title: Acceptability of Mental Health Apps for Aboriginal and Torres Strait Islander Australians: A Qualitative Study.
abstract: BACKGROUND
  Aboriginal and Torres Strait Islander Australians experience high rates of mental illness and psychological distress compared to their non-Indigenous counterparts. E-mental health tools offer an opportunity for accessible, effective, and acceptable treatment. The AIMhi Stay Strong app and the ibobbly suicide prevention app are treatment tools designed to combat the disproportionately high levels of mental illness and stress experienced within the Aboriginal and Torres Strait Islander community.
  
  
  OBJECTIVE
  This study aimed to explore Aboriginal and Torres Strait Islander community members' experiences of using two culturally responsive e-mental health apps and identify factors that influence the acceptability of these approaches.
  
  
  METHODS
  Using qualitative methods aligned with a phenomenological approach, we explored the acceptability of two culturally responsive e-mental health apps through a series of three 3-hour focus groups with nine Aboriginal and Torres Strait Islander community members. Thematic analysis was conducted and coresearcher and member checking were used to verify findings.
  
  
  RESULTS
  Findings suggest strong support for the concept of e-mental health apps and optimism for their potential. Factors that influenced acceptability related to three key themes: personal factors (eg, motivation, severity and awareness of illness, technological competence, and literacy and language differences), environmental factors (eg, community awareness, stigma, and availability of support), and app characteristics (eg, ease of use, content, graphics, access, and security and information sharing). Specific adaptations, such as local production, culturally relevant content and graphics, a purposeful journey, clear navigation, meaningful language, options to assist people with language differences, offline use, and password protection may aid uptake.
  
  
  CONCLUSIONS
  When designed to meet the needs of Aboriginal and Torres Strait Islander Australians, e-mental health tools add an important element to public health approaches for improving the well-being of Aboriginal and Torres Strait Islander people.
authors.affiliation: Darwin Remote Mental Health Service, Top End Mental Health Service, Northern Territory Department of Health, Darwin, Australia. josie_povey@hotmail.com.
authors.forename: Josie
authors.identifier: http://orcid.org/0000-0001-6961-4674
authors.initials: J
authors.lastname: Povey
authors.forename: Patj Patj Janama Robert
authors.identifier: http://orcid.org/0000-0002-0362-499X
authors.initials: PP
authors.lastname: Mills
authors.forename: Kylie Maree
authors.identifier: http://orcid.org/0000-0002-7841-4751
authors.initials: KM
authors.lastname: Dingwall
authors.forename: Anne
authors.identifier: http://orcid.org/0000-0001-9540-1939
authors.initials: A
authors.lastname: Lowell
authors.forename: Judy
authors.identifier: http://orcid.org/0000-0002-9403-3393
authors.initials: J
authors.lastname: Singer
authors.forename: Darlene
authors.identifier: http://orcid.org/0000-0002-2346-7856
authors.initials: D
authors.lastname: Rotumah
authors.forename: James
authors.identifier: http://orcid.org/0000-0003-0998-116X
authors.initials: J
authors.lastname: Bennett-Levy
authors.forename: Tricia
authors.identifier: http://orcid.org/0000-0002-4123-7229
authors.initials: T
authors.lastname: Nagel
mesh_terms: D000293:Adolescent; D000328:Adult; D001315:Australia; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000523:psychology / Q000628:therapy*; D008603:Mental Health; D008875:Middle Aged; D063731:Mobile Applications; D010342:Patient Acceptance of Health Care; D036301:Qualitative Research; D012111:Residence Characteristics; D013315:Stress, Psychological / Q000523:psychology / Q000628:therapy*; D055815:Young Adult; D000092864:Suicide Prevention
keywords: acceptance and commitment therapy; cognitive behavioral therapy; culturally competent care; indigenous populations; mental health; mobile apps; therapeutics