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Digital contact tracing (DCT) apps have been implemented as a response to the COVID-19 pandemic. Research has focused on understanding acceptance and adoption of these apps, but more work is needed to understand the factors that may contribute to their sustained use. This is key to public health because DCT apps require a high uptake rate to decrease the transmission of the virus within the general population. This study aimed to understand changes in the use of the National Health Service Test & Trace (T&T) COVID-19 DCT app and explore how public trust in the app evolved over a 1-year period. We conducted a longitudinal mixed methods study consisting of a digital survey in December 2020 followed by another digital survey and interview in November 2021, in which responses from 9 participants were explored in detail. Thematic analysis was used to analyze the interview transcripts. This paper focuses on the thematic analysis to unpack the reasoning behind participants’ answers. In this paper, 5 themes generated through thematic analysis are discussed: flaws in the T&T app, usefulness and functionality affecting trust in the app, low trust in the UK government, varying degrees of trust in other stakeholders, and public consciousness and compliance dropping over time. Mistrust evolved from participants experiencing sociotechnical flaws in the app and led to concerns about the app’s usefulness. Similarly, mistrust in the government was linked to perceived poor pandemic handling and the creation and procurement of the app. However, more variability in trust in other stakeholders was highlighted depending on perceived competence and intentions. For example, Big Tech companies (ie, Apple and Google), large hospitality venues, and private contractors were seen as more capable, but participants mistrust their intentions, and small hospitality venues, local councils, and the National Health Service (ie, public health system) were seen as well-intentioned but there is mistrust in their ability to handle pandemic matters. Participants reported complying, or not, with T&T and pandemic guidance to different degrees but, overall, observed a drop in compliance over time. These findings contribute to the wider implications of changes in DCT app use over time for public health. Findings suggest that trust in the wider T&T app ecosystem could be linked to changes in the use of the app; however, further empirical and theoretical work needs to be done to generalize the results because of the small, homogeneous sample. Initial novelty effects occurred with the app, which lessened over time as public concern and media representation of the pandemic decreased and normalization occurred. Trust in the sociotechnical capabilities of the app, stakeholders involved, and salience maintenance of the T&T app in conjunction with other measures are needed for sustained use.

Background: Levels of well-being are declining, whereas rates of mental health problems remain high in young people. The World Health Organization defines mental health as not merely the absence of mental disorder but also includes social and psychological well-being as integral to positive mental health, highlighting that mental health is applicable to young people with mental health conditions and those without a diagnosis of a mental health condition. Reduced mental well-being have been identified in studies of young people with clinical populations, as well as in populations consisting of nonclinical young people. Self-help digital interventions can be delivered at mass at a low cost and without the need for trained input, thereby facilitating access to support for well-being. Self-help interventions are effective in young people with mental health conditions, but systematic reviews of such studies have been limited to randomized controlled trials, have not included reduced well-being as an inclusion criterion, and do not consider engagement factors such as retention. Objective: The objective of this study was to systematically review all controlled studies of digitally delivered, self-administered interventions for young people aged 9 to 25 years, with perceived or clinically diagnosed reduced psychological well-being. Participant retention and effectiveness of the interventions were also explored. Methods: A systematic search of the PsycInfo, EMBASE, Cochrane, Scopus, and MEDLINE databases from inception to 2021, reference searches of relevant papers, and gray literature was carried out for digitally controlled studies conducted with young people with perceived or clinically diagnosed reduced well-being, aimed at improving psychological well-being. Data were extracted to identify the effectiveness and retention rates of the interventions and the quality of the studies. Results: Overall, 1.04% (12/1153) of studies met the inclusion criteria: 83% (10/12) of studies were randomized controlled trials and 17% (2/12) were controlled pre-post studies. Most (6/12, 50%) studies aimed to improve symptoms of depression; 3 interventions aimed at both anxiety and depressive symptoms and 2 studies aimed at improving social functioning difficulties. Owing to the high risk of bias across interventions and lack of similar outcome measures, a meta-analysis was not conducted. Retention rates across studies were regarded as good, with moderate to high retention. Overall, the findings indicated that predominantly self-administered self-help interventions improved well-being in the areas targeted by the intervention and identified additional areas of well-being that were positively affected by interventions. Few interventions supported psychological well-being that was different from those used by young people with a clinical diagnosis of mental illness or young people from neurodiverse backgrounds. Conclusions: The findings, along with the advantages of self-help interventions, highlight the need for upscaling self-help interventions to better support vulnerable populations of young people who experience poor psychological well-being. Trial Registration: PROSPERO CRD42019129321; https://tinyurl.com/4fb2t4fz

