Fae Marie Hiramis
Young adults in Aotearoa New Zealand face high rates of psychological distress alongside constrained access to face-to-face mental health care. Digital mental health interventions (DMHIs) such as Just a Thought (JaT), a free, web-based cognitive behavioral therapy (CBT) programme, are increasingly promoted as part of the stepped-care response. However, less is known about how young adults in distress actually experience and engage with JaT in the context of their wider help-seeking journeys. In this thesis, I aimed to explore how the young adults engage with JaT situated in the context where long waitlists and limited access to face-to-face care have prompted interest in digital mental health interventions as low-threshold, scalable support options. Working from a critical realist perspective and drawing on health psychology and engagement theory (including the COM-B model: Capability, Opportunity, Motivation - Behaviour), I conducted in-depth semi-structured interviews with a small group of young adults (aged 18–25) (n=8) who had been offered or used JaT through university and youth services. Recruitment occurred through clinical services (e.g. student health and counselling), self-referral pathways (posters and social media), and collaboration with service providers. Interviews focused on how participants first encountered JaT, what motivated them to try it, what supported or hindered ongoing use, and how they understood JaT’s place in their overall care. I analyzed the data using reflexive thematic analysis. I developed four themes: (1) ‘Reaching for something in the gap’, this theme situates JaT as a bridge and supplement within constrained services, used “in the meantime” while on waitlists or between appointments, and valued for providing a sense of doing something active for one’s mental wellbeing; (2) ‘Helpful, but hard to hold onto’, this theme describes how distress and life load (study and work demands), and limited energy made it difficult to sustain engagement, even when JaT was perceived as useful; (3) ‘Self-guided CBT in a human world’, this theme captures the tension between appreciating JaT’s tools and psychoeducation and, for many, wanting relational, responsive support that a self-guided programme cannot provide; and (4) ‘Designed for everyone, fitting unevenly’, this theme highlights how JaT’s web-based, text-heavy, “for everyone” design was experiences as visually appealing and accessible, yet often effortful, easy to forget, and only partially tailored to diverse needs and contexts. Together, these findings suggest that while JaT is experienced as a genuinely useful resource, engagement is strongly shaped by young adults’ capability and opportunity to use it within busy, distressing, and digitally saturated lives. My study suggests that JaT may be most effective when positioned as a low-effort, mobile-friendly, and optionally blended “bridge” within youth mental-health pathways, rather than as a stand-alone solution.