Acceptability and implementation of digital mental health supports for marginalised young people across Ireland: A mixed-methods study

Digital mental health tools are increasingly promoted as scalable supports for young people, yet implementation remains inconsistent, particularly for marginalised youth. Acceptability and usability are key determinants of successful adoption, but little is known about how these factors shape engagement across diverse youth populations.

The aim of the study was to examine the acceptability, usability, and implementation potential of 11 evidence-based digital mental health tools among marginalised young people across the Republic of Ireland (ROI) and Northern Ireland (NI).

A mixed-methods design integrated baseline surveys (n = 38), a two-week trial of digital tools delivered through a co-designed Google Site, online workshops/individual interviews (n = 22), and a final usability and engagement survey (n = 24). Usability was assessed using the System Usability Scale (SUS), engagement using the Twente Engagement with E-Health Technologies Scale (TWEETS), and mental wellbeing using the Short Warwick–Edinburgh Mental Well-Being Scale (SWEMWBS). Qualitative data were analysed thematically and mapped to the Consolidated Framework for Implementation Research (CFIR).

Only two tools exceeded the SUS usability benchmark. Engagement was moderate overall, with one tool achieving the highest engagement despite lower usability. SWEMWBS scores indicated moderate baseline mental wellbeing. Thematic analysis identified five acceptability themes: credibility and trust; accessibility and ease of use; positive content supporting emotional regulation; personalisation and self-monitoring; and engagement and habit formation. CFIR analysis highlighted usability, institutional trust, cultural relevance, and emotional needs as core implementation determinants. Digital literacy was high and supported engagement, and usability remained a critical gateway to implementation. Designers and commissioners of digital mental health tools should ensure that supports are simple, trustworthy, culturally relevant, and youth-centred to enable adoption among marginalised young people. Implementation strategies are needed that will co-design with diverse youth communities and prioritise youth work settings as well as governance clarity.

Author Summary

Digital mental health tools are often promoted as a way to support young people who face barriers to traditional services, yet we still know little about how acceptable or usable these tools are for diverse youth communities. In this study, we worked with marginalised young people aged 18–25 across the Republic of Ireland and Northern Ireland to understand how they experience a range of evidence-based digital mental health supports. Using surveys, workshops, interviews, and a two-week trial of eleven tools, we explored what makes digital supports feel trustworthy, easy to use, engaging, and relevant.

We found that usability is a critical gateway: young people are far more likely to use tools that are simple, intuitive, and free of unnecessary steps. Trust in recognised health or youth organisations also strongly shaped engagement. Many participants used digital tools for emotional regulation—especially those offering positive or calming content—and valued features that helped them track their mood or personalise their experience. However, complex interfaces, paywalls, and unclear credibility reduced uptake.

Our findings show that digital mental health supports must be youth-centred, culturally relevant, and easy to navigate to be successfully implemented, particularly for marginalised young people.