# Barriers and Enablers to Young People’s Posting, Responding, and Reading Behaviors on Mental Health Forums Using the Behavior Change Wheel: Qualitative Study

## TL;DR

This study explores what motivates or discourages young people from engaging with online mental health forums, using interviews and behavior change frameworks to identify ways to improve these platforms.

## Contribution

The study identifies specific behavior change techniques to enhance engagement with youth mental health forums, based on qualitative insights from young users.

## Key findings

- Anonymity and positive user interactions encourage active participation in forums.
- Moderation and mobile optimization influence both positive and negative engagement outcomes.
- Emotional responses and perceived safety are key factors in young people's forum use.

## Abstract

Web-based mental health forums have the potential to play a significant role in providing accessible support for young people, supplementing in-person services and contributing positively to their mental well-being. However, limited engagement often constrains their impact and effectiveness in supporting young people.

Using the Behavior Change Wheel framework, this qualitative study explores the barriers and facilitators to young people’s engagement with web-based mental health forums, focusing on the behaviors of creating new posts, responding to posts, and reading posts. Behavior change techniques (BCTs) are identified to address these barriers.

Semistructured interviews were conducted with 13 young people aged 17-25 years who use UK-based youth mental health forums. Three participants self-identified as men, 8 as women, 1 as nonbinary, and 1 chose not to disclose their gender. Transcripts were coded using the Theoretical Domains Framework (TDF), followed by inductive theme generation. TDF barriers were then mapped to BCTs to suggest intervention strategies.

Thematic analysis revealed ten inductive themes across 5 TDF domains. Of these, 3 were enablers, 2 were barriers, and 5 functioned as both enablers and barriers. The findings indicated that skills, beliefs about consequences, emotions, and the social and physical environment are key influences on young people’s engagement with web-based mental health forums. Positive emotions experienced after using the forums enabled posting, responding, and reading behaviors. Enablers of more active participation (ie, posting and responding) included anonymity and positive interactions with other users. The presence of moderators acted as an enabler for all 3 behaviors by providing a safe environment, but also as a barrier to posting, as moderation could restrict the content of users’ posts. Similarly, mobile access facilitated posting, responding, and reading, whereas layouts not optimized for mobile use acted as barriers to typing and reading on the go.

This study contributes to the existing knowledge base by examining the different ways in which young people engage with youth mental health forums. Different strategies may be prioritized and adopted depending on whether forum providers aim to increase more active forms of engagement (eg, posting and responding, which can be encouraged by fostering positive interactions with other users) or overall engagement (eg, establishing clear rules of engagement and optimizing web page content for mobile access can benefit all forms of engagement). These insights can help improve the delivery of youth mental health forums and foster a positive ecosystem of support for young people.