From exploration to co-design: Understanding and redesigning workplace mental-support services

Workplace mental-health support services (MSS), including employee assistance programs, are widely implemented yet chronically underutilized, with uptake rates often below five percent. This persistent gap between availability and use raises critical questions about why employees do not engage with formally accessible and confidential support. Existing research has documented attitudinal, stigma-related, and organizational barriers, but offers limited insight into the behavioral mechanisms sustaining non-use in everyday work contexts. To address this, the present study explores the underutilization of within a high-tech organization in Türkiye characterized by persistently low service uptake. Guided by the Capability, Opportunity, Motivation-Behavior (COM-B) model, an exploratory qualitative study involving semi-structured interviews with 13 employees who had never accessed the available service, followed by a participatory co-design component. Reflexive thematic analysis was used to explore key barriers and facilitators across COM-B domains, while co-design activities captured employee-generated suggestions for redesigning support. The findings indicate that persistent non-use of mental-support services was not attributable to a single dominant barrier, but emerged from the combined effects of cognitive uncertainty about service relevance, structural constraints embedded in everyday work practices, and motivational tensions related to professional identity and emotional fatigue, which together reduced the likelihood that employees would initiate support-seeking. Co-design outputs translated these barriers into concrete redesign directions, including simplifying entry points, embedding support within everyday workflows, and strengthening visible organizational endorsement. By identifying how the interaction among capability, opportunity, and motivation conditions maintains non-use, this study provides a behaviorally grounded explanation for the persistent underutilization of workplace mental-support services. The findings highlight the need for organizational approaches that move beyond awareness and availability toward behaviorally aligned system design to enable meaningful employee engagement.