Models, frameworks, and strategies used to implement digital interventions targeted to youth mental health: a scoping review protocol

Abstract

Introduction

The use of digitally enabled technology is considered a promising platform to prevent morbidity and enhance youth mental health as youth are growing up in the digital world and accessing the Internet at increasingly younger age. This scoping review will identify, describe and categorise the models, frameworks and strategies that have been used to study the implementation of digital mental health interventions targeted at youth aged 15–34 years.

Methods and analysis

We will conduct a scoping review following the Arksey-O’Malley five-stage scoping review method and the Scoping Review Methods Manual by the Joanna Briggs Institute. Implementation methods will be operationalised according to pre-established aims: (1) process models that describe or guide the implementation process; (2) evaluation frameworks evaluating or measuring the success of implementation; and (3) implementation strategies used in isolation or combination in implementation research and practice. Primary research studies in all languages will be identified in CINAHL, Cochrane Central Register of Controlled Trials, Embase, ERIC, Education Research Complete, MEDLINE and APA PsycINFO on 6 January 2025. Two reviewers will calibrate screening criteria and the data charting form and will independently screen records and abstract data. We will use the Evidence Standards Framework for Digital Health Technologies by the National Institute for Health and Care Excellence to classify digital interventions based on functions, and a pre-established working taxonomy to synthesise conceptually distinct implementation outcomes. Convergent integrated data synthesis will be performed.

Ethics and dissemination

Ethical approval is not applicable as this scoping review will be conducted only on data presented in the published literature. Findings will be published and directly infused into our multidisciplinary team of academic researchers, youth partners, health professionals and knowledge users (healthcare and non-governmental organisation decision makers) to co-design and pilot test a digital psychoeducational health intervention to engage, educate and empower youth to be informed stewards of their mental health.

STRENGTHS AND LIMITATIONS OF THIS STUDY.

• We will conduct a comprehensive literature search of multiple bibliographic databases for literature on implementation of digital interventions targeted to improve youth mental health.

• Our scoping review will follow the Arksey-O’Malley five-stage scoping review method and will conform to the manual from the Joanna Briggs Institute.

• We will use the Evidence Standards Framework for Digital Health Technologies by the National Institute for Health and Care Excellence to classify digital interventions based on their functions.

• We anticipate extensive data searches given the rapid and continuous nature of the development and dissemination of digital health interventions.

• We foresee challenges related to accurately outlining implementation methods and associated outcome measures accurately based on the published record, as overlapping terms and terminologies may be used to define or describe equivalent concepts.

Background

Youth experience mental health disorders that are significantly underdiagnosed¹,⁴ and undertreated,⁵,⁷ despite evidence indicating that approximately one in five young people globally experience symptoms of a mental health condition each year.⁸,¹¹ Subthreshold symptoms of a mental health disorder also warrant attention as they are associated with increased risk for persistent psychological distress and adverse developmental outcomes if unaddressed.¹² Concurrently, youth worldwide are growing up in an increasingly digitised world, with more than 70% of youth having access to the Internet and greater than 65% of youth in low-income households with consistent access to the Internet.¹³,¹⁵ Although digital engagement introduces potential risks (eg, cyberbullying and sedentary behaviour), it also offers a scalable and accessible platform for mental health promotion. Digital mental health interventions (most commonly delivered via smartphone or tablet applications) are particularly promising in low-resource settings, where structural barriers often impede access to conventional mental healthcare.^{16 17} The development and availability of these applications—estimated to exceed 2 million, with only~2% classified as medical¹⁸—have markedly outpaced the establishment of a rigorous, evidence-based implementation framework to guide their integration into practice.¹⁹

Advancing the effective use of digital mental health tools necessitates the application of implementation science, which offers conceptual methodologies to support the translation of interventions into real-world contexts. Implementation models, frameworks and strategies are three types of various conceptual methods that are used to identify mechanisms by which the implementation of an intervention is more likely to succeed.²⁰ While implementation models are often more specific and prescriptive, describing steps in the implementation process to guide the translation of research into practice, implementation frameworks organise, explain or describe information to provide a structure, overview, outline or plan consisting of various descriptive categories.²¹ Implementation strategies refer to the techniques used to enhance the adoption and sustainability of a programme or practice.^{20 22} A lack of awareness on how, and to what effect, digital mental health tools for youth has used implementation science prevents full understanding of the obstacles to be overcome when fundamentally translating evidence to practice. There is a real need to identify and adequately describe the use of implementation methods that allow digital mental health interventions to enact and maintain change.

