Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
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BMC medical research methodology
Digital focus groups in healthcare interventions: A reflexive methodological analysis of how socio-technical and relational factors co-produce qualitative data.
BACKGROUND: Digital focus groups are increasingly used in health research, yet their methodological implications within complex interventions remain insufficiently examined. When conducted with pre-existing cohorts, digital focus groups may function not only as evaluative tools but also as relational and socio-technical encounters that shape the generation of qualitative data. The goal of the present study was to examine how digital focus groups operate within this context. METHODS: This study presents a methodological re-analysis of focus group material originally collected for the evaluation of a hybrid psychosocial prevention intervention, examining how digital focus groups operate within this context following the perspective of Situational Analysis. Digital focus groups were conducted with participants who had completed the hybrid intervention together in fixed cohort groups, meaning participants were already acquainted with one another prior to the focus group sessions. For the analysis, the transcripts were examined using descriptive, inductive coding. Verbatim quotations were used as methodological markers to illustrate how relational, emotional and technological factors shaped the data. RESULTS: Pre-existing cohort cohesion strongly influenced how participants engaged in the digital setting, fostering emotional safety, peer-supported learning, motivational reinforcement and opportunities for self-regulation. Digital platforms structured visibility, turn-taking and synchronization, while differences in devices, connectivity and digital literacy affected participation and the stability of group interaction. The researcher role expanded to include facilitation, technical troubleshooting and emotional anchoring, making the research team part of the socio-technical infrastructure. At times, the focus groups elicited supportive or motivational effects that echoed elements of the intervention itself, blurring the line between evaluation and unintended interventional effects. CONCLUSIONS: Focus groups in intervention research operate as relational encounters rather than neutral data-collection tools. This applies particularly to Digital Focus Groups. Recognizing how pre-existing relationships, technological environments and researcher involvement shape interaction is essential for methodological transparency and rigorous interpretation. The findings highlight the importance of reflexivity, attention to digital differences, and awareness of unintended interventional dynamics when designing and interpreting digitally mediated qualitative methods in healthcare contexts. Furthermore, the findings indicate that the choice between digital and in-person FGs should not be guided by pragmatic considerations alone, but by the relational, technological and institutional conditions of the research situation. TRIAL REGISTRATION: DRKS-ID: DRKS00033080 (registration date: December 7, 2023).
13 July 2026
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Coproduction Without Youth? Closing the Participation Gap in Digital Mental Health Research
Young people are among the most intensive users of digital and generative artificial intelligence (GenAI)-enabled mental health tools, yet they remain underrepresented in the research and design processes that shape these technologies. Although participatory approaches such as co-design and patient and public involvement are widely endorsed as best practices, youth involvement in digital youth mental health (DYMH) research is often inconsistent, superficial, or limited to late-stage consultation. This participation gap risks producing interventions that are misaligned with young people's lived experiences, priorities, and vulnerabilities, particularly in the context of rapidly evolving and scalable GenAI systems. This Viewpoint aims to reexamine the underlying drivers of the participation gap in DYMH research; clarify how participation is conceptualized and implemented across disciplines; and propose concrete, actionable recommendations to support more meaningful and consistent youth involvement across the research life cycle. We draw on interdisciplinary literature from digital mental health, human-computer interaction, child-computer interaction, and health research policy. Our Viewpoint integrates conceptual frameworks (eg, Lundy's model of participation), existing reviews of co-design practices, and emerging evidence on GenAI in mental health. We adopt a life cycle-oriented perspective to examine how youth participation is distributed across stages of research and development, including problem formulation, design, implementation, and evaluation. We identify 3 interrelated drivers of the participation gap. First, conceptual and linguistic fragmentation obscures what participation entails in practice, with terms such as co-design, participatory design, user-centered design, and patient and public involvement used inconsistently across disciplines. Second, youth involvement is uneven across the research life cycle, with participation often concentrated in early ideation or usability testing but largely absent from upstream decision-making and downstream evaluation. Third, institutional barriers-including ethics review processes, consent requirements, funding constraints, and adult-centric research norms-systematically limit meaningful youth partnership. These challenges are amplified in the context of GenAI, where opaque "black box" systems, simulated therapeutic interactions, and rapid deployment cycles introduce distinct risks if youth perspectives are not integrated. We propose a set of minimum expectations to address these gaps, including explicit specification of participatory models, life cycle mapping of youth involvement, reporting of youth influence on decisions, dedicated funding for participation, proportional ethics frameworks, and mechanisms for youth-informed governance of GenAI systems. Closing the participation gap in DYMH research is both an ethical imperative and a practical necessity. Moving beyond aspirational commitments requires embedding youth participation as a standard, resourced, and accountable component of research, design, and governance. In the context of rapidly evolving digital and GenAI technologies, failure to do so risks producing interventions that are scalable but not safe, credible, or responsive to the needs of young people.
27 June 2026
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