Developing an innovative standardised image-based measure of adolescent mental health
Lead Research Organisation:
UNIVERSITY COLLEGE LONDON
Department Name: Division of PALS
Abstract
The main way we find out about people's mental health is through written questionnaires. This means we do not hear the voices of certain groups, such as those with literacy or educational needs, neurodivergent people, and those with English as an additional language. These questionnaires have often been developed with White populations, meaning they may be less appropriate for people from Black and minoritized ethnic groups.
Image-based measures may address some of these problems. These measures use images to convey information when asking questions, let people respond using images, or use images both to convey information and for responses. One example could be using a sliding scale to select between dynamic images of different weathers to represent different emotional states. There is no widely used image-based questionnaire for adolescent mental health.
Our aim is to increase the inclusivity of mental health questionnaires. We will develop a digital image-based questionnaire for young people 8 to 18 years. There are 3 stages to our project.
1. We will look at existing image-based mental health questionnaires, so that we have examples to start conversations in the next stage.
2. We will work with a diverse group of 8 to 10 young people with lived experience of mental health difficulties. They will be co-researchers, meaning they will lead the research and take part in it. Over 6 workshops, we will co-develop the content and design of the image-based questionnaire, before testing and refining a prototype. We will provide training and ongoing support for the co-researchers. From the outset, we will discuss their goals of being involved, how they would like to be involved, and any support needs.
At the start of this stage, we will speak to groups of young people, researchers, and practitioners to understand what they would like from an image-based questionnaire. We will speak to them again during co-development for their feedback on the questionnaire.
3. We will speak to 12 to 15 young people to hear their feedback on the questionnaire when it is nearly finished. We will also ask them to complete it, thinking aloud as they do so we can understand in detail how they interpret the questionnaire and what drives their responses.
The main output will be a version of the questionnaire that can be used in a larger study, called the Adolescent Health Study, so that it can be fully tested. The questionnaire and our research materials will be freely available so other people can use it and repeat the study to develop similar questionnaires for other topics.
We aim to empower young people to be able to lead the research. The involvement of co-researchers will provide an opportunity to gain research experience for young people from groups that experience additional barriers to research careers. Our project has been designed based on our rich experience of patient and public involvement to ensure young people lead the decisions and conduct of the research. We will also work with a young person peer researcher who will be trained and supported to be involved in all stages and decisions of the project.
This project will mean that in the future, we will be better able to understand the mental health of all young people, including those from groups who voice is seldom heard in research.
Image-based measures may address some of these problems. These measures use images to convey information when asking questions, let people respond using images, or use images both to convey information and for responses. One example could be using a sliding scale to select between dynamic images of different weathers to represent different emotional states. There is no widely used image-based questionnaire for adolescent mental health.
Our aim is to increase the inclusivity of mental health questionnaires. We will develop a digital image-based questionnaire for young people 8 to 18 years. There are 3 stages to our project.
1. We will look at existing image-based mental health questionnaires, so that we have examples to start conversations in the next stage.
2. We will work with a diverse group of 8 to 10 young people with lived experience of mental health difficulties. They will be co-researchers, meaning they will lead the research and take part in it. Over 6 workshops, we will co-develop the content and design of the image-based questionnaire, before testing and refining a prototype. We will provide training and ongoing support for the co-researchers. From the outset, we will discuss their goals of being involved, how they would like to be involved, and any support needs.
At the start of this stage, we will speak to groups of young people, researchers, and practitioners to understand what they would like from an image-based questionnaire. We will speak to them again during co-development for their feedback on the questionnaire.
3. We will speak to 12 to 15 young people to hear their feedback on the questionnaire when it is nearly finished. We will also ask them to complete it, thinking aloud as they do so we can understand in detail how they interpret the questionnaire and what drives their responses.
The main output will be a version of the questionnaire that can be used in a larger study, called the Adolescent Health Study, so that it can be fully tested. The questionnaire and our research materials will be freely available so other people can use it and repeat the study to develop similar questionnaires for other topics.
