New paper sheds light on myHealthE usability and accessibility

With children and young people's mental health services facing unprecedented levels of demand, it's important for families to monitor children's mental health outside of appointments. However, response rates for mental health questionnaires are historically low. This is why we created myHealthE. Launched in 2021, myHealthE is an online platform for families accessing their local Child and Adolescent Mental Health Services, or CAMHS. Here, caregivers can respond to questionnaires about their child’s mental health throughout their CAMHS journey. In 2023, in response to community feedback, we introduced curated resources and signposting to myHealthE via the Virtual Waiting Room. Watch this video to find out more about how myHealthE is transforming local CAMHS. 

In May 2023, we released a survey to myHealthE users on its accessibility, usability, and users’ overall comfort with digital services. We have just published our analysis of the survey results in JMIR Pediatrics and Parenting. 

We have done a lot of work in the past year and a half to respond to the feedback from this survey; read on to find out how users’ input has been used to improve myHealthE. 

Increasing the accessibility and visibility of information about services  

You said: Parents highlighted areas where they would like more information, such as ‘updates on local group meetings’ and ‘tools to assist parents or webinars for accessing tools and services’. Many also highlighted simply not being aware of the information on myHealthE, with one user commenting ‘I wasn’t aware of these new resources… I recommend promoting those more’. Indeed, only 10% of respondents had noticed the launch of the Virtual Waiting Room in January 2023, indicating we needed to work on making this more visible. 

We did: We have taken steps to increase the visibility of information about local boroughs’ specific services within myHealthE. For example, once parents complete the initial questionnaire, they receive a pop-up that redirects them to pages on ‘information while you wait’ and ‘about your service’. We are also increasing the visibility of information on users’ local CAMHS.  

Key learning: We need to publicise myHealthE changes better. Some of the user comments highlighted things we were already doing – showing that any update is only as good as your ability to let users know about it. We hope that further improving the visibility of our existing resources can meet a variety of user needs, and that continuous feedback will help us make further changes to myHealthE. 

Integrating myHealthE into families’ CAMHS journey  

You said: Receiving customised information and not feeling ‘lost in the system' were important to users. One user wrote ‘I don’t know if anybody reads the information collected.’ Users commented positively on aspects of myHealthE which gave insights to their CAMHS journey, with one user noting that ‘[c]ompleting the questionnaires and seeing the results over time helps me understand my son’s progression.’ 

We did: We are continuing to improve the way we communicate to caregivers about myHealthE. The first communication that caregivers receive from their local CAMHS after referral will no longer be an email asking them to sign up to myHealthE. They will instead be sent a text with a video about their local borough’s CAMHS. This video then explains myHealthE, highlighting how it can be used to support people's journey through CAMHS. On the clinicians’ side, we are offering training to make clinicians more aware of myHealthE. This will allow them to integrate the information and support that myHealthE and the Virtual Waiting Room offer into their regular care, providing a more smooth and interconnected experience for families.  

Key learning: There are a number of things that myHealthE is already doing well in terms of getting users the information and data they need in an accessible way. However, a greater degree of integration between clinical services and the platform, and an onboarding process that feels fully embedded into the overall CAMHS journey, would support better communication with users. 

Designing with accessibility in mind 

You said: Many users highlighted how mobile phone accessibility was key, with one user commenting ‘I struggled to remember where to logon. I [wish] there was an app’. Our results showed that 98% of users were accessing myHealthE through a mobile phone.  

We did: Knowing that most people access myHealthE on mobile phones, we have focused our design decisions on mobile phone accessibility. For example, there is a myHealthE page where parents can access their CAMHS acceptance letter, at the end of which they are signposted to further resources. In initial designs, the letter was long, such that users might have missed the signposted resources if they didn’t scroll down far enough. We have reduced its length to maximise the visibility of these resources for mobile phone users.   

Key learning: The growing ‘digital divide’ between those who can and cannot easily access digital services has rightfully received a lot of attention. Thankfully, myHealthE is still supporting these families; the automation of myHealthE saves each CAMHS administrator and clinician an estimated 40 minutes per week: equalling thousands of hours per service per year. This frees up critical time on busy CAMHS teams to identify and work closely with people who may struggle to access digital services like myHealthE. Recent data indicates that myHealthE is not only reaching but increasing engagement with diverse groups in our community; over 2023, we saw an increase of 8,631 in completion of the SDQ questionnaire, which represents a 314% increase for non-white ethnic groups.  

But it’s important to consider nuance in where the digital divide lies: the majority of people in the UK have some type of online access, with estimates that over 90% of homes in the UK have access to a mobile telephone. The ‘digital divide’, then, isn’t just about having a device through which to access services: it’s about having the digital skills to use those services. Our data support this idea: the survey showed that people from higher-income homes marked themselves as more confident using digital services. In order to not entrench inequalities via the digital divide, it is our job to design systems that are easy to navigate, and communicate their function and purpose to people in a simple way. We are hoping to work more on supporting access to digital services through myHealthE. One of the myHealthE team, Dr. Shuo Zhang, is currently completing a mixed methods project as part of her PhD which will include an exploration of the experiences of people from marginalised backgrounds waiting for CAMHS. We look forward to hearing the findings from this important research, and learning how we can make myHealthE even more accessible.