JMIR FORMATIVE RESEARCH

Adeane & Gibson

Original Paper

Using Web-Based Content to Connect Young People With Real-life
Mental Health Support: Qualitative Interview Study
Emily Adeane*, BA; Kerry Gibson*, PhD
School of Psychology, The University of Auckland, Auckland, New Zealand*

all authors contributed equally

Corresponding Author:
Kerry Gibson, PhD
School of Psychology
The University of Auckland
Symonds Street
Auckland, 1010
New ZealandPhone: 64 211180431
Email: kl.gibson@auckland.ac.nz

Abstract
Background: Young people experience high rates of mental health problems but make insufficient use of the formal services
available to them. As young people are heavy users of the internet, there may be an untapped potential to use web-based content
to encourage this hard-to-reach population to make better use of face-to-face mental health services. However, owing to the vast
range of content available and the complexities in how young people engage with it, it is difficult to know what web-based content
is most likely to resonate with this age group and facilitate their engagement with professional support.
Objective: This study aimed to identify the types of web-based content young people identified as more likely to prompt youth
engagement with mental health services.
Methods: This study used a qualitative design conducted within a social constructionist epistemology that recognized theimportance of youth empowerment in mental health. Digital interviews using WhatsApp instant messenger were conducted with
37 young people aged 16-23 years who participated as “expert informants” on the priorities and practices of youth in web-based
spaces. The data were analyzed using reflexive thematic analysis to identify the types of web-based content that participants
believed would encourage young people to reach out to a face-to-face mental health service for support.
Results: The analysis generated 3 main themes related to the research question. First, participants noted that a lack of information
about available services and how they worked prevented young people from engaging with face-to-face mental health services.
They proposed web-based content that provided clear information about relevant mental health services and how to access them.
They also suggested the use of both text and video to provide young people with greater insight into how face-to-face counselingmight work. Second, participants recommended content dedicated to combating misconceptions about mental health and negative
portrayals of mental health services and professionals that are prevalent in their web-based spaces. They suggested content thatchallenged the stigma surrounding mental health and help seeking and highlighted the value of mental health services. Finally,
participants suggested that young people would be more likely to respond to “relatable” digital stories of using mental healthservices, recounted in the context of a personal connection with someone they trusted.
Conclusions: This study offers recommendations for professionals and service providers on how to better engage young people
with real-life mental health support using web-based content. Web-based content can be used to challenge some of the barriers
that continue to prevent young people from accessing face-to-face mental health services and underlines the importance ofincluding young people’s voices in the design of web-based mental health content.
(JMIR Form Res 2023;7:e38296) doi: 10.2196/38296
KEYWORDS
young people; mental health; online help seeking; internet; mental health services; digital interviews

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Introduction
Young people experience high rates of mental health problems;
however, <20% of those in need will access professional help
[1,2]. In New Zealand and other similar countries, there is arange of services available to help young people (defined by
the United Nations as being aged between 15 and 24 years) [3]with mental health problems, including those offered by healthcare providers, schools or universities, and community-basedorganizations. However, researchers have recognized that there
are a number of practical, psychological, and social barriers thatprevent young people from reaching out to these supports,
including a lack of knowledge about what services are available,
prior negative experiences of help seeking, concerns about thestigma attached to having a mental health problem, and apreference for self-reliance in dealing with their difficulties[4,5]. Due to these barriers, many young people do not seek
help when they need it, including (and especially) individuals
experiencing suicidality and those from marginalized
communities [6]. Early intervention is key to preventing
long-term mental health problems among young people, andthere is a need to explore creative strategies to overcome thebarriers that prevent young people from getting the help theyneed [7,8].
Given young people’s high internet use, there is a growing
awareness of the potential for this platform to provide mental
health information and resources that might facilitate thishard-to-reach group’s access to mental health support [9].
Despite their reluctance to seek help for mental health problems
in real life, many young people are willing to look on the web,with surveys suggesting that 30% to 50% of young people haveused the internet to access psychological information or support[10-12]. As professionals recognize the potential of web-based
resources to reach young people in distress, there is a burgeoning
number of internet interventions available to youth populations.
Young people are now able to receive professional support on
the web, including through video, text, or email counseling[13,14], or via tools such as moderated peer forums [15]. Youthmay also access cognitive behavioral therapy courses throughapps [16] or games such as SPARX, created by researchers at
the University of Auckland [17].
These web-based mental health supports have been welcomed
for their ability to reduce clinician burden and offer relatively
equal treatment access to individuals, regardless of location,
mobility, or economic status [18]. However, it has also beenrecognized that web-based interventions might not be suitable
for all young people. For some young people, web-based support
might be inappropriate because of their complex profiles of risk
and regular disengagement [19]; for other young people,
face-to-face counseling might be a preference [20]. Recent
research has called for increased recognition of the role thatweb-based resources can play in helping young people accessthe full range of mental health support available to them, bothin the virtual and real world [9].
Although most research in recent years has focused on thedesign and evaluation of internet-based interventions, lessattention has been paid to the potential of the internet to facilitatehttps://formative.jmir.org/2023/1/e38296

