Commentary: we don’t know what we don’t know: co-design and implementation science to advance digital psychological interventions

High-quality research requires a balance across rigor, adaptability, and partnership with those with lived experience. Keevers et al.'s (this issue) systematic review responds to persistent gaps in the prevention, diagnosis, and treatment of psychological difficulties among youth with neurological disorders (NDs; e.g., epilepsy, cerebral palsy, traumatic brain injury) by examining digital psychological interventions (DPIs), defined as internet-based interventions that deliver psychological skills. Keevers et al. (this issue) note that youth with NDs experience higher rates of anxiety and depression and face heightened mental health access barriers (e.g., mobility issues, specialist shortage). Given that youth with NDs may present with similar symptom profiles and barriers to accessing psychological services as youth with complex chronic conditions, principles of DPI are also applicable to other pediatric populations with complex conditions (Stiles-Shields et al., 2019). Keevers et al. (this issue) indicate that DPIs can address several accessibility barriers for pediatric populations by delivering cost-effective, flexible psychological interventions (Andrén et al., 2022; Gandy et al., 2018; Titov et al., 2019). However, for DPIs to fulfill the potential of increasing access to psychological support for youth with complex chronic conditions, it will be necessary to: (a) actively collaborate with youth, caregivers, primary care providers, specialists, etc., (hereafter referred to as “key players”) in the development and implementation of DPIs.; and (b) systematically evaluate the modifications necessary for DPIs feasibility in real-world implementation contexts.