Abstract
The COVID-19 pandemic has had a significant impact on individuals, families, and communities, leading to increased stress, anxiety, and mental health issues. To address these needs, Together for Wellness/Juntos por Nuestro Bienestar (T4W/Juntos), a website providing mental health resources, was created. This study aims to understand the experiences of users of the T4W/Juntos website, to learn about the benefits of the website for its users during the pandemic, and to identify areas for improvement. A thematic analysis was conducted with answers given by 199 participants who responded to at least one of six open-ended questions that were included with other close-ended questions (reported elsewhere) in an electronically administered survey. The open-ended survey questions were developed with input from diverse stakeholders, including under-resourced populations. The sample was recruited through partnerships with 11 state-wide agencies. Five main themes were identified from analysis of the data. The major themes were (1) Disruptions and Challenges Experienced During the COVID-19 Pandemic, (2) Benefiting from an Accessible Website, and (3) Wanting Access to Additional Resources. The University of California, Los Angeles (UCLA), Institutional Review Board (IRB) for Human Subjects approved the study, and participants provided informed consent. The website provided access to resource links that brought needed information, a sense of empowerment, and support for individuals dealing with mental health issues related to the pandemic. Participants highly recommended the website to others. However, they also suggested improvements such as more specific resources and additional languages.
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The COVID-19 pandemic has brought attention to mental health as a crucial public health issue (Goodsmith et al., 2022; Rains et al., 2021). The physical distancing, business closures, and school closures, as well as the grief and stress associated with the pandemic, have had profound mental health consequences (Pfefferbaum & North, 2020; Wells et al., 2022). The pandemic has also disproportionately impacted communities of color, including African-American, Asian and Pacific Islander, Indigenous, and Latinx populations (Moreno et al., 2020). The ongoing attention to police violence toward African-Americans, as well as systemic racism against other groups including Asian-Americans, has further exacerbated these mental health consequences (Gillard et al., 2021).
Mental health is a crucial aspect that determines an individual’s ability to manage stress, make decisions, and maintain interpersonal relationships (Gillard et al., 2021). The COVID-19 pandemic has had a substantial impact on mental health globally, leading to an increase in mental health conditions of those with pre-existing mental health problems (Gillard et al., 2021; Rains et al., 2021). Qualitative research methods have been employed to gain insight into the real-life experiences of individuals suffering from mental health issues during the pandemic (Shah et al., 2022). These methods, including phone/video interviews, and survey questionnaires have provided valuable information about the real pain and struggles of individuals suffering from mental health difficulties during the COVID-19 pandemic (Shah et al., 2022). The pandemic has also had a significant impact on children and adolescents, causing feelings of depression and maladaptive behaviors (Cullen et al., 2020; O’Sullivan et al., 2021). The lockdowns and quarantine policies have led to a rise in domestic violence, loneliness, depression, self-harm, and suicidal behaviors (Kumar & Nayar, 2021).
During these unprecedented times, technology has played a critical role in addressing the mental health challenges posed by the pandemic (Torous et al., 2020). Telehealth and video telehealth have provided patients with the ability to connect with doctors and therapists through video chat or over the phone (Alhusseini et al., 2020; Taylor et al., 2020). This has increased access to mental health services and improved the quality of care for those struggling with mental health during the pandemic (Torous et al., 2020). Prior to the pandemic, technology was already being used to increase access to mental health services (Torous et al., 2020). During the pandemic, the widespread use of technology has seen a 69% increase in organizations reporting that online mental health resources and video features were used by most of their employees (Molfenter et al., 2021). These services have resulted in depression and anxiety reduction among older adults (Gould & Hantke, 2020; Molfenter et al., 2021).