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young people’s access to face-to-face mental health support.
However, some existing research indicates that web-based
education and support can serve as a valuable conduit to help
young people connect to formal mental health services in theirlocal areas [21-24]. For example, studies have shown thatweb-based tools can help young people identify when they havea mental health problem [25], and informational websites canprovide encouragement and guidance on seeking professional
help [26-28].
However, young people’s web-based engagement with mental
health information extends well beyond these professional
informational resources, with many young people choosing touse informal social media networks instead [29]. Although there
is some evidence of peers encouraging harmful practices related
to mental health [30], these informal networks might also
provide peer encouragement to seek professional help [31].
These studies suggest that both formal and informal web-based
engagements have the potential to facilitate offline mental healthhelp seeking, at least some of the time.
Ito et al [32] argued that young people do not use different partsof the internet in isolation. Instead, similar to patrons at a buffet,
they take content from various stations, which may vary in terms
of privacy, modality, or formality [32]. The mental healthinformation available to young people ranges fromprofessionally curated material on static websites topeer-produced videos on YouTube or TikTok and more personal
and private Facebook or Instagram messenger groups. A recent
review of young people’s preferences for mental healthinformation suggested that they often relied on search engines
to explore a wide range of resources available, that they tended
to use formal professional websites less often than other sources,
and that they also made use of a variety of informal discussion
forums and other web-based communities to gain information[9]. In terms of specific site features that are valued by young
people, interactive functionality and social networking
capabilities appear to be key [33]. Youth also engage withmental health content more if it is multimedia or throughYouTube and contains personal experiences, humor, or detailed
information about what treatment looks like [34]. However,there is still much to be learnt about the types of content thatare most likely to resonate with this age group and facilitate
their engagement with real-life support.
It is important to understand which resources young people
attend to in their web-based world, what ideas and modes ofpresentation this generation of youth are more likely to resonate
with, and what specific content would encourage them to seek
professional mental health support. To do this, it is vital tounderstand young people’s own web-based practices andpreferences for mental health content.
It is common for research to investigate young people’s
engagement with a particular mental health website or tool todetermine its impact [35]. However, given the wide array of
web-based sources and modalities available to young people
seeking support or information on mental health, exploring theimpact of a particular set of web-based resources may miss thecomplex and fluid way young people engage in this terrain.
Another obstacle to understanding young people’s preferences
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for mental health content is that adults, including professionals,
are often deliberately excluded from young people’s virtualworlds. Young people value these web-based spaces precisely
because they provide protection and privacy from adult intrusion[32]. In the largely hidden worlds of young people’s internet
use, it is difficult to know what types of content they areattending to and which they ignore. The only way to mediate
this lack of access to young people’s web-based worlds is toengage their own expertise and determine what types of content
they connect to on the web and what they take from theseengagements.
Qualitative methodologies provide a way of accessing young
people’s own accounts of their experience, with the advantageof placing them in a meaningful context [36]. However, there
are several hurdles to overcome when researching young
people’s preferences and practices in the web-based
environment. Power imbalances plague youth research and often
prevent young people from engaging openly with researchers[37]. Furthermore, different data collection methods with young
people pose unique challenges. Face-to-face interviews, inparticular, present problems of access for young people who
might have limited independence, mobility, and time [38]. It
can also be difficult for young people to accurately convey thereality of web-based practices through verbal interviews
conducted face-to-face or on the phone. In addition, in thesensitive area of mental health research, the same barriers thatprevent young people from reaching out to professional support
may influence the extent to which they will speak openly about
these things to researchers [39]. Using familiar digitaltechnologies to interview young people may help them feel
more comfortable sharing information about their web-based
practices, especially in relation to mental health [40].
Existing literature in this area suggests that the internet may
offer the potential to facilitate young people’s engagement withmental health support. However, it also demonstrates that weneed to understand more about the types of mental healthresources young people encounter in their complex web-based
lives, which resources they find compelling, and which are more
likely to facilitate their willingness to reach out for mental healthsupport in real life. To maximize the potential of the internet
to facilitate young people’s access to help, it is vital to match
mental health messaging to this generation’s priorities andconcerns [41].

Methods
Research Design
This research draws on young people’s knowledge of youth
mental health practices to address the following researchquestion: “What types of web-based content do young people
identify as being more likely to encourage them and their peers
to use ‘in real-life’ mental health services?”
The study was designed to explore the web-based worlds ofyoung people, using youth informants to provide insights into
their own preferences and practices, and those they observed
among other young people in their web-based networks. The
study used a novel digital interview method using WhatsApp
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instant messaging to facilitate young people’s comfort in sharing
information on the sensitive topic of mental health and theirease of describing web-based content and practices.
This research is underpinned by a social constructionist
epistemology that recognizes that the terrain of mental healthmight be interpreted within youth culture in ways that are
different from professional views [29,41]. It also draws from ayouth empowerment approach that aims to amplify young
people’s voices on key issues that affect them [42]. The
researchers used reflexive thematic analysis, a theoretically
flexible model that is consistent with these underlying paradigms
and that allows researchers to explore commonalities in people’s
experiences across a number of participants [43]. This approachasserts the importance of recognizing the impact of a
researcher’s identity and positioning with regard to the researchitself. The first author is studying to be a clinical psychologist
but also related to participants as a young person and fellow“digital native” [44]. The second author is a clinical psychologist
and researcher who approached the topic from outside theparticipants’ age demographic. As a research team, we wereconscious of the need to challenge our own professional andadult assumptions and make space for the views of the young
people participating in our study.

