Table 4 eHealth consider adolescent developmental fit and needs [63,64,65,66,67,68]

Lindsay et al. (2018) [64]

Aim: Systematic review of electronic mentoring TXs (for accessing social and peer support)

Methods

• 25 articles published between 1993–2018

• P: Children or youth aged 12–26 with disabilities

• Countries: from 6 developed countries (14 US, 6 Canada, 2 Netherlands, 1 Australia, 1 Israel, 1 South Korea)

• E-Mentoring delivery model: The electronic mentoring interventions varied in delivery format and involved 1 or more of the following: interactive websites, virtual environment, email, mobile apps, Skype video calls, and phone calls. A total of 13 studies involved one-to-one mentoring, 6 had group-based mentoring, and 6 had a combination of both

• Types of mentors: mentors who had a similar type of disability to the mentee (k = 12), mentors who were near-peers without disabilities (k = 2), and adult mentors without disabilities (k = 7)

• TX dosage: The overall duration and dosage of the TXs reviewed ranged from 0.31 h per week to 2 h per week, occurring over a period of 4 to 24 weeks. Exposure ranged from 2 months to 4 years

• When compared with face-to-face mentoring, e-mentoring through interactive websites had similar outcomes for self-efficacy, quality of life, and self-management and for dealing with daily life

• The benefits of e-mentoring programs for disability youth were similar to the youth without disabilities

• 11 studies testing significance, 9 (81%) reported a significant improvement in at least one of the following: career decision making, self-determination, self-advocacy, self-confidence, self-management, social skills, attitude toward disability, and coping with daily life

• Positive effects of e-mentoring were reported for all types of mentors but, given the heterogeneity of outcomes, it was not possible to compare the effectiveness of types of mentors across studies

Low et al. (2019) [66]

Aim: Review Technology-based tools (web- or mobile-based TXs) for supporting AYAs health

Methods

• 29 studies (14 qualitative, 8 efficacy trials, 5 mixed methods) published between 2006–2009

• P: 7–28 years old (5 studies exclusive only adolescents). AYAs with chronic disease (e.g., diabetes, rheumatic disease, asthma, cystic fibrosis, hemophilia, et al.)

• Countries: only developed countries (US, Canada, Netherlands, UK, Ireland, Australia, Germany)

• eHealth TXs: 13 via a website, 4 via mobile app

• AYAs preferred TX design: using preexisting technology (e.g., mobile app)

• Preferred delivery method: with visual appealing feature (graphics, games, audiovisual); learning through interactive games or watching educational short videos at a kiosk; tracking function, affordable/accessible, provide support

• Preferred communication strategies: using peers to comment on the topic (e.g., disease management tips, transition/experience), updated research or disease news, and practical info (e.g., the difference between child and adult care, staff members). Mental health support was found to be an appreciated feature (e.g., manage anxiety, stress, IPV, alcohol use) (k = 3)

• Preferred Support from Peers or Health Care Professionals: AYAs preferred an online support group (k = 3), network opportunity with peers (k = 7), online discussion forums (k = 4), using existing social media & gaining connection w health provider (k = 4)

• eHealth design based on theory: 8 TXs were based on theories such as Social Cognitive, Self-Efficacy, Self-Determination, and Social Learning Theory

• Perceive usefulness or acceptability (k = 16): Most TXs (k = 11) receive a positive reaction. AYAs were receptive to receiving medical information electronically

• Efficacy for web-based TXs (k = 8): Meta-analyses showed no significant group differences across time on quality of life, self-efficacy, and self-management

Jeminiwa et al. (2019) [63]

Aim: Review of Theoretical Frameworks for evaluating the Quality of mHealth App for adolescent use

Methods

• 13 articles published between 2007–2017

• All studies included qualitative data (6 mixed methods, 6 qualitative)

• P: Target adolescent ages of 12–18 years and Normally developing

• Countries: All developed countries (US, Canada, Germany, Ireland, UK)

• Purpose of Apps: Apps were designed for self-managing health (including asthma, cancer, type 1 diabetes, sickle cell disease, STIs, lupus, or mental health)

• App features preferred by adolescents: Most commonly preferred features include the ability to track results or self-management progress, connect to social media, offer peer support through social media, and gain points or prizes through app gamification

• Adolescents and adults differ in design preference

• Adolescents prefer networking with their peers, or people of a similar age group, whereas adults prefer people with similar conditions, and trusted family and friends

• For provider support, adolescents were primarily interested in providers’ ability to view health data for monitoring purposes and the ability to ask questions and receive feedback from providers

• App Quality Rating Criteria: Common rating criteria include the degree of app customizability, ease of use, visual appeal, interactivity (with peers, clinicians, or social media), and self-management capability

• The theoretical framework for Evaluating Quality of mHealth App: 5 dimensions emerged: 1) Technical Quality (including 8 constructs, such as app ease of use); 2) Engagement (including 6 constructs, such as app interactivity); 3) Support System (including 6 constructs, such as decision support, behavior change or learning support features); 4) Autonomy (including 3 constructs, such as app accessibility in terms of control, cost); and 5) Safety, Privacy, and Trust (including 3 constructs, such as app credibility, safety)

McCashin et al. (2019) [67]

Aim: Synthesize the literature regarding the experience of young people who have used technology-assisted Cognitive Behavioral Therapy (iCBT)

Methods

• 14 qualitative studies published between 2013–2018

• P: School-aged young people (> age 6 and < 18)

