops Ongoing Youth Advisory group 600+ young Australians participated in the project
Over 600 young people have been involved in the design, development and evaluation of NextStep.
These were a mix of young people who had sought help for themselves or a friend in the last 2 years and those who had not. They were recruited using a recruitment agency to ensure they were not already familiar with ReachOut and were from a diverse range of life experiences, gender and ages. Where possible, we carried out workshops and testing in regional Australia.
Throughout the process they were active participants and co-designers in order to ensure that the tool is relevant, meaningful and engaging for them. They participated in:Participatory design workshops to help us understand the current help-seeking journey and how it might be improvedDesigning and testing concepts Prototype testing and continuous UX testing at key stages of the project Co-design workshops focussed on functionality, design and multimedia contentOngoing online youth advisory group
This number also includes yp who participated in the RCT. 9
Value
"It was very self-paced. There's a lot of fear in seeking help that you may be judged or not be able to do it privately and at your own pace"When youre distressed you want a simple, clear recommendation but you also want choice if it doesnt work for you"
When taking their first steps to actively seek help, young people are stepping into the unknown and outside their comfort zone.
ReachOut NextStep can help simplify this process and provide a starting point.
When taking their first steps to actively seek formal help or self-help, young people are stepping into the unknown and outside their comfort zone. Young people spoke about the value of the tool to help simplify this process and provide a starting point.
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Enable me access anytime on any deviceWalk me through the processValidate my feelingsShow me I'm not aloneGive me a sense of hopeTune into me (my changing needs)Make it easy to act/connectGive me a place to start and show me whats next
Findings: User Goals
Throughout the co-design process, young people helped us identify a set of User Experience goals. From a young persons perspective the tool should:
Enable them access anytime on any deviceWalk them through the processValidate their feelingsShow them that theyre not aloneGive them a sense of hopeTune into them and their changing needsMake it easy to act/connectGive me a place to start and show me whats next
At each stage of the project we checked in with young people to see if these goals were still relevant and evaluated how well we were meeting them. They were a good guide to see what we needed to improve on.
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ReachOut NextStep
Im now going to give you a very quick overview of the tool starting with an onboarding video. 12
ReachOut NextStep
Step 01 Users select from a list of symptoms in everyday language. Young people have let us know that even just going through the list starts to meet the user goals of validating their feelings and helping them know that they are not alone. It also encourages self-reflection.
Some of these symptoms e.g. I have a plan to hurt myself and end this map to a danger alert. It is up to the participant whether they select Im ok, continue to the next step. We have found through monitoring live analytics data that the majority of people close the pop up at this step and are more likely to take an action e.g. call a help-line on the last page of the tool once they have worked through all of the questions. 13
ReachOut NextStep
Symptoms are then categorized into what we call in the back end issues. These arent just mental health issues but also other risk factors and precursors including worrying about the future (employment, money etc), relationships and sexual health.
At Step 02 Participants are given a place to start they can choose what is going on we dont rank them as only they will know what they are ready to work on.
Step 03 Personalising - this has a double purpose of helping the user understand and think through how much the issues are affecting them and also feeds into the algorithm that provides personalised support options14
ReachOut NextStep
Step 04 - Recommends the best support option but also gives choice- Helps them to feel prepared and to know what to expect- Makes it easy to connect
Also includes stories, statistics, practical tips and a PDF download of their recommendations. 15
ReachOut NextStep90 Symptoms12Issues5 Severity levels 25Apps an tools5 Online forums14 Chat services41 Phone services28 Face2Face services29 Practical tips250+ Articles/stories12 Videos60 Pathways THOUSANDS of possible combinations
As you can see, we recommend a wide range of services based on 90 symptoms. Each recommendation is state based. There are thousands of possible combinations a young person may select.16
Randomised Controlled Trial403 participants
Following development of the minimum viable product, our colleagues at University of Melbourne conducted a randomised controlled trial.
Methods:Recruited YP in Australia aged 18 25 years Methods: Social media (most successful recruitment strategy), and search engine marketing~400 participants enrolled in the trial randomised into two arms: i) intervention arm; ii) usual search strategies (control)Approx. 200 in each armParticipants surveyed at baseline, immediately after using tool, then 1 and 3 months later
Examined the perceptions of participants in the intervention arm (yellow) compared to control (blue) across a number of domains of satisfaction
Quality:the quality of the way you looked for help?Support:Did you get the kind of support you wanted?Needs met:To what extent the help-seeking method meet their needs?Recommend:would they recommend they the approach to a friend?Satisfaction:Overall general sense of satisfaction with the helpseeking method you used?Trust:how much they trusted the method you used to look for help during the study?
Participant ratings Next Step trending to being a lot better than usual search strategies. Link group was generally more satisfied than usual help-seeking group (Immediately, at 1- and 3-months)
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Randomised Controlled Trial403 participants Positive AffectNegativeAffect
Positive affect was primary outcome measureMeasured at 4 time pointsControl shown in blue and intervention in yellow- Both control and intervention had an impact in increasing positive affect over timeIntervention had higher impact but wasnt statistically significant might be some experimental noise going on.
- Secondary outcome measure was negative affect- Again both groups showed an impact in decreasing negative affect, but the intervention arm showed a greater decrease in negative affect immediately after using tool and at 1 month, compared to the control group. These findings were statistically significant. - The results suggest that participants feel less negative after using intervention possibly related to a sense of relief that the tool imparted18
Randomised Controlled Trial403 participants
Measured by Assessed Quality of Life (AQOL) measure used a lot in health economics.The control group is shown in blue and demonstrates a decline in quality of life over the 3 month time period.However when we look at the intervention group shown in yellow, the decline in QoL is less following use of the tool measured at both 1 and 3 months post intervention
Hypothesis if no intervention there is a possibility of escalation and the situation may worsen in the short term. Short term intervention such as Next Step may play a role in altering the trajectory provide an alternative pathway.Potentially due to sense of hope.19
Its that comfortable sense that the website gets you, its there to support a lot of people.
It is more specific to your situation. It doesnt overblown it or underestimate it it gives you exactly what you need.
It reassures you that there is always someone looking out for you.
Some feedback from user research20
3 MONTHS INAbout 11,500 users in Australia Conversion from Step 02 to Step 04 is 75%Average time spent on tool is 5 minsAverage number of symptoms is 10.08
TOP 5 Issues Selected
I'm feeling stressed, anxious, worried or down4,551I'm having problems with people close to me1,236I'm worried about my drug and/or alcohol use757I'm stressed about body image, eating or exercise718I'm thinking about ending my life627
Between January and April, there have been aprox 11,500 Australian users.
Users are highly engaged if they start the tool and move past the next step, they are very likely to make it to the final recommendation stage.Over 5 mins on the tool most of which is the information on the final page around the recommendations. This is quite a long engagement for an online tool.
Able to look at the issues users are selecting, and can see links with seasonal trends.e.g. christmas drugs and alcohol; when back at uni more selecting stress and anxiety
Wealth of information on behaviours and self-reported mental health concerns.21
Be where I am
A really exciting possibility of the NextStep tool is that it can be white labelled to live or sit in different online spaces taking the tool to where young people are and removing the barrier of them coming to us.
This is a mockup of what it may look like on a University Health Service website. We are currently exploring some pilot areas to inform whether this approach will be viable.22
@ReachOut_AUS
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