Recruitment
We recruited participants through youth development agencies,
youth groups, and youth social media networks, for example,
Instagram and Facebook pages belonging to individuals andorganizations. Potential participants needed to be aged between
16 and 23 years, based in New Zealand, and identify as regularinternet users. We wanted participants who could serve as“expert informants” on young people’s digital practices
regarding mental health. As our focus was eliciting participants’observations about practices in their web-based networks, we
did not require that they have a direct experience of mental
health problems themselves. Instead, we asked for participants
who had “an interest in youth mental health.” However, it was
clear from the interviews that many of those who participatedin the study had used web-based resources to help them with
their own mental health. Young people who were interested toparticipate in the study contacted the researchers through email
or a dedicated research phone. Potential participants were thenprovided with the necessary information and the opportunity to
ask questions. Immediately before beginning the interview,
researchers messaged each participant on the WhatsApp
platform to confirm whether they had read the information andconsent forms, had any questions, and agreed to participate. An
affirmative written response from each participant (eg, “yes I
consent”) was included in each transcript as a proof of informed
consent. The researchers then collected demographic information(age, gender, sexuality, ethnicity, occupation, and location) andproceeded with the interview. Participants were offered a NZ
$30 (US $19) gift voucher as compensation.

Participants
A total of 37 young adults participated in this study. Participants
were aged 16-23 years, with all but 6 participants aged <20years. Of these 37 participants, 24 (65%) identified as women,
12 (32%) as men, and 1 (3%) as nonbinary. There were 67%
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JMIR FORMATIVE RESEARCH(25/37) heterosexual, 11% (4/37) bisexual, 8% (3/37) gay, and
3% (1/37) asexual participants. A further 11% (4/37) participantschose not to disclose their sexuality. The participants
self-described their ethnicity, resulting in overlapping data forseveral participants and no data for 1 individual. Of the 37
participants, 21 (57%) were identified as New Zealand
European, 5 (13%) as Māori, 5 (13%) as Asian, and 2 (5%) as
Pasifika. Furthermore, 3 (8%) participants were from the Middle
East, 3 (8%) from Africa, and 2 (5%) from other European
countries. Most of the participants resided in large cities in New
Zealand, with only 5% (2/37) participants from smaller towns.
The researchers judged the overall body of data to be sufficientfor the aim and type of this research [45].

Data Collection
We conducted interviews using the instant messaging platform
WhatsApp. Our previous use of this data collection methodology
was found to facilitate young people’s comfort in talking about
the sensitive issue of mental health and allowed participants toaccurately represent their web-based practices through digitalcommunication such as textspeak, emojis, and screenshots [46].
Reflections on the experience of using WhatsApp as a medium
to conduct these interviews have been described elsewhere[40,46]. Interviews took place between September 2019 and
May 2020 and lasted between 45 and 105 minutes.
The interviews followed a semistructured guide, with open
questions designed to elicit responses about young people’s
engagement with mental health resources in their web-based
environments. We asked participants to reflect on their own
experience as well as the practices of others in their web-based
networks, using questions such as “What mental health resources
do you use?” “What makes young people attend to theseresources?” “What stops young people from using mental healthservices irl [in real life]?” and “What content would make youor others more likely to use these services?” We also used arange of prompts, including requests for examples or further
explanation, and encouraged participants to share screenshotsof relevant web-based content if desired.

Data Analysis
Researchers exported both written and nontextual interview
data into transcripts, removed identifying information, and thenstored them on a secure university computer. These transcripts
were analyzed using reflexive thematic analysis, which
recommends a recursive method for identifying themes orpatterns of meaning [43,47]. Transcripts were read repeatedly
for data familiarization and were examined in relation to thecentral research question. We labeled relevant statements withshort descriptive codes such as “relatable” or “easy to find.”
These initial ideas were collated, and their connections werevisually mapped out. We identified tentative themes that werethen refined recursively and collaboratively within the researchteam. Analytic decisions were reached via consensus, a quality
assurance process consistent with the study’s underlying
epistemology [48,49]. The language used by participants intheir digital communication was reproduced in its unedited form
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were coded and labeled in a similar fashion. This content wasreported in the results through the use of image descriptions or
reproductions of written text present in screenshots (eg, acomment under a YouTube video).