We aim to empower young people to be able to lead the research. The involvement of co-researchers will provide an opportunity to gain research experience for young people from groups that experience additional barriers to research careers. Our project has been designed based on our rich experience of patient and public involvement to ensure young people lead the decisions and conduct of the research. We will also work with a young person peer researcher who will be trained and supported to be involved in all stages and decisions of the project.
This project will mean that in the future, we will be better able to understand the mental health of all young people, including those from groups who voice is seldom heard in research.
Technical Summary
Our aim is to increase the inclusivity of self-report mental health measures for adolescents by developing an innovative, digital, standardised image-based measure for young people 8 to 18 years. One example could be using a sliding scale to select between dynamic images of different weathers to represent different emotional states.
There are 3 research questions, each with a corresponding work package:
1. What is the existing evidence on image-based based mental health measures?
We will conduct a systematic review to identify image-based measures. The primary output will be examples of different types of measures to use in the next work package.
2. What do young people 8 to 18 years from diverse groups want from an image-based measure?
We will recruit and train a diverse group of 8 to 10 young people with lived experience. They will be co-researchers, for a community-based participatory action research study. Over 6 workshops, we will co-develop the content and design of the image-based measure, testing and refining a prototype in partnership with our development team. At the outset, we will hold separate focus groups with young people, researchers, and practitioners to understand their needs from such a measure. We will speak to them again during co-development for their feedback on the measure.
3. What are young people's thoughts and experiences when completing the image-based measure?
We will test the final prototype with 12 to 15 young people using interviews and think aloud tasks.
The primary output will be a deployment version of the measure for use in the Adolescent Health Study pilot, so that the psychometric properties can be assessed ahead of potential use in the full study.
The protocol, methods, measure, and underpinning code will be publicly available for other people to use the measure and reproduce the methods. This will enable other researchers to develop similar measures and/or to use the measure.
There are 3 research questions, each with a corresponding work package:
1. What is the existing evidence on image-based based mental health measures?
We will conduct a systematic review to identify image-based measures. The primary output will be examples of different types of measures to use in the next work package.
2. What do young people 8 to 18 years from diverse groups want from an image-based measure?
We will recruit and train a diverse group of 8 to 10 young people with lived experience. They will be co-researchers, for a community-based participatory action research study. Over 6 workshops, we will co-develop the content and design of the image-based measure, testing and refining a prototype in partnership with our development team. At the outset, we will hold separate focus groups with young people, researchers, and practitioners to understand their needs from such a measure. We will speak to them again during co-development for their feedback on the measure.
3. What are young people's thoughts and experiences when completing the image-based measure?
We will test the final prototype with 12 to 15 young people using interviews and think aloud tasks.
The primary output will be a deployment version of the measure for use in the Adolescent Health Study pilot, so that the psychometric properties can be assessed ahead of potential use in the full study.
The protocol, methods, measure, and underpinning code will be publicly available for other people to use the measure and reproduce the methods. This will enable other researchers to develop similar measures and/or to use the measure.