We report a protocol for a scoping review designed to identify, describe and categorise the implementation models, frameworks and strategies that have been used to study the implementation of digital interventions targeting youth mental health. To the best of our knowledge, this is the first knowledge synthesis of this topic, which builds on our existing knowledge synthesis projects focused on describing the development of mental health interventions to improve well-being outcomes among youth.^{23 24} The results of this scoping review will directly inform integrated knowledge translation interventions at the individual, family unit, and health and education system levels to engage, educate and empower youth to be informed stewards of their mental health.

Review questions

This scoping review will be conducted as per the Arksey-O’Malley five-stage scoping review method²⁵ and the Scoping Review Methods Manual by the Joanna Briggs Institute.²⁶ The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) protocols guideline was used to develop the protocol.²⁷ We will adhere to the PRISMA extension for Scoping Reviews (PRISMA-ScR) to report findings from the completed scoping review.²⁸

For the purposes of this scoping review, we have defined implementation science as ‘the scientific study of methods to promote the systematic uptake of research findings and other evidence-based practices into routine practice, and, hence, to improve the quality and effectiveness of health services’.²⁹ The primary research question underpinning this scoping review is: which models, frameworks and strategies have been used by studies when implementing digital interventions aiming to improve youth mental health, and what implementation outcomes have they reported?

The components of study design, population, intervention, comparator, outcome, and timeframe and language are as follows:

• Study design: we will include implementation studies (of any design) reporting on the implementation of digital mental health interventions in any setting.

• Population: youth (between 15 and 34 years of age, inclusive) in any public (eg, home) or patient care (ie, inpatient and outpatient) setting. Data from their parent or guardian will be included if presented, but not required. No restrictions on pre-existing mental health conditions (for either youth or parent/guardian) will be applied.

• Intervention: we have defined interventions as any practice, programme or improvement effort. The intervention will be required to have two components. First, the intervention being implemented will need to have a digital (ie, online) approach/technique that aims to improve youth mental health and is accessible in any public (eg, home) or care (ie, inpatient and outpatient) setting. Second, the intervention will need to be complemented with an implementation model, framework or strategy that will be required to have one of the following three aims: (1) describing and/or guiding the process of translating research into practice; (2) evaluating implementation; or (3) enhancing adoptability or sustainability.²¹

• Comparator: any or no comparator will be accepted.

• Outcomes: any outcome will be accepted.

• Timeframe and language: any timeframe and language will be accepted.

Methods and analysis

This research builds on our funded national programme of public health crisis preparedness to examine the knowledge, perceptions, behaviours and associated impact of public health crises (such as the COVID-19 pandemic) on the Canadian public (aged ≥10 years) to develop evidence-informed interventions to enhance public readiness for health crises.²⁴³⁰,³²

Study designs eligible

We will include any published and peer-reviewed implementation study that reports new (ie, not previously published) data, including primary observational studies (eg, cross-sectional (surveys) and cohort studies), qualitative research, experimental studies (eg, randomised controlled trials and non-randomised controlled trials) or quasi-experimental studies. We will include hybrid effectiveness-implementation studies, simulation modelling and studies that used configurational comparative methods. We will exclude dissertations, reviews, commentaries, editorials, opinions, case studies and case reports, as well as articles in pre-print repositories (to mitigate the possibility of including conflicting information between the pre-print and the final form of the published article; table 1).

Table 1. Inclusion and exclusion criteria.

Inclusion	Exclusion
An implementation study of any design	The study is a protocol, review, commentary, editorial, opinion, case study, report from an expert advisory group or a pre-print
The study’s population includes youth between 15 and 34 years of age, inclusive	The study’s population does not include youth between 15 and 34 years of age, inclusive
The study reports on a digital intervention (ie, practice, programme or improvement effort) targeting youth mental health	The study does not report on a digital intervention (ie, practice, programme or improvement effort) targeting youth mental health
The study describes or references a model, framework or strategy used to assess implementation of a digital intervention targeting youth mental health	The study does not describe or reference a model, framework or strategy used to assess implementation of a digital intervention targeting youth mental health
The study outcomes are any implementation outcomes	The study outcomes are not any of the eight conceptually distinct implementation outcomes in a pre-established working taxonomy
The study presents unique data which have not been previously published or is the most recent and comprehensive analysis of the data	The study includes duplicate data from an earlier published study