Ethics Approval
Mental health is a sensitive issue, and ethical considerations
were at the forefront of our minds in planning and conducting
this research. Information sheets provided to the participants
before the interviews outlined the potential risks of participationand information on support services. The interviews wereconducted under the supervision of the second author (KG) who
is a clinical psychologist with experience in youth mental health.
Interviewers monitored the participants’ responses for signs of
distress and were prepared to reprovide information on support
services as needed. The University of Auckland Human
Participants Ethics Committee approved this study (reference023698).
There were some ethical challenges raised by the use of theWhatsApp interview method. The researchers clarified with theparticipants that the WhatsApp interview would take place ata particular time, but they were able to add comments for 14
days afterward. They were also encouraged to review theirtranscript to check whether they wanted to edit or remove any
information. If participants chose to include a screenshot fromtheir social media networks to illustrate a point, it was edited
to remove all identifying information and stored with thetranscript.

Results
Overview
A total of 3 themes and 7 subthemes were identified in the data.
The 3 main themes each refer to the different types of content
that participants identified as being likely to facilitate young
people’s engagement with face-to-face mental health services:
first, content that provided clear information about mental healthservices; second, content that challenged misconceptions
surrounding the use of mental health services; and finally,
content that provided a relatable experience with someone who
had used mental health services.

Information About Mental Health Services
This theme captured participants’ strong desire for
improvements to the quality, scope, and presentation of
web-based information regarding how to access face-to-facemental health services and how counseling actually works.

How to Access Counseling: “A Step-by-Step Guide”
This subtheme highlighted young people’s lack of knowledge
about mental health services and the barrier this posed toaccessing professional support. Participants explained thatpsychoeducational websites often simply advised young people
to just “speak to a doctor or counsellor” [P17] with theassumption that they would know how to go about doing this.
Rather than a simple task, participants pointed out that young
people actually had to gather a large amount of information foreach potential service before even beginning to connect withthem, including the basic details such as who; what; where; as
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well as costs involved, availability, and admission criteria. One
participant captured how daunting this fact-finding mission
could be, leaving them feeling like “i literally wouldn’t know
where to start with finding a therapist” [P21].
Participants also highlighted the difficulties of knowing how tosift through all of the web-based information about mental healthservices once they had begun searching for it. They
acknowledged that a vast amount of information could be foundon the web but noted that this created difficulties for them infiltering out what was relevant or appropriate to their situation.
Rather than facilitating help seeking, the deluge of information
seemed to instead put young people off engaging with mental
health services, as one participant explained:
It’s interesting because in truth there is already a lotof info online. If I were to make the right searches I’d
be bombarded with all of this info which would
supposedly help me...however, I feel as though it’smore about the way the info is packaged. For firsttime info getters, it may seem a bit overwhelming,and prevent us from going back. [P13]
Participants suggested that rather than being bombarded withinformation, they and other young people would preferinformation that directed them to relevant resources for theirage and situation:[Its] just that so many options come up and I don’tknow who is good and who is not and for someone
my age with not much money the free options tend tonot show up very much. If there was a resource that
could show me people to go to I would be far more
likely to actually contact someone and get help before
I get to a low point where I’m desperate for help
again. [P34]
Participants’ preferences for targeted resources also extended
to geographical considerations. They noted that a particulardisadvantage of web-based material is that it does not necessarily
take geographical boundaries into account, and they wanted toknow which services were available in their local community.
As one participant elaborated:
they’re a bit hard to learn about those ones online
because every community has different resources
available to you...[it would help] if it was clear what
support was available to the young people in yourcommunity. [P11]Perhaps reflecting previous failed attempts at help seeking,some participants emphasized that they also wanted reassurance
that a particular service would be willing to admit them and thatthey would not find themselves facing additional barriers suchas not meeting admission criteria or unaffordable fees.
Participants also explained that they wanted content thatprovided “quick answers” to their questions about mental healthsupport and preferred sites that provided up-front information
or gave real-time responses to queries. One participant captured
this in their comment that they wanted “a service that gave me
fast results, for example an online chat or a FAQ, rather thanan email that could take days to be responded to” [P20].

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Furthermore, young people not only wanted information thatwould lead them to appropriate mental health services but theyalso wanted detailed guidance on how to access these, forexample, “a clear pathway to get access to that specific support.
So even if you know it’s there, you know how to use it” [P11].
Participants noted that the practical and administrative tasks
associated with seeking professional support could be very
daunting for a young person in distress and suggested “probably
the biggest help would be like a step-by-step guide for who tocall, how to pay, etc.” [P21].
The task of booking therapy appointments was seen as a hurdle
for many participants, especially when this involved speaking
over the phone as one young person explained:a huge, huge aspect of the process that I think turns
people off is having to call to book. [P37]
Another participant suggested how web-based resources could
make the booking experience less intimidating for young people
and therefore increase their chances of actually reaching out,saying if “booking an appt was easy and efficient (ideally online
through a form), that would be good in encouraging that young
person to go ahead with it” [P31].