Background Shared and reflective practice when conducting Patient and Public Involvement and Engagement (PPIE) with underserved communities requires a collaborative approach to understand how best to involve public contributors across the lifecycle of a research project. Researchers from the MindTech research group at the University of Nottingham, UK, conducted three studies aiming to improve healthcare services for people living with tics, and address gaps in current treatment provision: (1) ‘ Tourette’s Hear Us ’ – a qualitative exploration of experiences accessing healthcare for tics; (2) INTEND ( Improvi Ng Tic services in E nglaND ) – a study to develop a care pathway for children and young people with tics and (3) ORBIT-UK ( Online Remote Behavioural Intervention for Tics UK ) – a study to transform an online behavioural intervention for tics into a digital treatment implemented in services. Each study included a PPIE panel. We present these three case studies of how PPIE was conducted and key learnings across them. Methods PPIE panels were actively involved in project design, recruitment, data collection, interpretation, and dissemination. Research teams documented the PPIE activities and their impact on the research. Collaboration between researchers facilitated discussions of the progress and impact of PPIE in each study and enabled shared learning to collectively improve future PPIE methods. Learnings Our key learnings, developed through challenge, discussion, and resolution, are presented across the three case studies and include: the importance of representative PPIE panels comprised of members with genuine lived experiences; the provision of safe and inclusive spaces to support members to share their perspectives; supporting communication to facilitate contributions and engagement; tracking and reflecting on the impact of PPIE activities on the project; and sustaining involvement throughout the research cycle, including co-authoring outputs. Evaluating PPIE methods through panel feedback was also highlighted. Conclusions This paper provides new insights into how people with tics can be meaningfully engaged as research partners, and additional adjustments that should be made to accommodate the unique and involuntary nature of tics. These learnings extend beyond tic disorders, offering transferable methodologies to strengthen PPIE. Plain English summary Background Patient and Public Involvement and Engagement (PPIE) means actively involving people with personal experience of a health condition as collaborators in the research process, not just involving them as study participants. The lack of established healthcare services for people with tics in England has led to long waitlists and insufficient access to specialist treatment. People with tics and their families have described feeling abandoned and let down by healthcare services. It is therefore important that the needs of people affected by tic disorders are prioritised, their voices heard, and their viewpoints considered and acted upon when conducting health research intended to improve outcomes for these groups. Here we describe PPIE in three studies conducted at the University of Nottingham, U.K., focusing on shared learning across the studies and recommendations for how to improve PPIE. Methods Across the studies, PPIE members informed the research design and processes, and guided the interpretation of study findings through their lived experience perspectives. Learnings We learned how to (1) create genuine, diverse PPIE groups to create comfortable spaces to share lived experiences; (2) design activities for PPIE panel members with diverse needs; (3) maintain contact with PPIE members throughout the research cycle to keep them updated and engaged and seek their feedback. Conclusions We aim to continue to improve how PPIE is incorporated into tic disorder research to ensure it is guided by people with lived experience and leads to greater benefits for the tic community.

Background Self‐harm and suicide related behaviours are increasing in young people, and clinical support is not adequately meeting needs. Improved approaches to assessment and the clinical management of self‐harm will result from codesign processes and include greater shared decision‐making between young people and practitioners. The CaTS‐App (an adapted digital version of the existing Card‐Sort Task for Self‐harm research tool) aims to facilitate a collaborative understanding of adolescent self‐harm and support decision‐making within clinical settings. The codevelopment of a digital, clinical tool which meets the needs of multiple stakeholders requires careful consideration. Methods We present a case‐study describing the participatory aspects of the development of the CaTS‐App, which included comprehensive patient involvement, research activities and coproduction with diverse young people aged 17–24 with lived experience of self‐harm. We share our processes and activities to deliver safe, engaging, sustainable, ethical and responsible participatory practice and co‐created knowledge, in the codevelopment of the CaTS‐App. Results Activities spanned a 48‐month period in both face‐to‐face and online settings. Example processes and activities are provided in narrative, tabular and diagrammatic form, alongside discussion of the rationale for choices made. A summary methodology is also shared to stimulate continued discussion and development of participatory approaches in digital mental health. Conclusions The paper contributes important insight and practical detail for the delivery of genuine participatory processes in digital mental health development when working with a population who may be considered vulnerable. We discuss a case‐study and working methodology for meaningful, safe and responsible involvement in the early Planning and Discovery phase of the development of a novel assessment and intervention app for self‐harm—the CaTS‐App This paper contributes to important discussions about the process and value of centering and evaluating participatory processes in the development of digital mental health interventions for self‐harm.