Organisations
| Description | Training and development |
| Geographic Reach | Local/Municipal/Regional |
| Policy Influence Type | Influenced training of practitioners or researchers |
| Impact | The improved educational and skill levels of the workforce have seen the confidence of the workforce grow. The application of their learning has grown with each workshop iteration, with further opportunities to apply their learning in subsequent sessions. Furthermore, the application of their learned skills and knowledge has also reached other areas of work; whether this is other research projects or organisations, the positive changes have been recognised by senior staff and facilitators. |
| Title | Image Based Measure |
| Description | Is this going to be patented/trademarked? |
| IP Reference | |
| Protection | Trade Mark |
| Year Protection Granted | |
| Licensed | No |
| Impact | COMPLETE? |
| Description | Focus groups |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Other audiences |
| Results and Impact | Six focus groups took place during the project, totalling 43 attendees. The focus groups were divided into three demographics: young people, researchers and professionals. All participants were located within the UK. - Young people 12-18 (with experience of mental ill health or completing questionnaires or surveys about the health and wellbeing - Researchers (with experience working with young people with mental ill health or working in the field of mental health research with young people and using questionnaires or other mental health and wellbeing measures) - Practitioners (with experience working with young people with mental ill health and using questionnaires or other mental health and well-being measures) The intended purpose of the first focus group was to gather insight for the series of workshops that would be taking place soon after with young people to develop the image-based measure. We gathered insights that would inform and support the development of the measure. The second focus group offered an opportunity for the prototype to be reviewed. The feedback and insight facilitated critical and necessary adaptions to the prototype before testing. The focus groups also provided an environment for the co-researchers to practice the skills required within focus group preparation and delivery. The second focus group was supported by all ten co-researchers who supported the development of the semi-structured questions, topic guide, PowerPoint resources, activities (Icebreakers), note taking and facilitating/delivering parts of the session. These experiences offered a novel opportunity for the co-researchers to engage and develop new skills and confidence in understanding focus group logistics and practicalities. |
| Year(s) Of Engagement Activity | 2023,2024 |
| Description | Workshops |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Study participants or study members |
| Results and Impact | A series of ten four-hour workshops took place over six months with ten participants (now referred to as co-researchers) 12-18 years. The workshop was facilitated by a research fellow, two research assistants and one young champion research assistant. The workshops were underpinned by Participatory Action Research (PAR), which sought to conduct research 'with' rather than 'on' the co-researchers. The main aim of the workshops for the co-researchers was to develop an image-based mental health measure. Other objectives included: 1. Knowledge exchange: provide training and insight towards research methods (focus groups) 2. Knowledge exchange: provide training and insight towards research analysis (thematic) 3. support young people's confidence (including group speaking/work, creative thinking, negotiation, presentation, IT skills) 1. All ten co-researchers attended the optional training for focus groups. None had experienced a focus group before, and within this session, the co-researchers developed many of the core questions used in an external focus group. The same can be said for creating a topic guide that was used to structure the one used within the focus group. The training also gave them a better understanding of the types of research that can be carried out, which many have reported to be interested in as part of their future studies. 2. All ten co-researchers attended the optional training for thematic analysis, and none had experience in thematic analysis. Several of the co-researchers were keen to use the skills they had learnt as part of their future studies. 3. Many young people have reported that the project has helped them in other areas of their lives. Public/group speaking is challenging for many, and they have developed skills to cope and execute this more effectively. The PAR approach facilitated an environment that nurtured this growth, generating a culture that encouraged critical thinking, negotiation, presentation and discussion, many reporting this to be a unique opportunity that has enabled them to learn skills they have then utilised within their home environments. The workshops utilised the IT platform MIRO and facilitated a new environment for young people to engage and develop their IT, presentation and collaboration skills. The workshops allowed the co-researchers to decide how they wanted to work and facilitated team-building opportunities. The workshops offered the co-researchers other opportunities to test their confidence and many other social skills. For some, this was a rare opportunity and saw them learning or growing these skills that would be harnessed within their social spheres. Finally, the co-researchers regularly ask for information about the project and how they might be able to be involved in further work. One example is a co-researcher asking to carry out their school work placement on the project. The organisation is developing an itinerary to enable this and support young people in learning about the organisation and their involvement in writing a paper. The workshops also saw an impact on the facilitators. The workshops offered the research fellow several new learning opportunities: using PAR with young people and working with IT development teams to develop interactive measures, leadership, and training for others. The skills harnessed have furthered their understanding of working in this way, and they have been invited to share the success, development and application of the method with the Anna Freud organisation. For the young champion, they have had the opportunity to develop their facilitation and resource development skills. They could apply these skills in workshops, focus groups, and planning sessions. The project was the first exposure the research assistants had to PAR. Having been provided with a range of development opportunities, they have supported the development of resources, the designing and refining of the sessions and the facilitation of workshops and focus groups. Following their interest and enjoyment in the project, the research assistants have actively requested further information from the research fellow to develop their knowledge in PAR and how this could be applied in future research. |
| Year(s) Of Engagement Activity | 2023,2024 |