Participants eligible

Eligible study populations will include youth between 15 and 34 years of age, inclusive, as defined by Statistics Canada³³. Eligible studies do not need to include immediate (ie, nuclear) or extended (ie, relative) adult family members (>18 years of age, or as defined in the individual study), although these studies will be included if other population criteria are met. If results for youth-family dyads are reported in separate publications, we will include both studies. We will include studies that report on interventions that are or are not mediated by another individual (or group) in addition to the youth (or parent/guardian; eg, mental health interventions that are mediated through therapists).³⁴

Interventions eligible

The intervention is any practice, programme or improvement effort related to positively impacting youth mental health. We will focus on digital mental health interventions that are online interventions delivered via digital technologies such as smartphones, websites and text messaging. We will consider interventions that are accessible in any public (eg, home and school) or care (ie, inpatient and outpatient) setting. In addition, interventions will also need to be complemented by a model, framework or strategy to assess intervention implementation that has at least one or more of the following three aims: (1) describing and/or guiding the process of translating research into practice; (2) evaluating implementation; or (3) enhancing adoptability or sustainability.^{21 22} While we will accept any models, frameworks or strategies (meaning, they need not be specific to youth and/or mental health), they will need to have a detailed structure described in the included paper or in a cited reference.

Outcome measures eligible

Any implementation outcome measure will be considered acceptable for inclusion in this review.

Timeframes and languages eligible

We will accept studies conducted within any timeframe and published in any language (with an abstract in English). Studies published in languages other than English will be translated using professional translation services.

Search methods for identification of studies

Articles will be identified in CINAHL, Cochrane Central Register of Controlled Trials, Embase, ERIC, Education Research Complete, MEDLINE and APA PsycINFO on 6 January 2025. The search strategies were developed by a librarian co-investigator (DLL) in collaboration with various members of the team (SJM, CZC, FBH and JPL). A range of broad search terms will be used to maximise the yield of the search for studies. Search terms were selected based on components of youth mental health, digital interventions (broadly inclusive of practices, programmes and improvement efforts) and implementation research. The full search strategy for all databases can be found in (online supplemental table 1).

Selection of eligible studies

At the title and abstract screening stage, a subset of the team (SJM, CZC and FBH) will achieve 100% agreement on a calibration exercise of 50 random citations prior to commencing selection of eligible studies; calibration will continue until agreement is reached. After reliability in reference screening is ensured, the same three reviewers (SJM, CZC and FBH) will use Covidence to independently screen titles and abstracts in duplicate for potential inclusion using screening questions developed for this review (table 2). Any study selected by any reviewer at this stage will progress to the next stage. After initial screening, the three authors (SJM, CZC and FBH) will examine full texts independently and in duplicate for eligibility and for development of the final data charting table. A separate calibration exercise will then be performed for screening reference lists of selected articles (eg, literature reviews or summary reports on this topic). The three independent authors (SJM, CZC and FBH) will screen reference lists of selected articles (including reviews) in duplicate to identify additional relevant articles for potential study selection; original articles will be sourced, and the full text assessed for eligibility. Disagreements in study selection at the full-text stage will be resolved by a fourth reviewer (JPL).

Table 2. Screening questions to identify relevant literature.

Screening domain and question	Characteristics for assessment
	Yes—include	No—exclude	Unclear—include
Title and abstract screening questions to be used to identify literature to be included in the full-text screening process
Study design: does the title/abstract describe an observational or experimental primary research study, including focus groups and qualitative inquiries?	Yes: the study uses an observational or experimental primary research study, including focus groups and qualitative inquiries	No: the study is a protocol, review, commentary, editorial, opinion, case study, case report, thesis, preprint or a report from an expert advisory group	Unclear: tt is unclear if the study uses an observational or interventional primary research design, including focus groups and qualitative inquiries
Publication type: does the title/abstract come from a published study?	Yes: the study is a published study	No: the study is not a published study	Unclear: it is unclear if the study is a published study
Population: does the population of interest include youth between 15 and 34 years of age, inclusive?	Yes: the study population includes youth between 15 and 34 years of age, inclusive	No: the population of interest does not include youth between 15 and 34 years of age, inclusive	Unclear: it is unclear if the population of interest includes youth between 15 and 34 years of age, inclusive
Intervention: is the study’s intervention any digital intervention that is targeted at youth mental health and is complemented by an implementation method?	Yes: the intervention of interest includes a digital intervention that is targeted at youth mental health and is complemented by an implementation method	No: the intervention of interest does not include a digital intervention that is targeted at youth mental health and is not complemented by an implementation method	Unclear: it is unclear if the intervention of interest includes a digital intervention that is targeted at youth mental health and if the intervention is complemented by an implementation method

