Barriers and strategies to improve digital mental health intervention uptake among college students of color: A modified Delphi study

Abstract

Purpose

Digital mental health interventions (DMHI) may enhance equity in college student mental health, but engagement with them is poor. Little is known about barriers and strategies to enhance DMHI uptake among college students of color. The goal of this study was to attain expert consensus on important barriers to DMHI uptake and important and feasible engagement strategies to enhance DMHI uptake among college students of color.

Methods

The study utilized a modified, three-round Delphi survey. Researcher and industry stakeholders with relevant expertise participated (n = 35). Across rounds, experts generated and rated the importance and feasibility of barriers and strategies to promote DMHI uptake for students of color. Experts viewed group consensus and importance ratings between rounds and were provided the opportunity to re-rate items. Barriers and strategies were coded into frameworks using rapid qualitative analysis and grounded theory techniques.

Results

A total of n = 63 barriers and n = 64 strategies were derived, and consensus on level of importance was met for 98% of barriers and strategies. Key barriers included mistrust of mental health services and lack of culturally responsive care. Strategies spanned levels of implementation and emphasized codesign, diverse representation, reducing user burden, addressing privacy issues, and embedding DMHI within existing infrastructure.

Conclusions

This study identified barriers and strategies for improving DMHI uptake for college students of color. The subset of highly feasible and important engagement strategies derived in this study provides direction for the design of scalable engagement interventions with the potential to improve DMHI implementation and reduce disparities in care receipt.