Usability testing of a digital tool to support behavioural activation for depression with young people aged 12 to 18

Background Adolescents with depression cannot access timely support due to pressures on specialist mental health services. We developed and tested a manualised version of behavioural activation—a brief psychological intervention—for delivery in the community by non-specialists. We digitalised the paper version of the behavioural activation manual as a more accessible and user-friendly route for completing therapy tasks. Methods Young people who received manual-based behavioural activation as part of a large trial were invited to test the digital tool. Following a demonstration, participants were asked to use the digital tool in their own time over 4 weeks, completing tasks such as activity scheduling that they had previously completed using pen and paper. Participants then attended a one-to-one interview lasting approximately 30 min to provide feedback on the digital tool. All interviews were audio-recorded and transcribed verbatim and analysed using Template Analysis. Results Overall, 14 participants, aged 13-to-17-years [M: 15.4 ( SD = 1.6)] and comprising 10 females, 3 males and one individual who was non-binary took part. Five key themes, each comprising two subthemes, were identified. These centred on a) the perceived strengths of the digital tool, b) access and engagement, c) using the digital tool both independently and with a professional as well as its position in the wider treatment pathway, d) the role of the digital tool in relapse prevention and e) suggested ways to enhance the overall utility of and engagement with the digital tool. Conclusions Overall, the young people perceived the digital tool to be a useful and accessible resource that could support their mental health journey, both during and after therapy. The digital tool's features for planning, reflection, and visualizing progress were particularly valued. Identified improvements included the incorporation of reminders, in-app guidance, customization options, and a journalling feature to enhance engagement and the therapeutic value of the digital tool. Clinical Trial Registration https://doi.org/10.1186/ISRCTN57377955 Identifier: ISRCTN57377955.