How Counseling Works: “Knowing What it Is Actually
Like”
This subtheme highlighted young people’s need for more
information about what would be required of them if theyattended a face-to-face mental health service. Formal mental
health support was depicted as an unfamiliar terrain for mostyoung people, with many relying on the little they had gleaned
from popular media to inform their perspectives as one
participant explained:
My mind can’t help but think of scenes from movies
and TV for examples since I know so little about
counselling in general. [P23]Participants said that more detailed information about how
counseling worked could help to challenge some of the
misconceptions and the mysteries surrounding mental healthand counseling in youth networks:
if there are resources online that describe the process
of visiting counselling services, I think it would takesome of the fear or stigma away that would otherwise
prevent younger people from seeing it as a viableoption for them. [P7]Participants suggested that web-based information could, forexample, help demystify what happened in the first session ofcounseling or tell young people more about how the process ofcounseling worked in general. Speaking openly with aprofessional about distress was particularly intimidating. One
participant recommended that web-based videos of simulated
counseling conversations might help young people see how
counselors guide the conversation so “you don’t have to worry
that you won’t have anything to talk about” [P37].
In addition to not knowing what to say, participants noted thatyoung people were unsure about how they were expected tobehave when they attended a mental health service. One
participant explained that because counseling was so unlike
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their other experiences, they were anxious about what would
be required of them in this setting:I think I would only use it if I was...informed on how
to act or something? For me it’s a very non ordinary
experience so I’m not sure what the expected“etiquette” or something is. Basically knowing what
face-to-face counselling is actually like. [P23]Participants also noted the potential for initial web-based contact
with a counseling service to give young people a reassuring
taste of what it might be like to attend in person, with one
saying:I think having online services would be a great idea
so that people can have counselling online until they
are comfortable with the idea of going in person, as
I know for some people that scares them. [P22]

Challenging Misconceptions About Mental HealthServices
This second theme identified participants’ ideas for using
web-based content to combat some of the stigma andmisconceptions surrounding mental health help seeking that
could prevent young people from reaching out for mental healthsupport.

Encourage Recognition of the Need for Support: “They
Are Worthwhile and Deserve Help”
This subtheme captured the recommendation for content that
could challenge young people’s perceptions that they were notentitled to mental health support. The reluctance of young people
to use mental health services was partly ascribed to a concernthat their problems were not valid or sufficiently serious towarrant professional help. One participant illustrated this witha screenshot of a YouTube comment that stated:young people have been raised to believe theirproblems don’t matter and aren’t worth sharing withpeople. [P14]
Another participant explained that young people felt a need toevaluate whether their problem was “big enough” to deserve
support and that they might “think that their problems are minor
and normal and that by asking for help they would be being
dramatic” [P22].
Participants also explained that some young people might feellike they were burdensome or unworthy of support. As one
participant explained, young people are “not wanting to trouble
anyone. A lot of people in that headspace don’t feel worthy ofanybody else’s time” [P5]. Against the context of these obstacles
to young people seeking help, participants explained that it was
important that web-based resources give young people theexplicit message “that they’re not a burden and they are worthyof help...just letting them know that they are a priority, and theirwellbeing is important” [P36].

Destigmatize Professional Help: “Normalizing Going toCounseling”
Participants conveyed the importance of addressing the stigma
that they felt still surrounded mental health. Almost all
participants mentioned stigma as a key barrier to professional
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support seeking and felt that web-based content needed toaddress this obstacle to facilitate young people’s engagementwith mental health services. One participant suggested using
statistics to challenge the idea that help seeking was unusual,explaining:
I think knowing how normal it is for people to seek
offline support would help! It’s always a hard step totake but once you realise how common it is for people
to seek offline help it makes it easier. [P4]
Other participants suggested that if more young people wereseen “speaking about [their] experiences online where it canreach a lot of people,” that this may help with “normalising
going to counselling or seeing a therapist” [P7]. Anotherparticipant explained how content with an undramatic and morenormalizing tone may also be less likely to unnerve young
people. As one participant explained:
I believe that if the info just began in a very calm way
and discussed how we could potentially reach out inreal life/offline, young people would feel like getting
help offline can be achieved. [P13]
Participants explained that to normalize help seeking,approaching a mental health service should be treated as an“ordinary,” everyday task. One participant’s suggestion
reiterated this idea for “something that doesn’t make it out asa big deal” [P20]. Another participant suggested that it might
be possible to reduce the “seriousness” of web-based mental
health information by using humorous messaging. As she
explained, mental health information may be more engaging
for young people “if it was put into meme form, I think young
people genuinely find it easier to connect with difficult thing[s]through humour” [P36].
Participants also suggested that mental health services use
images or short-form video-based platforms such as Instagram
and TikTok so that content about mental health services would
seem more familiar and less alienating. One participant
explained that this was because such pages were “colourful andlook like any other Instagram story post so you don’t feel likeyou’re having to go to a counsellor and they don’t make you
anxious” [P18].

