Health Literacy Recommendations for Digital Mental Health Treatments.

Free-text comments from 213 participants who completed unguided iCBT were analyzed to develop recommendations for digital mental health treatments.

• The sample included 213 people who had completed unguided internet-delivered cognitive behaviour therapy (iCBT) for depression and anxiety as part of a trial.
• 357 free-text comments (likes, dislikes/other suggestions) were collected and analyzed via thematic analysis.
• The sample was divided into n = 80 lower health literacy and n = 133 higher health literacy participants.
• The treatment was unguided iCBT targeting depression and anxiety.

The co-development process involved iterative review by a multidisciplinary project team and focus group consultations with people with lived experience.

• A multidisciplinary project team with professional and lived-experience expertise (n = 9) reviewed and refined drafted recommendations.
• Focus group consultations were conducted with people with relevant lived experience (n = 8).
• The initial recommendations were drafted based on thematic analysis and then iteratively modified through these consultations.
• The team included members with both professional expertise and lived experience.

The co-development process resulted in seven final recommendations for digital mental health treatment design and delivery.

• The seven recommendations are: (1) Focus on informative and practical content; (2) Prioritize accessibility and ease of use; (3) Structure content in a progressive, layered way; (4) Enhance interactivity and engagement; (5) Employ strategies to enhance motivation and accountability; (6) Consider participants' emotional wellbeing; (7) Incorporate diverse modes of delivering content.
• Most recommendations were based on comments from people with both lower and higher health literacy, not exclusively one group.
• The recommendations were described as forming 'a flexible and practical framework for dMH treatment developers and service providers.'

Real-world engagement with digital mental health treatments remains a challenge when scaling up these interventions.

• The paper identifies that digital mental health treatments have 'garnered much attention for increasing access to treatment, yet real-world engagement with these treatments remains a challenge.'
• People with lower health literacy are identified as a group that already experiences inequities in health care.
• Upscaling dMH treatments risks excluding groups with lower health literacy if equitable design is not prioritized.

The authors conclude that further research is needed to test the feasibility and impact of implementing the recommendations across different contexts.

• The authors state that 'further research is needed to determine the feasibility and impact of implementing these recommendations across different dMH treatment delivery formats, settings, and populations.'
• The recommendations are described as needing to be tested more before broad implementation.
• The framework is described as 'flexible and practical' but its real-world impact remains to be evaluated.