Screening domain and question	Characteristics for assessment
	Yes—include	No—exclude
Full article screen questions to be used to identify literature for inclusion in the systematic review *full article screening questions include all screening domains and questions from title and abstract screening, and one additional domain
Outcome: the full article presents any outcome(s) that is related to implementation	Yes: the outcome(s) is related to implementation	No: the outcome(s) is not related to implementation

Data charting from included studies

Data charting will be carried out by the same authors who performed the screening and full-text review (SJM, CZC and FBH), and will include study identifiers and study design, participants, exposure information (including detailed information on the intervention and implementation method such as theoretical underpinning of the method itself), outcome information (mapped to the eight conceptually distinct implementation outcomes proposed by Proctor et al²²), and conclusions and recommendations of the authors (table 3). Digital mental health interventions for youth will be summarised quantitatively, as well as qualitatively, in thematic analysis, for which the process is described below.

Table 3. Data to be abstracted from eligible studies included in the review.

Data domain	Data categories
Study identifiers: from a published study	Name of authors; study title; publication type; publication date; journal, volume, issue and page numbers of publication; place of publication (ie, first author’s institutional email address); and digital object identifier
Study design: primary research	Study type or design; time frame of study; location of study (ie, country); and region of study (localised when reported)
Participants: youth and (if reported) their family member or guardian	Definition and size (ie, N) of the source population(s) at risk; relevant demographic information (eg, age, sex, gender, geographical location (city/country/continent), ethnicity, grade in school, type of school and relationship to guardian if not parent)
Intervention: digital intervention targeting youth mental health and implementation method	Intervention type, duration (if applicable); steps or guiding principles to conduct the intervention (eg, elements or a stepwise protocol); derivation of the intervention from empirical evidence (ie, if derived from observation and experiment, or published theory); minimum expertise to conduct the intervention (ie, whether additional personnel are required (eg, social worker and psychiatrist)); limitations to the intervention (eg, requirement of stable WiFi connection); implementation method, timepoint(s) of assessment and implementation assessor
Outcome: implementation outcomes	Acceptability, adaptation, appropriateness, costs, feasibility, fidelity, penetration and sustainability; conclusions and recommendations of authors; and themes and subthemes, including exemplary quotations from studies reporting qualitative findings

A data charting form based on the Evidence Standards Framework for Digital Health Technologies by the National Institute for Health and Care Excellence that classifies digital interventions based on their functions and defines corresponding evidence standards will be created in Microsoft Excel.³⁵ The data charting form will be piloted and tested by the data abstractors (SJM, CZC and FBH) on a subset of studies (ie, 5% of studies if n>50, 10% of studies if n≤50) to ensure clarity. The research team will achieve 100% agreement prior to commencing data charting from eligible studies; calibration will continue with new sets of 50 random citations until agreement is reached. Following pilot testing, the form will be adapted as recommended by the abstractors to improve usability and completeness. The first author (SJM) and one additional abstractor (CZC or FBH) will complete data extraction for all included records. Data abstraction will be completed independently; the first author will complete data abstraction for all included studies, and the additional abstractor will check and verify the abstracted data for accuracy. Disagreements will be resolved by a fourth reviewer (JPL).

We will adopt the heuristic, working ‘taxonomy’ of eight conceptually distinct implementation outcomes proposed by Proctor et al: (1) acceptability is defined as the perception that an intervention is agreeable, palatable or satisfactory; (2) adoption is defined as the intention, initial decision or action to try or use an intervention; (3) appropriateness is defined as the perceived fit, relevance or compatibility of the intervention for a given practice setting, provider, or consumer, and/or perceived fit of the intervention to address a particular issue or problem; (4) cost (incremental or implementation cost) is defined as the cost impact of an implementation effort for the intervention; (5) feasibility is defined as the extent to which an intervention can be successfully used or carried out within a given agency or setting; (6) fidelity is defined as the degree to which an intervention was implemented as it was prescribed in the original protocol or as it was intended by the developer(s); (7) penetration is defined as the integration or institutionalisation of an intervention within a service setting and its subsystems; and (8) sustainability is defined as the extent to which a newly implemented intervention is maintained within a service setting’s ongoing, stable operations.³⁶ Implementation outcomes reported in the included studies will be categorised as other and thoroughly described. Outcome measure domains are our primary outcome, irrespective of the differences among tools considered by the various studies.

