Teen Mental Health

Online study with 23 teenagers on designing technologies for coping with stress: 10 weekly design activities over 3 months, exit interviews, and surveys.

Published in the conference of Interaction Design and Children (IDC) 2019: Full paper PDF

Research team

Arpita , Calvin Liang, Emily Y Zeng, Kanishk Shukla, Miguel Rios Wong, Dr. Sean A. Munson , and Dr. Julie A. Kientz .

My role

I led our research team in processes of recruitment, designing study protocols, activities, and storyboards, moderating online groups, conducting interviews and data analysis, and writing.

Motivation

Majority of teenagers in the United States struggle with health issues due to high stress. In this transitioning age, most teens lack access to mental health care due to challenges with transportation and paying for care. It is also difficult for teens to participate in research due to time and access constraints.

To address concerns with access and involve teens in designing tools to support their mental health, we enrolled 23 teens in two online groups.

Research Questions

  1. What needs do teenagers envision for support with stress management?
  2. How might technologies support needs of teenagers for stress management?
  3. What are opportunities and challenges in using asynchronous online groups as a method to engage teenagers in designing for wellbeing?

Images drawn and posted by teen participants in response to what stress looks (and/or feels) like to them.

Methods

We enrolled 23 teens (13-19 years) in two private online groups on Slack. Participants chose Slack because they wanted to remain anonymous and used pseudonyms. I moderated the groups and posted 20-minute online activities per week (e.g., every Tuesday) for 3 months. The teens participated in 10 design activities, surveys, & exit-interviews.

Participants: 23 teens participated in the study (11 aged 13-17, 12 aged 18-19 years). To respect autonomy and access for teens, we waived the need for consent from parents and obtained emergency contacts of a trusted adult who could be reached during adverse events (e.g., disclosure of suicidal ideation or medical emergency).


Surveys: We used surveys to quantitatively understand measures of teens' stress and usefulness of the activities they did on the group.

  • We asked teens to fill out Perception of Stress Scale (PSS) before and after the study.
  • At the end of the study, we asked participants to rate each activity on a scale of not helpful at all (0) to most helpful (10)


Design Activities: We posted 20-min design activities on each of the 10 weeks. The focus of these activities include:

  • Psychoeducation
  • Sharing about stress and what stress looks (and/or feels) like to them
  • Providing advise on scenarios I designed based on top rated stressors (e.g., school, family, financial stressors)
  • Private diary entries (e.g., writing a letter to stress, prompts to reflect on people who are helpful)
  • Try out existing apps for 4 days and provide feedback
  • Feedback on Storyboards on technologies to help work with families on stress management
  • Codesign tools for stress and mental health management


Interviews: At the end of the study , we invited all participants for a 30-60 min interview with us to learn about their experience participating in the study and get their individual perspectives on stress management.

Collage of images drawn by teen participants in response to the prompt: "what does stress look like to you?"

Findings

Needs for Designing for Stress Management

Three major themes emerged from the inductive qualitative analysis of the data from online activities and interviews.

1. Meeting Teens at their Perception of Control: Teen participants' drawings and description of text on different activities showed that they felt overwhelmed by stress. This perception acted as an additional barrier for them to be in control of completing their work and other responsibilities under constrained time and resources. They wanted support that would help them emotionally vent and feel less overwhelmed. They also wanted to be connected with others (such as peers or a helpline) who would listen. When feeling overwhelmed with external circumstances, they also used technology for logistical support such as to plan their activities. They perceived technology could help them with reminders about activities for self-care when they were not emotionally inclined to do so without external help.

2. Empowering Teens’ Developing Sense of Self : Teens wanted to have ownership in sharing and organizing content about mental health with other teens and parents. They also wanted technology to support them with self-reflection and journaling as they were progressing through different developments in their life. Lastly, teens highlighted the value in being able to track their data and understand their mood over time using apps such as Pacifica.

Three aspects of technologies that can help teens feel empowered to learn and share about themselves and their mental health.

3. Scaffolding varying boundaries of Social Support: As teens were in the phase of transitioning and becoming independent from family, they expressed the need for technologies to respect varying boundaries around privacy, autonomy (e.g., who makes the decision), and what they wanted to share with family (e.g., not wanting to share calendar/deadline information with parents). They seeked parental support mainly for logistical support. Most teens wanted emotional and informational support from peers, siblings (if they had any), and other trusted adults such as teachers and counselors.

Teen participant's drawing of their "social support map" to depict whom they feel comfortable in asking for which type of support.

Designs

Teens brainstormed ideas and preferred designs in which technology could help them learn self-support. Here are some examples of prototypes brainstormed and preferred by teens.

Mini Goals

This idea was presented by a teen and designed by Kanishk Shukla and me. to help them with logistical planning and help them break down their work to feel less overwhelmed.


My third idea is an add-on app to your calendar that gives you mini goals based on what it sees coming up in your calendar.

For example, if I had a research paper due in a week's time, it would give me mini goals based on those parameters and on days where it shows that you don't have much activity.

- Søren

Stress Box

This idea was presented by a teen and designed by me based on the concept of using a physical box to keep things that reminds the teen to do activities for self-care when they open it during stressful situations.


"A website that creates a personalized ‘stress box.’ A stress box would be a box of things (or even a list of reminders) or really anything that may help you when you are stressed. Examples can include your favorite baby blanket, a chocolate bar, a letter to yourself, etc.. A personalized stress box would require a couple of questions that outline common sources of your stress and suggest items to put in your stress box."

- Crembrulee

Teens Advice

Designed and presented on the group by me and preferred by teen participants. They built on it to add additional categories.


"There could be categories too like: 'Dating & Romance’, 'Hygiene & health', 'Family', 'LGBTQ', 'School', 'Social Life', 'Mental Disorders' etc. These topics can branch off, like, 'Hygiene & Health'– 'Sleep', 'Menstrual Periods’, 'Birth Control' , and then 'Mental Disorders' – 'Learning Disorders', 'Self-Harm', 'Eating Disorders', 'Anxieties’, 'Mood Disorder.’ "

- Red Velvet Queen

Reflection

  1. The online method allowed us to work with teen participants using a variety of activities over a period of 3 months. We collected data through different phases that affect stress such as during exam, vacation, and transitions from holidays to start of school.
  2. Overall, participants said the asynchronous format of this method helped them participate and the 20 minute activities fit into their busy schedules for the most part. We gave teens extensions based on their school deadlines and finals and also personal commitments (e.g., family responsibilities, vacations). Teen also said that having one week to complete the activity gave them time to think. work through ideas, and respond to the activity.
  3. This method required a lot of coordinating on my part as a moderator. It was also difficult for me to turn my attention away as I would keep monitoring the group posts for potential adverse events. As the research progressed, I learned to balance this time burden by scheduling time shifts for my availability and responsibilities as a moderator. Posting the activities on a fixed day every day helped both me and participants with structure. It would be better to have multiple moderators who can swap shifts, especially if the activities involve sensitive content..
  4. Anonymity was preferred by teens and I hid all emails as the group admin. However, there was also less interactions among peers in the group. Participants said this could be increased by having more ice-breaker activities to know other teens' interests on the group.
  5. Adding synchronous elements such as scheduling a time window for most people to be online could also be helpful in activities that require back and forth communication and collaboration such as during co-design activities.

Slides from my IDC 2019 talk: PDF

Study protocols

This work is funded by the University of Washington (UW) ALACRITY Center under NIMH #1P50MH115837, UW Innovation Award, and NSF #IIS-1553167