Emerging technologies, such as Internet-based interventions, mobile applications, telemedicine, and virtual reality, offer opportunities to support patients suffering from mental health issues and provide access to evidence-based treatment in remote and rural areas (Gilmore et. al., 2017; Rizzo, 2019). In 2015, 89% of Americans and a median of 87% of people across 11 advanced economies reported using the Internet or owning a smartphone (Gilmore et. al., 2017). With the increasing use of technology, these innovations offer practical opportunities to scale mental health treatment and support patients in need (Gilmore et. al., 2017; Rizzo, 2019). Studies such as those by Timakum et al. (2022) have mapped the relationship between these technologies and mental healthcare, highlighting the rising trends in Internet-based interventions and mobile applications that offer new avenues for delivering mental health services (Timakum et. al., 2022). Additionally, digital mental health services, particularly those delivered via web-based platforms, have been recommended for expanding the accessibility of care. Such services must be designed with end-user considerations to ensure equitable access across diverse populations, as underscored by the COVID-19 pandemic’s impact on mental health care delivery (Lattie et. al., 2022).
In response to the COVID-19 pandemic, the California Department of Health Care Services Behavioral Health Division, in collaboration with the Mental Health Services Oversight and Accountability Commission, initiated a project aimed at developing free accessible digital mental health resources for under-resourced communities across the state. To this end, the UCLA Center for Health Services and Society, UC Davis, and Chorus Innovations were tasked with leading the effort to curate and provide a comprehensive list of digital mental health resources through a dedicated website called Together for Wellness/Juntos por Nuestro Bienestar (T4W/Juntos).
Development of the T4W/Juntos Website
In March 2020, as part of its Federal Emergency Management Agency/ Substance Abuse and Mental Health Services Administration (FEMA/SAMHSA) mental health crisis counseling contract, the California Health Care Services Division of Behavioral Health has enlisted UCLA as a subcontractor to create a website that offers links to digital mental health resources (Goodsmith et al., 2022; Wells et al., 2022). The website is called “Together for Wellness/Juntos por Nuestro Bienestar (T4W/Juntos).” The T4W/Juntos website was launched in October 2020 through a collaboration with community agencies, UC Davis, and Chorus Innovation. Input was received from diverse groups, including Latinx, African-American, LGBTQ + , Asian-American, and parents of youth, among others. Eleven agencies, representing diverse population, have reviewed the website which included links to existing free evidence-informed and evidence-based mental health resources (Goodsmith et al., 2022; Wells et al., 2022). The website is continuously updated to ensure ongoing improvement. The first phase of evaluation was done in 2022 (Wells et al., 2022). Plans for future evaluation are also in place to assess the website’s effectiveness and impact.
T4W/Juntos includes 133 resources, such as websites, videos, hotlines, PDFs, apps, and YouTube links, that are organized into six main categories: (1) Learn about COVID-19, (2) Soothe Anxiety and Stress, (3) Support Resilience, (4) Cope with a Recent Loss, (5) Connect with People & Support Social Justice, and (6) Need to Talk to Someone. The resources include information on COVID-19, mindfulness meditations, tips on dealing with anxiety and stress, school well-being guides, resources for coping with loss, hotlines for support, and information on racial justice, among others. The resources are available in 13 languages.
The development of the website and the questionnaires was informed by the Technology Acceptance Model (TAM) (Venkatesh & Davis, 2000), and the Behavioral Model for Vulnerable Populations (Gelberg et al., 2000). The TAM highlights the role of user engagement and comfort in the use of technology (Venkatesh & Davis, 2000). Meanwhile, the Gelberg et al. (2000) Vulnerable Population Model considers the factors affecting under-resourced populations.
This study aims to expand upon a previous Together for Wellness/Juntos por Nuestro Bienestar (T4W/Juntos) evaluation study by offering a qualitative perspective on the experiences of a sample of T4W/Juntos website participants. The study responds to two research questions. First, during the COVID-19 pandemic, what are the perceived benefits of a website with links to free mental health resources for participants of various backgrounds who may suffer from mental health issues in California? Second, during the COVID-19 pandemic, what are the experiences of the participants of a free web-based app that offers mental health resources for Californians?
