Table 2.

Summary of key categories, feedback and tool modifications from phase 1 parent and youth focus group sessions

Category	Tool version and sample feedback*		Tool modifications
Approachability	1	The title of the answer options in each section ('no', 'mild', 'moderate', 'severe' concern) implies judgement; I felt embarrassed to choose ‘major concern’.	Scoring descriptors were limited to an ordinal number scale (0–3).
		Statements need to be more inclusive, for example, the 'Education' section should include homeschooled kids.	Scoring descriptors in the 'Education' section were updated to include homeschooled youth.
		Some kids may feel uncomfortable choosing a scoring option, because the category may have details that are not important to them, for example, someone may have anxiety but no mind tricks.	An ‘or’ was placed between statements in each scoring description, so youth do not need to meet all criteria mentioned to make a selection.
		Some words are confusing, when I read 'caregiver' I think about a housemaid or living support staff.	Terminology was simplified (eg, 'caregiver' was changed to parent/guardian).
	2	There is a sense of judgement associated with certain words/statements (eg, good grades).	Terminology with a potentially judgement connotation was removed (eg, changed 'good grade' to 'passing grades’).
		Kids may perceive a specific behaviour to be acceptable if it is put in the zero score category.	Descriptors in the zero category were reviewed to ensure they represent age-appropriate and acceptable behaviour.
		In the 'Relationship and bullying' section, it is missing romantic partnerships kids may be in.	Romantic partners were included in the 'Relationship and bullying' section.
		The 'Professionals and resources' section should distinguish youth who have 'long-term' support from those who sought occasional or one-time help.	Long-term mental health support was explicitly mentioned in the 'Professionals and resources' section.
Interpretability	3	Some of the words used in the tool have other meanings (eg, trigger).	Terminology with other common meanings was removed and replaced.
		The scoring descriptions are too verbose.	Sentences were made shorter, less wordy, with emphasis on key points.
		Some of the vocabulary is too advanced for younger kids to understand (eg, consensual, recreational, abuse).	Complex language was simplified (eg, consensual was changed to 'agreed to'; abuse was changed to 'threatened or hurt').
		There need to be more examples to make some of the statements easier to understand, like giving broad examples where it says, ‘practicing steps to end one's own life’, so it's clear this is referring to suicide.	Examples were added to further clarify complex issues, for example, ‘for practicing steps to end one’s life,’ examples such as ‘holding rope around neck’ were added.
	4	Where and how would the tool be used? And who would see the results?
		Idioms may not be understood by other kids (eg, ‘out of the blue’).	Idioms were removed.
		Some of the vocabulary is challenging (eg, contraception).	The term 'contraception' was changed to 'protection'.
		This tool is very exciting.
	5	The word ‘isolated’ may be difficult for some participants to understand.	The term 'isolated' was changed to 'alone'.
		Overall, it is really well written and easy to understand.
		The examples used in the tool are helpful.
	6	The tool makes sense and is easy to understand.
		In the ‘Relationship and bullying’ section, ‘fighting’ with a romantic partner could be verbal or physical.	In the 'Relationship and bullying’ section the term 'fight' was changed to 'argue'.
		The word ‘harm’ may be difficult for some participants to understand.	The term 'harm' was changed to 'hurt'.
	7	Everything was really clear and straightforward.

*Sample feedback corresponding to the specific version of MyHEARTSMAP that participants reviewed.