Codesign of digital health tools for suicide prevention: A scoping review
Authors: Wepa Dianne , Neale Martin , Abo-Gazala Waseem , Cusworth Sally , Hargan Jae , Mistry Manoj , Vaughan Jimmy , Giles Stephen , Khan Mehnaz 
Published: April 2023

The importance of codesigning digital health tools for suicide prevention has gained popularity since 2012. Promoted as cost-effective and innovative, digital health tools are widely used but seldom described or evaluated from a codesign lens. This scoping review provides an overview of the research and gaps in the delivery of codesigned digital health tools for suicide prevention. This review is phase two within a three-phase study. Phase one involved a scoping review protocol which informed this scoping review and the results will contribute to a proof-of-concept project to develop a digital tool for suicide prevention (phase three).

The search strategy followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-SCR) and Population, Concept, Context (PCC) framework to ensure reporting standards were maintained and supplemented by Arksey and O’Malley and Levac et al. The search dates occurred from November 2022 to March 2023. Five data bases were searched: Medline, Scopus, CINAHL, PsycInfo and Cochrane Database of Systematic Reviews. Grey literature searches included government, non-government health websites, Google and Google Scholar.

3260 records were identified from the initial search and 61 were included in the final review. All members of the research team screened the included records. Data from published and grey literature were extracted and a narrative approach identified the results and five themes (acceptability by users, future inclusion of experts-by-experience, inconsistent use of Patient and Public Involvement (PPI), digital tools to supplement face-to-face therapy and digital divide).

We found that none of the data from the included studies used codesign methodology and experts-by-experience roles were minimised as members of focus groups, advisory groups, pilot studies or at the final stage of usability testing. Future research is required where codesign involves co-authorship with experts-by experience, end-to-end partnership from design, implementation and evaluation of digital health tools for suicide prevention.

Author summary

As more people turn to digital technology (such as mobile apps and websites) to help with their mental health, they enjoy many of the benefits such as feeling less judged and being more affordable than face-to-face therapy. There are also risks involved such as how privacy is managed and reliance on the distressed person to self-manage their signs and symptoms. We found that people who have experienced suicidal thoughts and carers did not have an equal voice with those that developed the digital tools for suicide prevention. Our group comprising of experts-by-experience, health professionals, a mental health nursing student, technology expert and researchers felt that there was a gap in this area and met on a monthly basis for one year to see what the literature was saying. We found that the term codesign was used a lot but when we looked deeper into the articles and websites, we noted that experts-by-experience were only included to test apps or were involved in focus or advisory groups. We will be using the information from this scoping review to apply for funding to develop a digital solution that is truly designed with and by the people that need it the most.