Methods
Study Design
The present study is a qualitative examination of answers to six open-ended questions related to mental health experiences during the COVID-19 pandemic answered by participants via an electronic survey. The six survey questions were developed in collaboration with stakeholders from diverse communities, including ethnic minority groups, parenting groups, and organizations focused on LGBTQ concerns, among others. One hundred ninety-nine participants responded to at least one of six open-ended questions that were included with other close-ended questions (reported elsewhere) in an electronically administered survey.
Recruitment Process
The recruitment of participants was conducted in partnership with 11 state-wide agencies, including NAMI California, Healthy African American Families, United Parents, Cal Voices, NorCal MHA, Health Education Council, Vision y Compromiso, and the California LGBTQ Health and Human Services Network, with the intention of ensuring a comprehensive and inclusive perspective. To be accountable to diverse communities across California, each agency was engaged in inviting clients, partners, and staff to participate in the study. Participants were eligible if they had online access, spoke English or Spanish, and were aged 18 + years. Participants were asked to review the website materials for at least 30 min and complete the surveys. The first phase involved a brief, voluntary, opt-in survey. In the second phase, a baseline survey was administered (September 20, 2021, to April 4, 2022) that included two open-ended questions, and participants were compensated for their participation. In the third phase, a follow-up survey was administered (October 22, 2021, to May 17, 2022) 4–6 weeks after the initial survey, and included four open-ended questions. Participants received a $25 electronic gift card for each event they participated in.
Four hundred nighty-five individuals completed the eligibility screener. Of the 446 participants who were eligible, 367 (82.3%) consented. Of the 367 who consented, 315 (85.8%) completed baseline surveys and 193 (53%) participants responded to follow-up questions.
One hundred nighty-nine participants responded to at least one of the six open-ended questions of the electronic survey by typing answers into textboxes. Of these 199 participants, 144 answered an open-ended question in the baseline survey (i.e., 90 answered the first and 54 answered the second baseline question) and 152 answered an open-ended question on the follow-up survey (i.e., 36 answered the first, 42 answered the second, 21 answered the third, and 53 answered the fourth question on the follow-up survey). Table 1 offers a comprehensive overview of the open-ended questions that were included in the electronic surveys administered to study participants.
Ethics Approval
The University of California, Los Angeles (UCLA), Institutional Review Board (IRB) for Human Subjects approved the study (20–002163-AM-00008). Participants were provided informed consent and were informed that their data would be de-identified and stored securely, and their contact information would only be used for follow-ups. Participants received a $25 electronic gift card for each event they participated in.
Data Analysis
After conducting baseline and follow-up surveys and receiving responses of the open-ended questions, data was analyzed qualitatively using Braun and Clarke’s thematic analysis (TA) (2006, 2022). The majority of the responses given in the baseline survey were similar to those given in follow-up surveys. Therefore, the data was analyzed as a whole to provide a more comprehensive understanding of the participants’ experiences over time.
The process of TA has been described by Braun and Clarke as a theoretically flexible method that organizes, describes, and interprets qualitative data (Braun & Clarke, 2006, 2022; Clarke & Braun, 2013). The first step was for the first author to get familiar with the data by reading and re-reading the survey responses closely. Then, initial codes were generated in two rounds; the first author did the first round of coding and three volunteer student research assistants helped in coding for the second round. At least two team members coded all data. MAXQDA 2022 software was used to manage the data. Mean percent agreement on codes created by coders was more than 75%. Disagreements were resolved by discussion among the coders. After coding all data, the first author clustered similar codes into preliminary topic groups and the process of searching for themes ensued. Once themes were identified, the next step involved developing definitions based on overall meaning and naming the themes. Then each sub theme was illustrated using quotations from the data that captured the essence of the theme.
Results
Participants Characteristics
Table 2 presents demographic data for the 199 participants who responded to at least one open-ended question. The mean age of 199 participants who responded to at least one open-ended question was 40.2 years. The largest group among them identified as Hispanic. The majority of the sample reported attending some college or being college graduates. English was the preferred language for the majority of 199 participants.