If data presented in a study is unclear, missing or presented in a format that is unusable or cannot be abstracted, we will attempt to contact corresponding authors for clarification. We will contact authors via email, and a follow-up email will be sent 2 weeks later. We will allocate a 4-week period to receive responses from authors beginning from the time of the initial contact attempt. Thereafter, we will document missing data in the review.

Strategies for data synthesis

We will use the convergent integrated approach as described by the Joanna Briggs Institute to synthesise the abstracted data.³⁷ This process includes combining abstracted data from quantitative studies with the abstracted data from qualitative studies through data transformation; quantitative data will be ‘qualitised’, as codifying quantitative data is less error-prone than attributing numerical values to qualitative data. ‘Qualitising’ will also involve a narrative interpretation of the quantitative results to create textual descriptions, allowing integration with qualitative data.³⁸ These textual descriptions will be assembled and pooled with qualitative data that is extracted directly from the included qualitative studies. Data will be stratified across digital intervention types as well as implementation methods and outcomes to produce the overall findings of the review; evidence clusters and gaps will be reported.

Presentation of the results

We will provide the final search strategy for each database and all ancillary searches as appendices. A flow chart, following the PRISMA-ScR,²⁸ will illustrate where citations were eliminated during searches and screening stages, including rationale for exclusion of studies in the full-text stage. All included studies will be presented in a narrative synthesis. A table of characteristics of included studies will be provided to describe study identifiers and period of study, sample and setting, intervention, implementation outcome(s), and conclusions and recommendations of authors. Descriptive statistics will be provided as extensions of this table when appropriate or in the narrative synthesis. Results from our convergent integrated approach to data synthesis will be presented as a separate table and summarised narratively in the results.

Patient and public involvement

Engaging youth and their families in research is necessary to learn how social systems (eg, families, schools and communities) and systemic inequities impact day-to-day lives and overall well-being.³⁹ The proposed review will abide by the CIHR (Canadian Institutes of Health Research)-guiding core principles of inclusiveness, mutual respect, support and co-building.⁴⁰ We will adhere to the GRIPP (Guidance for Reporting Involvement of Patients and the Public)-2 reporting guidelines for patient and public involvement.⁴¹ Youth and family involvement was considered in priority setting discussions and group consultations. Youth and family were involved in protocol development and will continue to be involved in the project through to and including dissemination of the published report and implementation of the evidence-informed recommendations. Our multidisciplinary team of knowledge users, researchers and healthcare providers (eg, physician, clinical psychologist, epidemiologist and sociologist) have established a track record of co-leading national peer-reviewed grants and research success in publishing with knowledge users.^{42 43}

Knowledge translation plan

We will engage youth, families and knowledge users within an integrated knowledge translation approach using the Knowledge-to-Action framework by Graham et al⁴⁴ as the underpinning knowledge translation framework. We will disseminate and deliver the deliverables of this review (table 4) using the ‘Inform, Activate, Collaborate Framework’ developed by our team⁴⁵ to promote continuity among various audiences. This will allow the opportunity to elicit generalisable findings that can directly inform policy and practice related to youth mental health generally, and in preparation for periods where youth may experience augmented stressors (eg, public health crises).

Table 4. Anticipated deliverables from the scoping review.