Developing clear, adaptable, and engaging methodologies is critical for advancing the understanding and prevention of self-harm and suicide. This paper presents a review of the development, application and adaptation of the Card Sort Task for Self-Harm (CaTS), a structured, interactive tool designed to map individual pathways to self-harm. Grounded in psychological theory and co-developed with input from people with lived experience, CaTS uses 117 evidence-informed cards representing thoughts, feelings, events, behaviours, and support-related factors. Participants place these cards along a timeline spanning the period before and after a self-harm episode, enabling the identification of both risk and protective factors as well as the sequencing of relevant experiences. The inclusion of blank cards supports personalisation, ensuring the tool remains sensitive to diverse experiences. Unlike traditional psychometric measures, CaTS emphasises holistic understanding and temporal patterning. Since its initial application, CaTS has been adapted for use with varied populations, delivery formats, and research settings. This paper outlines the conception and evolution of CaTS, highlighting the tool’s potential for clinical, research and participatory applications, and utility in training and public engagement. By offering a flexible, person-centred approach, CaTS advances inclusive and nuanced exploration of self-harm processes, offering a novel way to explore often-overlooked, complex temporal dynamics. Not applicable.

IntroductionWhile digital technologies can increase the availability and access to evidence-based interventions, little is known about how users engage with them and the mechanisms associated with effective outcomes. Process evaluations are an important component in understanding the aforementioned factors. The ‘SPARX-UK’ study is a randomised controlled pilot and feasibility trial evaluating personalised human-supported (from an ‘eCoach’) vs a self-directed computerised cognitive behavioural therapy intervention (cCBT), called SPARX (Smart, Positive, Active, Realistic, X-factor thoughts), aimed at adolescents with mild to moderate depression. We are comparing supported vs self-directed delivery of SPARX to establish which format should be used in a proposed definitive trial of SPARX. The control is a waitlist group. We will conduct a process evaluation alongside the trial to determine how the intervention is implemented and provide context for interpreting the feasibility trial outcomes. We will also look at the acceptability of SPARX and how users engage with the intervention. This protocol paper describes the rationale, aims and methodology of the SPARX-UK trial process evaluation.Methods and analysisThe process evaluation will use a mixed-methods design following the UK Medical Research Council’s 2015 guidelines, comprising quantitative and qualitative data collection. This will include analysing data usage of participants in the intervention arms; purposively sampled, semi-structured interviews of adolescents, parents/guardians, eCoaches and clinicians/practitioners from the SPARX-UK trial; and analysis of qualitative comments from a survey from those who dropped out early from the trial. Quantitative data will be analysed descriptively. We will use thematic analysis in a framework approach to analyse qualitative data. Quantitative and qualitative data will be mixed and integrated to provide an understanding of how the intervention was implemented and how adolescents interacted with the intervention. This process evaluation will explore the experiences of adolescent participants, parents/guardians, eCoaches and clinicians/practitioners in relation to a complex digital intervention.EthicsEthical approval was granted by the National Health Service (NHS) Health Research Authority South West - Cornwall & Plymouth Research Ethics Committee (Ethics Ref: 22/SW/0149).DisseminationContextualising how the intervention was implemented, and the variations in uptake and engagement, will help us to understand the trial findings in greater depth. The findings from this process evaluation will also inform the decision about whether and how to proceed with a full randomised controlled trial, as well as the development of more effective interventions which can be personalised more precisely via varying levels of human support. We plan to publish the findings of the process evaluation and the wider project in peer-reviewed journals, as well as disseminate via academic conferences.Trial registration numberISRCTN: ISRCTN15124804. Registered on 16 January 2023, https://www.isrctn.com/ISRCTN15124804.