Results from Qualitative Analysis
The five main themes that were identified from the analysis of the data are (1) Disruptions and Challenges Experienced During the COVID-19 Pandemic, (2) Benefiting from an Accessible Website, (3) Most Commonly Used Resources Found on T4W/Juntos Website, (4) Suggestions for Improving Users’ Experience and Impact of the Website, and (5) Wanting Access to Additional Resources. A detailed description of the themes below offer perspective on the multidimensional mental health experiences reported by this sample during the unprecedented times of the pandemic.
Theme 1: Disruptions and Challenges Experienced During the COVID-19 Pandemic
Sub-theme 1: Confusion Related to Health and Fear about Safety During COVID-19 Pandemic
One of the primary challenges experienced by the participants of the study during the pandemic was confusion related to health and fear about safety. “Anger at mask refusers” was a sentiment among those who described themselves as having taken precautions to protect themselves and others. Participants also expressed “Extreme disappointment in non-maskers and negativity toward corporate media,” highlighting the frustration felt by those who took steps to follow guidelines. Participants stated feeling anxious about the risks of exposure to the virus. One reported “High levels of anxiety about retaliation from non-vacciners/non-mask wearers in my community” was a significant source of stress.
The resentment toward those who refused to follow guidelines led to a sense of isolation for some participants, as they struggled to navigate shared spaces with others who did not follow the same protocols. Participants also expressed fear and frustration related to the politicization of the pandemic, with some feeling that the government had not done enough to prevent the spread of the virus. One participant noted, “Incredible sadness from the mass death and government’s inability/unwillingness to prevent it.” Additionally, the mandating of vaccination was a source of stress for some participants, as they noted concerns due to mandating of vaccination even though they already have immunity from having COVID-19.
Sub-theme 2: Personal Life Challenges: Family and Relationships
Another challenge experienced by participants was navigating their personal lives during the pandemic. Participants stated the challenges they faced supporting their children with disabilities. One participant listed “Extreme problems navigating children with ASD resources,” which highlighted the difficulties faced by families with disabled children during the pandemic.
The pandemic also had a significant impact on family dynamics, with individuals experiencing tension and conflict at home. One participant listed a concern that “Challenges with different beliefs about COVID-19 with family members” was a source of tension. In other cases, the pandemic caused significant strain on personal relationships; one participant noted “It wasn’t due to COVID-19, but my long-term (12 + years) relationship ended just as the initial shutdown began (March 2020).” Participants also expressed sadness and grief over the loss of loved ones to COVID-19, with one individual noting, “Extreme grief due to the loss of my father due to COVID-19.”
The pandemic also disrupted important life events and experiences for many individuals. One participant reported “Feeling like I’ve lost the experiences of my early twenties” implying a sense of sadness for having to put important life plans on hold due to the pandemic. Additionally, participants mentioned they were unable to see family members or attend important events due to travel restrictions and lockdowns. As one participant noted, “I was not able to visit my mom in Mexico,” highlighting the emotional toll of being separated from loved ones.
Sub-theme 3: Emotional Struggles
From anxiety and depression to compassion fatigue and PTSD, the responses provided by website users revealed the breadth of emotional experiences people were encountering. The pandemic has been a time of great uncertainty and disruption, leading to increased anxiety and worry for many individuals; one user expressed fear of the stress related to returning to an office setting. They wrote, “Anxiety about working in an office. My overall health has improved since working from home. I’m afraid of the stress related to going back to an office setting.” Other emotional struggles resulted from the impact of isolation; one user described their quarantine experience as “jail-like.” Another participant shared, “Unusual and long-lasting uptick in sensory overwhelm symptoms after being inside for a long time: outside felt too bright, too loud, etc.” which illustrated how being confined to one space for extended periods led to sensory sensitivity and subsequent feelings of stress when encountering the outside world. Similarly, another participant named another kind of overload, “Compassion fatigue,” which they said stemmed from “emotionally supporting friends who struggle to cope with ‘shelter-at-home’ policy.”