Promote the Value of Mental Health Services: “TheImportance of Face-to-face”
This subtheme conveyed the recommendation that web-based
content should be used to counter negative views of mental
health services and promote more positive representations. Someof the participants described encountering off-putting
descriptions of mental health professionals and counseling intheir web-based environments. For example, one participant
provided this account:
Like, I’d be scrolling through Twitter and see a postof how bad psychiatrist are and they just want yourmoney and to have a laugh. You need to fix yourself
and psychiatrists are fake. [P17]Participants suggested that web-based content that actively
challenges some of these negative perceptions and accounts

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would be valuable to convince young people that accessing
mental health support is a safe and worthwhile activity.
Participants also explained how web-based descriptions ofnegative experiences with therapy could make young people
question the efficacy of mental health services and dissuade
them from trying it for themselves. As one participant explained,a barrier for her seeking help was hearing about “how it doesn’t
work for some people or others would have something bad tosay about it which would make me worry about wanting to do
it as well” [P35]. A simple solution to this was suggested byanother participant, who advocated for more “positive stories
from people who have been to see a counsellor” [P18], which
they felt would make young people feel hopeful that therapy
could work for them too.
Participants also suggested that young people accustomed tofinding mental health information and informal support on the
web might be less convinced that there was any further value
in using mental health services in the real world. As one
interviewee put it, “they may not understand that its possibly
very important for them to have face to face help” [P1].
Participants felt that it could therefore be helpful to promote
the value of these services, for example:
information about the importance of face-to-facemeetings and how it positively effects the mental
health e.g. promotions. [P14]This participant went on to suggest that this could be backed
up by “research or study showing that it helps, like statistics
etc” that might convince young people that it was worth trying.
Participants also suggested that these types of content mightneed to actively challenge young people’s reluctance to leave
the safety and familiarity of their web-based support seeking.
One participant elaborated, for example, that “listing the benefitsof the offline support as opposed to online” would be a helpful
strategy [P6].

Relatable Experience With Mental Health Services
This theme captures participants’ preferences for receiving
web-based mental health content from people they can relate
to and trust. This includes positive accounts provided by otheryoung people who have used counseling as well as influencers
and celebrities.

Accounts of Young People’s Positive Experiences ofCounseling: “Allow Young People to Relate to Them”
This subtheme describes the importance that participants
ascribed to hearing positive stories from other young people
who had used face-to-face mental health services.
Rather than responding to slick advertising, participants spoke
about how they were more inclined to respond to content if it
seemed “relatable” or came from a person they knew. They said
that young people would be more likely to approach face-to-faceservices if they could “hear experiences or personal stories of
the topic they need aid in” [P24]. They felt that this would help
people feel less isolated, as explained by one participant who
referred to a community mental health service with a strong
web-based presence which “has lots of stories of other people’s
experience so you know you’re not alone” [P11].
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Participants described how this relatable content made it easierfor young people to imagine themselves getting help and,
therefore, may increase their chances of seeking it. As one
participant suggested:
Maybe just making posts that shared different
people’s stories or perspectives related to mental
health which would allow young people to relate tothem and realise there is support out there. [P9]In addition to general therapy stories, participants wanted tohear from individuals who had actually attended the particularservice they were considering. One participant explained thathearing from someone relatable would help establish the service
as somewhere trustworthy:
I think once again being able to hear about people’s
experiences with them would be a great way topersuade people. It’s hard to try something new ortalk to someone new when you don’t know whether
that specific person or their company has worked forothers before. [P35]
Participants also wanted the ability to interact and ask questions
through “talking to other people who’ve used the same service”[P6] through web-based messaging systems. Some suggested
that this might be done anonymously to protect the identity ofpeople who had used mental health services, whereas otherssuggested asking “friends who i know go to therapy what they
did” [P21].
Participants noted that young people were often extremely
skeptical of content from unfamiliar people or organizations
and were likely to respond better to content from people theyknew and trusted. They noted that youth were suspicious of any
web-based material that appeared to reflect corporate orcommercial interests and experienced digital marketing as
annoying and invasive. As one participant put it:
When you’re in your downtime on Facebook orYouTube. Regardless of how important or good theadvertised service is, nobody likes ads. [P31]Participants emphasized that young people needed to trust theperson or organization delivering the message if they were to
respond to it. One participant explained:
Probably the biggest thing would be friends
supporting me in using it...Most of my contact withfriends be them people I know in real life, or online
ones, is through private messages and conversations.
So someone I trust in this way telling me they support
me seeking out further help, or maybe even offering
it as a potential solution would have the biggest
chance of me probably using it. [P2]Endorsements From Influencers and Celebrities:“People They Feel Like They Look up to but Also Relateto”
In their interviews, participants often suggested that celebrities,
other individuals with large web-based followings, and evenpopular “pages” could have a powerful impact on whether young
people seek mental health support. For example, it was proposedthat if these “influencers” openly acknowledged that they had
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been to counseling, their young followers might see it as a more
acceptable thing to do. Although help-seeking stories from peers
could be helpful, it was felt that this content would carry evenmore weight coming from influencers, who combine therelatability of peers with the prestige of celebrities. As one
participant explained:
for young people I’d say they’d need celebrities or
youtubers, people they feel like they look up to but
also relate to. [P7]
Popular users of the video-streaming site YouTube(“YouTubers”) were seen as particularly easy to identify with“because they’re people similar to oneself talking about theirrelatable experiences so they also sound like a friend” [P18].
The use of videos appears essential in allowing young people
to trust and relate to YouTubers. One young person captured
the sense of intimacy and authenticity conferred by this medium,
explaining that this was “because videos on YouTube makes
the person feel he/she is sitting with the other one. They see
and hear them. And plus they know that person is a real person”[P14].
However, some individuals expressed concerns about popular
accounts giving these sorts of endorsements, suggesting thatsome influencers may have ulterior motives:
I think to be careful who you take advice from,there’re lots of people online who say if you buy theirproduct/plan/whatever it’ll fix all your problems andsometimes it’s hard to know who you can trust. [P21]Participants also felt that young people would be wary ofrecommendations coming from newly created accounts and that
services must instead go through influencers who have alreadybuilt up a trusting relationship with their followers. As one
participant put it:
Yeah probably, it’d help if they were shared byestablished people/groups. Like, people can go andsee that its not the only thing they’ve posted andthey’re not just trying to sell something. [P36]

