Co-Designing Technological Mental Health Resources for Unaccompanied Migrant Youths

This UX research study was conducted as part of my PhD research and a four-year Innovation Training Network (ITN) – Technology-Enabled Mental Health for Young People (TEAM) funded by the European Union’s Horizon 2020 program under the Marie Skłodowska-Curie actions (MSCA) initiative. This training network focuses on different challenges of technology-enabled mental health services for young people. My PhD research focused on vulnerable groups among young people, particularly migrant youths who arrive in the EU unaccompanied by a responsible adult or who are left unaccompanied after their arrival.
Due to the high number of refugees arriving in Vienna in 2015, the PhD project was located in Vienna, Austria.

Promoting Psychological Resilience in Unaccompanied Migrant Youth with the Help of Mental Health Technologies

Unaccompanied migrant youths are exposed to many mental health risks (Höhne, van der Meer, Kamp-Becker, & Christiansen, 2020; Hodes, Jagdev, Chandra, & Cunni, 2008), and even after arriving in the country of destination, they experience many stresses such as continued unstable educational and living situation (Hodes & Vostanis, 2019) and discrimination (Fazel & Betancourt, 2018). Unaccompanied migrant youth could benefit from developing strong psychological resilience to adapt to this adverse situation, which, in turn, could prevent the onset of mental illnesses (Zolkoski & Bullock, 2012).

To prevent the onset of mental illness, practitioners and researchers working in this field recommend taking a social-ecological approach and integrating resilience-building interventions into the everyday life of unaccompanied migrant youth (Eruyar, Huemer, & Vostanis, 2018; Hodes & Vostanis, 2019). Research increasingly shows that technology can improve access to mental health interventions such as behavioral activation and interventions (Mohr, Burns, Schueller, Clarke, & Klinkman, 2013; Mohr et al., 2017; Rohani et al., 2019, 2020), CBT (G. Doherty et al., 2012), dialectical behavior therapy (Schroeder et al., 2018).

However, unaccompanied migrant youth still struggle in accessing appropriate mental health
resources in spite of their high need for mental health support.

Aim: Exploring Design Requirements of Technological Mental Health Resources

The following aims guide the UX research project:

Gaining an understanding of how social-ecological systems support and hinder unaccompanied migrant youth in using mental health apps as one form of resource
Exploring the design opportunities and requirements of technological resilience resources as an integrated part of unaccompanied migrant youth’s social-ecological environment

UX Research Methods

Co-Design Workshop
Thematic Analysis
Mind Mapping Activities
Ideation Methods
Development of A Design Framework
Conceptualization of Design Examples

Software

MAXQDA - Software for Qualitative Analysis
InDesign
Photoshop
Premiere Pro

I recruited unaccompanied migrant youth aged 16-24 years, based on WHO’s definition of youth through local NGOs such as mentoring programs and initiatives for unaccompanied migrant youths.

To accommodate different suitable workshop times, we offered two workshop series. In the first workshop series (WS1), five unaccompanied migrant youths participated. In the second workshop series (WS2), nine unaccompanied migrant youths participated. Each workshop series consisted of three workshop days.

The workshops were framed as participants creating their own company and developing their own app for better sleep and less stress as professional support workers recommended using less stigmatized terms to bypass the mental health stigma.

To evaluate existing available mental health apps, the participants worked with commercially available mental health apps. At the beginning of the first workshop, the participants engaged with four commercially available mental health apps, and then each participant chose one app, which they used throughout the rest of the workshop series and in-between the workshop days at home.

Activity		Material
Day 1: „Creating your own company and getting to know your competitors‘ products“
Collect activities and things that help to sleep and feel better		Mind map
Create a company name and slogan		Mind map and skechting
Explore four different apps and collect negative and positive aspect		Apps, screenshots, post-it notes
Choose the most interesting app
In-Between Day 1 and 2
Testing chosen app at home		Notebooks
Day 2: „Identify the weakness of your competitor’s product“
Collect more positive and negative aspects of the different apps based on testing at home		Mind maps with screenshots and post-it notes
Create a persona who would benefit of using the app		Mind map
Collect places, locations, barriers and facilitators of using the app		Mind map
Create one story where the app works well and one where the app fails		Storyboards
Day 3: „Create your company’s better concept“
Ideation activities to generate ideas		Mind map, paper, post-it notes
Create a prototype of your idea		Google Play Store description, paper prototyping
Pitch idea to a friend		Role-play

Design Artifacts Produced at the Workshops

Insights from Mind Maps

As part of mind map activities, participants collected points in time, places, barriers, and facilitators of using the apps, and characteristics of a person who would benefit from using the apps for better sleep and against stress.