Sub-theme 4: Education and Work-related Challenges
A broad range of challenges were faced by parents and children alike when it came to adapting to remote learning and changes in school policies during the pandemic. One parent shared that “Distance learning with my children was a challenge.” Another shared that “Schools sending kids home for headaches caused a loss of work wages due to kids missing school for normal everyday symptoms.”
The pandemic also impacted employment in various ways, as some employers required in-person services, while others transitioned to remote work. One participant reported back problems from working at home without a proper ergonomic setup. Another shared dissatisfaction with increased screen time saying, “Not wanting to use the computer because I have to use it for work all the time.” Additionally, financial concerns led one person to report, “Financially, I was very worried because there was no work for almost 6 months. I struggled to keep gas in my car and get food.” The pandemic’s impact on the economy and job market led to difficult decisions regarding career paths in search of financial stability.
Theme 2: Benefiting from an Accessible Website
Sub-theme 1: Empowerment and Support in Times of Need
The website seems to be a valuable resource for participants, providing them with tools to manage their mental health and well-being. One participant noted, “Using the website gave me a sense of control over my own well-being.” Participants felt that the website was empowering as it offered a balance of emotional support and educational resources that were informative and useful for anyone who needed help managing their mental health. One participant mentioned, “The website provides empowering and educational resources that help individuals feel supported and understood.” Another participant noted, “The resources provided by the website were very informative and empowering. I learned a lot about coping with anxiety and depression.”
The website also offered a sense of community to those who used it. Participants felt that it provided an additional source of support to complement their weekly therapy sessions. One participant noted, “I felt supported and felt reduced isolation by using the website.” Participants stated that they learned new techniques for managing anxiety and depression. Quotes such as “The resources provided by the website were very informative and empowering. I learned a lot about coping with anxiety and depression” and “The website offers a great balance of emotional support and educational resources. It’s a great tool for anyone who needs help managing their mental health” highlight how participants value the educational resources provided by the website.
Sub-theme 2: Comprehensive Information that is Easy to Understand
This sub theme reflects the participants’ feedback regarding the website’s ability to provide a wealth of information in an easily accessible and user-friendly manner. Participants appreciated the comprehensiveness of the information provided on the website, as evidenced by quotes such as “In my personal opinion, the information that is currently being shared is quite comprehensive.” Participants commented on the website’s ability to present information in a simple, easy-to-understand way, without overwhelming technical vocabulary. Other comments highlighted the website’s user-friendliness and the ease with which visitors could find the information they needed, such as “The website is very easy to understand and accessible for everyone.” Participants also shared that they valued being able to download and print resources for later use.
Sub-theme 3: Praise and Appreciation for the Website
Participants shared some feedback and comments about the website. One pointed out, “I really appreciate the effort put into creating the content on this website. It’s clear that a lot of thought and care went into it.” Quotes such as “Website is great,” and “Amazing website” demonstrated a high level of praise. Participants also appreciated the functionality and design of the website, as evidenced by comments such as “Looks great and functional.” In addition to praising the website’s resources, participants also highlighted specific aspects of the website that they found helpful. For example, one participant commented that “I found helpful videos on the website that I could share with foster and adoptive agencies.” Others noted the volume of resources saying, “there were so many resources” and a “great variety of resources for stress/anxiety.” Overall, participants found the website to be a valuable resource.