Discussion
Principal Findings
There is an underrealized potential for the internet to support
young people to use the face-to-face services that some mightneed. Although resources on the internet have the potential tofacilitate young people’s access to mental health services in thereal world, to be effective, these need to connect with thepriorities and concerns of contemporary youth. This study
provides important insights into the types of content that might
be more likely to prompt young people to use mental healthresources in real life.
Low awareness of services has previously been recognized asa barrier to help seeking [50]. However, given that young people
have access to a vast array of resources on the internet, it isperhaps surprising that they still felt that a lack of basic
information (such as the types and availability of local services,eligibility criteria, and contact details) was an obstacle for themto reach out for help. This anomaly seems to be a function of
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more general challenges associated with sifting through andevaluating the vast amount of information available on the web[51]. Web-based directories or tools that help young people
identify personally relevant services may go some way toaddressing this obstacle to help seeking. However, young
people’s struggle to find accessible mental health services intheir local areas may also reflect the ongoing practical barriers
that put some of these services out of the reach of many young
people in New Zealand [52].
Furthermore, despite the broad public awareness of counselingand other related mental health services in Western countries
such as New Zealand, young people might still struggle toenvisage precisely how these things work [50,53,54]. A
consequence of incomplete knowledge about what actually
happens in a mental health service is that young people may be
more susceptible to harmful myths or inaccurate fictional
representations of mental health care that form part of their
media world [55,56]. However, the same digital technology that
produces these myths may also offer unique opportunities toprovide young people with more accurate representations of
how a mental health service works. For example, videos
introducing staff members and touring the physical environmentof a service, or re-enacting different components of theengagement, including counseling sessions, might help break
down the barriers that prevent young people from using these
services. Young people’s comfort and familiarity with
web-based interactions may also provide a valuable opportunity
to allow them to “try out” aspects of a mental health service
before they find the confidence to use it. Other researchers haveacknowledged the value of web-based services as a way foryoung people to familiarize themselves with the experience ofcounseling before making the leap to real-life mental healthservices [26,27]. The opportunity to actually see and interact
with the same mental health professionals that they might latersee offline would likely enhance this effect.
The findings of this study also reflect the priority that thisgeneration gives to the immediacy of access to information andsupport, leading some to describe them as having “fast-twitch
wiring” [57]. For young people, mental health information andsupport must be available instantly and in the moment of need[41]. It would be valuable for mental health services to use theinternet to help young people quickly and easily book an
appointment and transition to offline services, if needed.
Our study also suggests that the internet could be used tochallenge some of the negative representations of mental healthand help seeking that prevent young people from reaching out
to mental health services for support. It is important tocounteract young people’s perceptions that their problems are
not “big enough” for support or that they would burden othersby doing this. This recommendation aligns with campaigns thattell young people that they do not have to put up with distressand that no problem is undeserving of support [50,58]. Stigma
is a well-established barrier to mental health help seeking, andunsurprisingly, the participants in this study were clearly awareof its impact on young people [39,50,58]. Interestingly,
participants’ suggestions for addressing stigma challenge theconventional illness representations of mental health commonlyused in public health promotion, such as “mental illness is an
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illness like any other” [59]. Instead, participants emphasizedthat experiencing distress and using mental health services
should not be pathologized but rather treated as a normal andordinary experience for young people. Of particular interest
were suggestions that using the short-form video andimage-based formats ubiquitous on youth social media networks
could help normalize mental health service use. This isconsistent with the widely held view that health messaging ismore effective when it resonates with people’s everyday
practices and common ways of communicating [60]. The
suggestion that humorous memes could be used to dilute the“seriousness” of mental health messaging may raise additional
challenges. In a study by Robinson et al [61], young people
rated suicide prevention materials with a humorous tone as theleast acceptable and having the lowest chance of persuadingthem to seek support. In contrast, Martini et al [34] found that
content from Buzzfeed’s mental health week had higher
engagement when humor was used. It would be important tofind the right way to present mental health issues using humor,
and more research might be needed to establish exactly how
this could work.
For the young people in this study, web-based resources wereseen as offering an opportunity to promote the value offace-to-face mental health support. Young people often
underestimate the need for support and may not recognize its
potential value to them [2]. However, there are likely to be
unique challenges in engaging a generation that might need tobe persuaded that there are benefits to real-world interactions
that cannot be provided on the web [33]. Having information
available on the web that outlines the benefits of using
face-to-face mental health services may go some way toward
remedying this [58,62]. Our research also highlights theimportance of directly comparing the benefits of offline mental
health services with the support and information young people
can access on the web. Young people often cite that the“distance” and feeling of (apparent or actual) anonymity makeweb-based mental health discussions easier [13]. They may
need strong encouragement to leave the comfort, familiarity,
and apparent safety of a web-based environment and confront
the challenges of face-to-face discussions about their mental
health.
One of the most significant findings of this study was theimportance of delivering content to young people in forms thatwere “relatable.” Young people in this generation are highly
aware of the importance of authenticity and tuned into thepotential for content and people who are “fake” [41].
Unsurprisingly, young people’s help-seeking behavior wasstrongly influenced by concerns about trust. Research conductedby the authors of this study has emphasized that young people
are only willing to engage with mental health content on the
web if they feel they can trust the person they arecommunicating with [46]. Young people have been noted to be
more inclined to turn to their peers for advice on mental healthissues, whether this be offline or on the web [41]. Consistent
with existing research, this study suggests the value of using
digital stories from peers who are seen as relatable andtrustworthy to communicate the value of reaching out for mental
health support. Many young people in this study saw influencers
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as trustworthy and relatable, as has also been shown in otherresearch [63,64]. YouTubers were seen as particularly authentic
owing to the “illusions of intimacy” they create through the useof video [64]. Although celebrity endorsements are not new,social media influencers appear to have a unique appeal,
combining the relatability of peers and the perceived expertiseand prestige of celebrities [65]. The use of web-based
influencers to promote face-to-face mental health services is a
developing area that holds considerable promise for promoting
youth mental health [66-69]. Professionals should carefully
consider how they might enlist local influencers to help thempromote their mental health services and use their trusting
relationships with young people to encourage their use.
In terms of methodology, this study demonstrates that instantmessaging interviews are an accessible and effective way togain an understanding of young people’s web-based practices[40].