Potential points in time were for instance: “5am morning”, “on the way”, “in breaks”, “having time” and places: “bed”, “park”, “library”. The variety of locations underlines the mobility aspect. In addition, the point of time points towards adapting the use of apps to tight schedules. As barriers, participants listed “flatmates being awake until midnight”, “not possible to go to a different room”, “dictating tasks”, “timing” and “amount of advice” and as facilitators of using the app: “needing to want help”, “having job with routine”, “giving you a task”. Characteristics of the persona were for instance “working during the night” and “not sleeping during the night but then sleeping in the morning until evening”. While these mind maps give an overview of the relevant aspects across all participants, the subsequent storyboard activity was done individually and thus the storyboard communicates what each participant considers most important

Insights from the Storyboards

The storyboards show how different social-ecological systems play out in the everyday life of unaccompanied migrant youths and how these hinder the successful usage of the apps. Each participant created at least one storyboard showing how the app does not work well and then a successive storyboard showing how the app would work well. Through the storyboards participants highlighted the relevant micro-systems (=direct social (support) systems) being roommates and/or accommodation, contacts they message via social media, family, partners, employer or job, and friends.

The influence of the macro-system (= policies and political regulations) becomes visible when comparing the storyboards where the apps are successfully used vs where the persona is unable to use the app effectively. For example, one participant’s first storyboard shows how the persona is stressed and feels unwell, and cannot use the app. In the second storyboard which includes the changes to be able to use the app, the persona leaves his job and has time to use the app and time for positive activities.

Participants depicted various means to overcome macro-systemic problems, e.g., managing time constraints by creating a very detailed plan of how to organize a whole week and reacting to the most difficult moments, e.g., when coming home after school where many tend to take a nap instead of staying awake. The storyboards also communicated stress caused by the technology due to the macro-systemic situation, namely being away from many close contacts, and how this conflicts with the usage of the mental health app. For instance, in one storyboard the persona gets frustrated by all the messages and notifications when turning on the internet to use the apps, deletes all notifications including the ones by the mental health app, and instead plays with his phone.

Insights from the Final Concepts

The paper prototypes and how the participants communicated these concepts through the play store descriptions suggest how the participants imagine the ideal app and which features seem to be especially important for them.

One feature which caused detailed discussion during the workshops was the password protection of the app as participants fear that both other people, including those they are forced to share accommodation with, and technology companies can access their data. In addition, the concepts are characterized by multi-modal content and adaptability.

One paper prototype shows a smartwatch which offers Good night stories” of varying lengths that are adaptable to the amount of time available to the user.

Another paper prototype shows a mobile phone-based prototype of an app that supports planning activities and setting reminders. Another key feature is that the app stores the users’ positive memories e.g., with friends represented by photos.

Accounting for Macro-system’s Influences on the Micro-systems
e.g., Machine learning and data-tracking solutions could support tailor timing, content, and means of delivery to the social and physical factors of the current micro-systems
Designing for the Social in the Everyday Living Situation
e.g., create challenges and shared activities promoting mental health such as Fitbit challenges for behavioral change
Designing for the Person of Trust
e.g., support connecting unaccompanied migrant youths to a person of trust to extend their social capital
Designing for Physically Distant Social Contacts
e.g., mental health apps do not function in isolation; thus, the app need to support managing competing tensions between apps (e.g., stressful news and messages delivered by social media apps)
Designing for the Chrono-system
e.g., apps identify pre-existing knowledge and preferred strategies and adapt content accordingly

Co-Designing Technological Mental Health Resources for Unaccompanied Migrant Youths

Promoting Psychological Resilience in Unaccompanied Migrant Youth with the Help of Mental Health Technologies

Aim: Exploring Design Requirements of Technological Mental Health Resources

UX Research Methods

Software

UX Research Process

Co-Design Workshops with 14 Unaccompanied Migrant Youths

Design Artifacts Produced at the Workshops

Insights from Mind Maps

Insights from the Storyboards

Insights from the Final Concepts

Analyzes of the Workshop Data

Design Framework and Design Requirements

Publication and Video Presentation