Exploring User Experiences With the Lift App for Emotional Well-Being Among Youth With Type 1 Diabetes: Qualitative...

Individuals living with type 1 diabetes (T1D) are at an increased risk of experiencing psychological distress; however, there remains a scarcity of scalable and widely accessible support services, particularly for adolescents and young adults. To address this gap, digital mental health interventions are becoming an increasingly important area of innovation in diabetes care.

This study aimed to explore qualitative feedback regarding the "Lift: Thriving with Diabetes" (Lift) well-being app, designed to support emotional well-being among adolescents and young adults with T1D, which was recently tested in a 12-week feasibility trial conducted in New Zealand and the United States.

Of the 59 adolescents and young adults and 22 support people who participated in the main Lift feasibility trial, 13 agreed to participate in this secondary qualitative study. Participants attended a virtual focus group or 1-on-1 interview to discuss their experiences using the app and to explore their perspectives on the app's engagement, functionality, and perceived impact on well-being and diabetes-related coping. Transcribed audio recordings were analyzed using directed content analysis, guided by the Mobile Application Rating Scale end-user framework (with topics of engagement, functionality, aesthetics, and information quality) and interpreted from a realist theoretical position.

In total, 9 adolescents and young adults (mean age 21.5, SD 2.06 years; n=5, 56% men) and 4 support people (2 fathers, 1 friend, and 1 partner; mean age 31.3, SD 18.92 years; n=2, 50% men) completed interviews. Overall, participants viewed Lift as engaging, easy to use, and emotionally impactful. The most positive feedback focused on the app's interactive features, particularly a well-being tree that "grew" with increased engagement, and its "calming" visual aesthetics. Users also reported meaningful emotional or behavioral impact, particularly in promoting connection, self-awareness, and practical coping strategies in living with T1D. However, user feedback also highlighted areas for improvement, including the need for improved content pacing, personalization, connection with other digital health tools, and greater gamification to sustain long-term engagement. Participants consistently expressed a desire for content tailored to their age, role (eg, support person vs young person), and personal preferences (eg, voice, pace, tone, and interactivity).

Findings underscore the potential of user-driven, emotionally intelligent digital tools to enhance well-being and connection for young people with T1D, as well as their support people. These insights can inform the refinement of Lift and the development of broader digital health interventions aimed at promoting well-being and fostering meaningful, sustained impact.