Deliverables	Audience	Methods
Framework of models, frameworks, and strategies used to implement digital interventions targeting youth mental health	Youth, family members, school educators, healthcare providers, researchers, advocacy councils and policy makers	Publish in high-impact journals; disseminate at relevant academic meetings; presentation at grand rounds
A bibliography of articles that describe how to use models, frameworks, and strategies to implement digital interventions targeting youth mental health	Youth, family members, school educators, healthcare providers, researchers, advocacy councils, policy makers and funders	Prepare a summary report outlining models, frameworks, and strategies to implement digital interventions targeting youth mental health that will include the primary articles, to be made available as a PowerPoint slide deck; non-traditional strategies to disseminate our results (eg, social media and blogs)
Identification and discussion on critical areas in the evidence base that require additional, original data as well as opportunities for systematic review and meta-analysis	Researchers and funders	Examine and consider identified knowledge gaps through recommendations for future research studies including specific research questions on this topic best addressed in systematic reviews with meta-analysis
An in-depth synthesis and comparison of results and insights on models, frameworks and strategies used to implement digital interventions targeting youth mental health, including categorisation of methods to assess each model, framework or strategy	Youth, family members, school educators, healthcare providers, researchers, youth advocacy councils and policy makers	Inform the co-design and pilot test of a digital psychoeducational health intervention—an interactive, web-based tool to engage, educate and empower youth to be informed stewards of their mental health; partnered with the O’Brien Institute for Public Health, The Sandbox Project, KT Canada, Children’s Healthcare Canada, Young Canadians Roundtable on Health, Solutions for Kids in Pain, 19 to Zero, and Maritime and Alberta SPOR Support Units for implementation

Ethics and dissemination

Ethical approval is not applicable as this review will be conducted on published data only. Findings of this study will be disseminated at national and international conferences. Findings will directly inform our pan-Canadian multidisciplinary team of researchers, public (youth and family partners), health professionals and knowledge users (healthcare and non-governmental organisation decision makers) to co-design and pilot test a digital psychoeducational health intervention—an interactive, web-based intervention to engage, educate and empower youth to be informed stewards of their mental health.

Discussion

With the increasing integration of digital technologies into public health, digital health interventions are widely regarded as tools that can enhance access to health services and information, promote self-care and patient empowerment, and reduce the financial and logistical burden on health systems.⁴⁶ Youth, often characterised as early adopters of technology,¹⁷ stand to particularly benefit from these innovations, including those targeting mental health outcomes. Previous systematic reviews on this topic have focused on the question of effectiveness of digital technologies to improve youth mental health^{47 48}—rather than implementation issues—giving an overview of existing interventions, ^{49 50} or focusing on specific mental health disorders, such as depression and anxiety.⁵¹

Empirical findings on the use of digital mental health interventions among youth remain mixed. Several studies report low levels of adherence and high attrition rates,⁵²,⁵⁴ while others demonstrate high acceptability and usability among young users.⁴⁹⁵⁵,⁵⁷ Despite this growing body of research, limited evidence exists on the cost-effectiveness of digital mental health interventions specifically for youth. While cost-effectiveness analyses have been conducted in other domains—such as digital interventions for cardiovascular disease⁵⁸ and insomnia⁵⁹—youth-focused mental health remains underexplored in this regard. As many countries continue to operate within resource-constrained health systems, rigorous research evaluating both the cost-effectiveness and generalisability of digital interventions is essential to support sustainable scale-up and broader implementation.⁶⁰

Our work will help identify gaps in implementation efforts where primary evidence is needed. There is a real need to identify and adequately describe the use of achievable, accessible and targeted implementation methods that allow digital mental health interventions to enact and maintain change. Streamlined, comprehensive and less costly implementation methods should be more freely available, with the necessary workforce development to support their use and evaluate their impact in mental healthcare. Our review is a step toward improving the implementation of digital interventions targeting youth mental health in a way that is valued among youth and allows for positive mental health outcomes among youth worldwide.

Anticipated challenges

We anticipate that a potential limitation of this review will be linked to selection bias, as it is possible that some articles may be missed in our searches owing to the variety of terminologies used in the literature. Researchers who have conducted reviews on theories, models and frameworks in other contexts have reported uncertainty related to these core concepts within studies included in the review.^{61 62} We have developed broad search strategies to deploy in various bibliographic databases to scope as much relevant literature as possible. We also anticipate challenges related to outlining implementation methods and associated outcome measures accurately based on the published record, as overlapping terms and terminologies may be used to define or describe equivalent concepts.⁶³ However, we have a strong and diverse team that has extensive experience with knowledge synthesis and implementation science and therefore has the experience and expertise to address these challenges. Our review will cover a range of digital mental health interventions that is likely to introduce some challenges for interpretation (eg, variation in study settings, methods and population). We plan to directly contact corresponding authors of included papers to request clarification as needed. In addition, as the field of digital mental health interventions is evolving at a rapid pace, many of the interventions included in our review may become outdated in the near term.⁶⁴ Using the Evidence Standards Framework for Digital Health Technologies by the National Institute for Health and Care Excellence to identify converging components of digital mental health interventions is nonetheless an important step forward.