Limitations
Although this research captured some of the diversity in New
Zealand’s young people, there was not a high number of Māori
and Pasifika participants [70]. This is a particular limitation
given that this group may be less inclined to use mental healthservices because of the history of colonization and exposure tosystemic racism [71]. This may limit the findings of thisparticular analysis, especially considering that these culturalgroups appear to have different help-seeking behaviors [72]. It
is also worth noting that this study primarily reflects theexperiences and preferences of urban young people, which may
be different from those living in rural areas [73]. Consistent
with the tenants of reflexivity in thematic analysis, we
acknowledge how our professional and personal backgrounds
as researchers will have affected and enriched the entire research
process, from conception to analysis. For example, this may beseen in our tendency toward eliciting and highlighting
participants’ perspectives, as they relate to mental ill health anddistress rather than well-being, which likely stems from ourexperiences within clinical psychology.

Conclusions
This study contributes to the ongoing efforts to make effective
use of the internet to support young people’s mental health. It
provides important insights into the types of web-based content
that young people believe would facilitate their and their peers’
engagement with face-to-face mental health services. The
findings indicate that to connect with young people, web-based
mental health content should provide relevant and detailed
information about services and how to use them. Web-based
content might also actively counter some of the psychologicaland social barriers that prevent young people from using mental
health services. One of the most important messages for service
providers or others wanting to reach young people in distressis acknowledging the unique importance of trust in engaging
with this group and mobilizing influencers and peer networks
to facilitate greater access to help. The internet has rich resources
for promoting mental health among young people. However,professionals need to learn from young people about whatmatters to them to make the most of this opportunity to engage
young people with professional support when they need it.
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Acknowledgments
The authors would like to acknowledge funding support from InternetNZ.

Conflicts of Interest
None declared.

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Edited by A Mavragani; submitted 27.03.22; peer-reviewed by C Pretorius, K Metsaranta; comments to author 15.08.22; revised
version received 14.10.22; accepted 31.10.22; published 04.01.23
Please cite as:
Adeane E, Gibson K
Using Web-Based Content to Connect Young People With Real-life Mental Health Support: Qualitative Interview StudyJMIR Form Res 2023;7:e38296
URL: https://formative.jmir.org/2023/1/e38296
doi: 10.2196/38296
PMID: 36598810©Emily Adeane, Kerry Gibson. Originally published in JMIR Formative Research (https://formative.jmir.org), 04.01.2023. Thisis an open-access article distributed under the terms of the Creative Commons Attribution License(https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium,provided the original work, first published in JMIR Formative Research, is properly cited. The complete bibliographic information,a link to the original publication on https://formative.jmir.org, as well as this copyright and license information must be included.

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