Theme 3: Most Commonly Used Resources Found on T4W/Juntos Website
Sub-theme 1: Resources to Enhance Emotional Strengths
The website offered participants various resources and techniques to build resilience and manage stress and anxiety. Participants appreciated the mindfulness resources available on the site. The UCLA Mindful App was one of the most commonly used apps by the users. Other commonly used resources were listed as the Mindful Meditation app and mindfulness activity videos. One user noted, “I use the Deep Breathing for Beginners and Tune In: A Mindfulness Activity for kids and the families I work with. It is an easy place for them to bookmark while also accessing the rest of the resources.” Another shared that “MindShift” and “Butterfly Breathing” were some of the resources that they found helpful. Another reported that “I use the Soothe Anxiety and Stress section quite a bit for myself and the parents and caregivers I work with.” Other participants highlighted the use of apps like Sanvello and Safe Place. The website also includes resources specifically designed for teachers which participants found useful. The grief support resources were also appreciated by participants, with one noting the importance of the “Grief support resources including videos and PDFs.”
Sub-theme 2: COVID-19 Related Information and Resources
Participants reported that they frequently used the information and resources related to the pandemic on T4W/Juntos. They said they learned a lot from COVID-19 general information and the COVID-19 vaccine information including details specifically for children. Overall, the availability of COVID-19-related information and resources on the website was seen as a valuable feature, with participants commenting on the need for up-to-date information and the changes related to COVID-19. As one participant put it, “Resources about COVID-19 and the changes with COVID-19 were the kinds of resources I consider to be important to have on the site.”
Sub-theme 3: Support Lines and Crisis Helplines
Providing participants with access to immediate support during times of crisis was identified as wanted and useful. Participants said they turned to these crisis resources available on the site, with one noting, “I use helplines most often.” The Crisis Helplines section provided participants with a variety of resources, including CalHope Connect and the CDC resources. The “Need to talk to someone” section on the T4W/Juntos website was also popular among participants looking for immediate support. Participants of the study appreciated the inclusion of resources such as 211 and CalHope Connect, which provided them with easy access to professional assistance.
Theme 4: Suggestions for Improving Users’ Experience and Impact of the Website
Sub-theme 1: Improve the Website’s Function Including Easier Access
Feedback from participants included ways to enhance the website’s usability and accessibility. One participant suggested that the T4W/Juntos team should “Make browser website more compatible to computer viewing, widen and add menu bar at the top of page. Streamline to require less reading and clicking to new sites.” The visuals on the website were generally praised by participants with one commenting that “The visuals are very helpful and easy to understand.” However, some participants suggested visual improvements, such as “Make each topic in bold written” for easier navigation or content type changes; one said, “I prefer more written resources rather than videos.” Another recommended closed captions on all videos. Participants shared other suggestions such as allowing connection to “an App available in App Store, that way it is easier to access info.” To make the website more accessible, some recommended offering local resources based on zip code and not just general warm-lines, which they felt were too informal. Another participant recommended including instructions on how to bookmark a page for easy, convenient access.
Sub-theme 2: Current Content Quality and Need for Continuous Updates
Participants valued high-quality and up-to-date content on the website. Some participants emphasized the importance of regular updates, and one claimed that “frequent updates to content” were necessary to keep them engaged with the website. Others pointed out specific areas where the content was outdated and needed updating, such as “The content in COVID and pregnancy” which they said “should be changed to reflect the changes in what we know about COVID, masks, surface contamination, etc.” One participant also requested that the website incorporate information on the “updated laws and politics of California regarding COVID and food security and homelessness efforts.” Another participant stated, “the content gave good general information with regard to mental health and stress.” However, some participants felt that the content was too long and could benefit from being more streamlined to require less reading and clicking. Others felt that the website could be more user-friendly in terms of its layout.
Sub-theme 3: Worthy of Being Promoted for Increased Public Awareness
Participants emphasized the importance of increasing public awareness of the website’s existence and usefulness. They suggested that the website should be promoted more widely through various digital and traditional channels, such as social media, television, and radio to reach those who could benefit from it. One stated the need for, “More advertising for greater public exposure.” Another suggested that the website should target specific populations, such as the immigrant community or the Baby Boomer generation, to increase its reach and impact. Participants specifically suggested that “local mental health affiliated organizations should be informed of the website’s usefulness to individuals with mental health conditions and to those suffering with a mental health condition.”
