Barriers and facilitators to men’s engagement with digital mental health screening in Estonia: An interpretive qualitative study of user archetypes and design implications

Mental health issues are prevalent among men, yet help-seeking remains low due to stigma, masculinity norms, and access barriers. Digital mental health (DMH) screening questionnaires offer opportunities for early detection, but their uptake among men remains limited. This study explored the barriers and facilitators influencing men’s willingness to use DMH screening questionnaires, with the aim of informing user-centered design that supports early detection and engagement. An interpretive qualitative study was conducted through semi-structured interviews with 17 purposively sampled Estonian men aged 20–54 in a highly digitalized context until data saturation was reached. Thematic analysis followed a mixed deductive–inductive approach, combining codes derived from the Technology Acceptance Model, Health Belief Model, User-Centered Design, and Behavioral Design with themes emerging from participants’ responses and evaluations of four screening questionnaires (PHQ-2, PHQ-9, EEK-2, and WHO-5). Key barriers included data privacy fears, distrust of digital solutions, lengthy questionnaires, and poor user experience, while facilitators included anonymity, institutional trust, short mobile-optimized questionnaires, personalized feedback, and clear next steps. As a main contribution, four archetypes were identified: Skeptic, Self-Manager, Explorer, and Situational Seeker, reflecting distinct patterns in privacy concerns, institutional trust, user experience preferences, and help-seeking orientations. Skeptics preferred anonymous, low-friction interactions and demonstrated low institutional trust, whereas Self-Managers valued autonomy, transparency, and evidence-based support. Explorers showed openness toward experimentation and engagement through intuitive and interactive design, while Situational Seekers engaged episodically depending on context and immediate need. Men’s uptake of DMH screening questionnaires is therefore influenced by a combination of social, psychological, and usability factors. Effective design should integrate anonymity, institutional credibility, transparency, user control, and actionable personalized feedback to support engagement and early mental health detection. The proposed archetypes provide a more actionable alternative to demographic and one-size-fits-all approaches for designing DMH questionnaires tailored to male users.