• Countries: 6 New Zealand, 2 US, 2 UK, 1 Ireland, 1 Sweden, 1 South Africa, 1 Spain

• CBT is used for behavioral/emotional intervention. It considers the complex relationship between one’s thoughts, feelings, and behaviors (TFBs) in managing behavioral health. CBT provides a structured intervention that necessitates the use of metacognition (thinking about one’s thinking) to recognize problematic patterns adversely impacting the individual. [69]

• For CBT to be effective with young people, it needs to be appropriately tailored to their developmental stage

• Technology-assisted formats of CBT (iCBT) include internet-CBT, computerized-CBT/cCBT, CBT apps, CBT games, tele-CBT, and virtual reality CBT

iCBT included in this review were TXs for mood & anxiety (k = 10), trauma or self-harm (k = 2), and physical difficulties (k = 2)

Comparing tech-assisted CBT with face-to-face CBT

Tech-supported CBT is feasible for young people: experience in 5 themes emerged

(1) helpfulness (helpful, positive experience)

(2) therapeutic process (CBT model can be understood, iCBT can guide cognitive-behavioral change and skills development)

(3) transferability of iCBT for young people in daily life (activities can be applied to young people’s everyday life setting, and can be used by parents and children together)

(4) gameplay experience (young people can be related to characters in the iCBT, and has good playability)

(5) limitations/negative experience (insufficient to address self-harm thought/behaviors; broad/ generalized content may not be helpful; over-reliance on reading and writing skills)

Reen, et al. (2019) [68]

Aim: Review of health information website design for adolescents and synthesize the usability

Methods

• 25 studies published in English and between 2000 and 2019 that assess the usability of health info. websites on any health topic using survey or qualitative evaluation methods were included

• P: Age 11–25 years (mean age was 15.2 years). The majority were non-clinical population (79%) and some with disability (12%). Participants

• Settings: recruited from medical/ clinical, school, juvenile justice, youth center, and community settings

• Health Information Website: designed to give general information for a combination of health topics (e.g., mental health, diet/weight management, drugs and alcohol, contraception, and sleep patterns)

Adolescent preferences of websites design–

• Appearance (visual appearance, organization) (k = 6): website with a simple layout and with color

• Navigation (k = 10): easily navigate, simple log-in

• Delivery of content (video, vignettes, animation) (k = 14): prefer short videos, images, audio clips, positive stories/ testimonials from other adolescents, and animations; content delivered to be easy to comprehend and through their peers

• Message source (k = 3): prefer website with a clear logo and website name that is suitable to the target audience, and gender-balanced

• Interaction & Participation (k = 18): prefer using games and quizzes, the ability to control/set goals or personalize the website, interacting with health professionals (for Q&A) or peers, social networking capability, and with incentive point-system

• Comparing adolescents' & adults' preferences: Adolescents’ prefer eHealth features are different from adults. The design needs to consider the context of adolescent social processes, low tolerance of delayed gratification, and attraction to novelty and fit with a neurodevelopmental model of adolescence

Usability was assessed in multiple domains (in the reviewed studies): appearance, navigation burden, content delivery methods, message source, interactive/participation function (see left column for design feature preferred)

Liverpool et al. (2020) [65]

Aim: Review models of delivery, facilitators, and barriers in engaging children and young people (CYP) in digital behavioral health TXs

Methods

• 83 articles (represent 71 mental health TXs)

• P: 2–24 years old CYP (46% with affect disorder,)

• Countries: 37% study (k = 31) from US and Canada, 28% (k = 21) from Australia and New Zealand, 25% (k = 21) from Europe, 8% (k = 7) from Asian and 1 from Brazil

• Model of delivery used in CYP digital behavioral health intervention: 6 modes of delivery were identified: (1) website TXs (n = 43; 50% RCT) (2) games and computer-assisted TXs (n = 23; 50% RCT) (3) Apps: web or mobile (n = 10; 40% RCT), (4) robots and digital devices (n = 3; 33% RCT), (5) virtual reality (n = 3), and (6) mobile text messaging (n = 1, RCT)

• Communication and support eHealth strategies: Website (email, text, social network, discussion forums, web-based message boards)

• Skill develop eHealth Strategies: game or computer-assisted, Apps, virtual reality, text message

• Psychoeducation eHealth strategies: games or computer-assisted (photos, stories, animations, quizzes, multimedia audio and videos)

• Information Dissemination eHealth strategies: all 6 models of delivery can be applied

Theory applied in Behavioral Health TXs design: Cognitive-behavioral, cognitive skills training, social skills training/ social support, applied behavior analysis TXs

Retain rates by eHealth Delivery model: the retention rates varied. The average retention rate for games and computer-assisted intervention studies was higher (86.95%), followed by websites interventions (78.87%), and apps (78.45%)

Barriers and Facilitators to engaging CYP in digital behavioral health:

• Person-specific features preferred: feeling a sense of person connectedness (connection to others with similar experience), sense of trust (trusted brand names, from a credible source, anonymity), motivating usage (elicit curiosity and perceive needs, sense of helpfulness influence usage)

• Intervention-specific features preferred: CYPs suggested features such as videos, having less text, ability to personalize or create a profile, ability to connect with others or receive text message reminders, providing a reward, self-paced, simple/easy understand/straightforward, age-appropriate, user-friendly, fit lifestyle as encouraging their use of the intervention