Theme 5: Wanting Access to Additional Resources
Sub-theme 1: Suggestions for Additional Mental Health–related Resources
Participants felt that the website could benefit from additional resources on different types of mental health issues to help individuals with mental health conditions. One participant shared they wanted more materials “Describing different types of mental illness, how to self-identify, spot in others, and get help.” One participant stated, “More stress relief resources for adults,” while another suggested, “More anxiety resources for kids.” Some participants requested “More detailed resources on how to find a therapist or mental health services.”
Sub-theme 2: Suggestions for Additional Resources for Specific Communities
Participants wanted more mental health resources that are tailored to specific communities. One participant noted, “Adding crisis hotline numbers like mental health hotline, or hotline for LGBTQ crisis” would be helpful. In addition, participants suggested the need for more culturally specific resources for people with disability. One requested more “resources about the senior population,” as senior centers were closing, and they noted many seniors feel isolated. Additionally, participants emphasized the importance of addressing mental health issues in racial minority groups. According to an African-American participant, “we have to learn to dismiss what our culture taught us about depression. We have to not be so strong all the time and let people know when we’re not okay.” Others suggested resources for racial trauma, as one participant stated, “A bit more talking the problems in Chinese Community because of the COVID-19.” Others want to see more resources around addiction, immigration, and indigenous communities. One participant noted there is a need for “information in Indigenous Language.” Overall, participants emphasized the importance of providing a diverse range of resources that are culturally competent and accessible to different communities.
Sub-theme 3: Suggestions for Adding Practical Need Resources
The need to provide more practical need resources was identified. As one participant suggested, the website should include “direction to physical resources such as where to find food, shelter, healthcare, etc.” Participants stated the website should also prioritize specific support resources for individuals with different needs. For example, there could be a section dedicated to “deafness” and “bullying resources.” Some wanted to see more specific resources including about “eating disorders,” “comorbidity and work-related issues,” “support for cancer care givers resources,” and “resources for special needs families.” Participants stated they could benefit from learning “Survival skills” that are especially useful during the crisis of a pandemic. Additionally, participants noted that the website could provide “Access to financial resources” such as “unemployment, CalFresh, Emergency Broadband Benefit,” and offer information on “changes in rent and housing laws due to COVID.”
Discussion
The COVID-19 pandemic caused unprecedented challenges for individuals and communities worldwide, including in California. In this study, we explored the perceptions of 199 individuals who used the T4W/Juntos website during the pandemic. The results of our thematic analysis revealed that participants reported a range of experiences during the pandemic, including financial struggles, difficulty with remote learning, family tension, and grief due to the loss of loved ones. Participants also reported using the T4W/Juntos website as a source of support and information.
The five main themes that emerged from the data analysis provide insight into the multidimensional mental health experiences reported by this sample during the pandemic. The first theme, “Disruptions and Challenges Experienced During the COVID-19 Pandemic,” highlighted the many difficulties participants faced during the pandemic, including disruptions to their personal and family lives. The second theme, “Benefiting from an Accessible Website,” focused on the advantages of using an online platform that provided mental health resources and tools to improve overall well-being. The third theme, “Most Commonly Used Resources Found on T4W/Juntos Website,” identified the most helpful resources for managing mental health and well-being that were available on the website. The fourth theme, “Suggestions for Improving Users' Experience and Impact of the Website,” outlined the changes recommended by participants to improve the website’s quality and functionality. Finally, the fifth theme, “Wanting Access to Additional Resources,” highlighted the need for more resources to address specific needs and challenges.
The T4W/Juntos website has played an important role in providing support and resources during the pandemic for this sample. Participants found the website to be a useful source of support for coping with the various challenges of the COVID-19 pandemic. Participants recommended the website to others and found it to be a valuable resource for finding local resources and connecting with others. However, some participants also provided suggestions for improvement, such as expanding it to include more resources for specific populations, more frequent updates to content, better visibility for the Spanish language section of the website, and making the website more accessible and easier to navigate.
In comparing our results to existing literature, we found similarities with other studies on the impact of the COVID-19 pandemic on mental health and well-being. Our findings align with those of a study conducted by Wang et al. (2020), which found that the pandemic had a significant impact on mental health and well-being, leading to increased anxiety, stress, and depression among individuals. Similarly, a study by Li et al. (2020) found that the pandemic had significant effects on the mental health of the general population, leading to an increase in psychological distress and other negative emotions. Our study further supports these findings by demonstrating the impact of the pandemic on a sample of individuals using T4W/Juntos website to get access to mental health resources.
Moreover, our study contributes to the growing body of research on the use of online resources for mental health support during the pandemic. Our findings align with those of a study by Marshall et al. (2020), which found that online resources were an important source of support for individuals during the pandemic. Similarly, a study by Weiner et al. (2020) found that online interventions were effective in reducing stress and anxiety related to the pandemic. Our study provides further evidence of the importance of online resources, such as the T4W/Juntos website, in providing support and resources to individuals during the pandemic.
One implication of our findings is the importance of accessible and user-friendly online platforms for providing mental health resources and support during times of crisis, such as the COVID-19 pandemic. The T4W/Juntos website provided a valuable resource for individuals facing mental health challenges during the pandemic, but there is a need for ongoing improvements and updates to ensure the website is meeting the needs of diverse communities.
Another implication is the importance of addressing the various challenges faced by individuals during the pandemic, including financial struggles, difficulties with remote learning, family tension, and grief. Mental health support and resources can play a crucial role in helping individuals cope with these challenges. For example, access to counseling services can provide individuals with strategies to manage stress related to financial uncertainty, offer guidance on effective communication within families to alleviate tension, and equip them with coping mechanisms to navigate the emotional impact of grief and loss during these challenging times.
One limitation of this study is that our study was conducted in California, so our findings may not generalize to other regions or populations. Future research could explore the perceptions of individuals in other states using similar resources in their states to gain a more comprehensive understanding of the impact of the pandemic on mental health and the effectiveness of online resources. Also, it is worth noting that our study’s participants were incentivized to review the website for at least 30 min and provide feedback as part of a research study. Therefore, it remains uncertain how the general population might utilize the website without such incentives, and to what extent their engagement and feedback might differ from our participant group.
Strengths of this study include the use of the Braun and Clarke thematic analysis (Braun & Clarke, 2006, 2022; Clarke & Braun, 2013), which is known for its coherent process, and the ability to provide a holistic understanding of data through a stepwise approach to qualitative analysis. Moreover, the sample size of 199 participants, who responded to at least one open-ended question, is relatively large for a qualitative study, which adds to the robustness of the findings.
Future research on the effectiveness of online mental health platforms such as the T4W website could inform health policy decisions regarding the integration of these resources into existing mental health care systems and the allocation of resources for their development and maintenance.
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Acknowledgements
We are grateful to our research team and colleagues for their collaboration and support throughout the study.
Funding
This study received funding from the G-31202 California Health Care Foundation 9/1/2020–8/31/202, Role: PI (Wells) Evaluation of Digital Mental Health (for COVID-19 response).
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SRK, JEB, MVH, AHG, KC, and KW designed the study. SRK and MVH analyzed the data. SRK drafted the manuscript. SRK, JEB, MVH, AHG, KC, and KW provided edits to the manuscript. All authors reviewed the final manuscript.
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The study was reviewed and approved by the University of California, Los Angeles (UCLA) Institutional Review Board for Human Subjects (20–002163-AM-00008). The author of this study received de-identified data from UCLA.
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All participants provided informed consent online and were advised that participation was voluntary and that data would be de-identified.
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Koushkaki, S.R., Banta, J.E., Heilemann, M.V. et al. Users’ Experiences with Web-Based Mental Health App During COVID-19. J. technol. behav. sci. (2023). https://doi.org/10.1007/s41347-023-00371-w
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DOI: https://doi.org/10.1007/s41347-023-00371-w