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Designing for all: A scoping review and critical analysis on how digital mental health interventions serve (or fail)
Ruixuan Zhang1, Mark de Reuver1, Angela D R Smith2
1Faculty of Technology, Policy and Management, Delft University of Technology, Jaffalaan 5, 2628BX, Delft, the Netherlands.
Background:
Women face unique and diverse mental health challenges and therefore require tailored interventions that address their specific needs and lived realities. Research has shown a lack of digital interventions designed for and with women from marginalized backgrounds, such as minority racial/ethnic backgrounds or with low socioeconomic status. If Digital Mental Health Interventions (DMHI) are not designed with active involvement of women from diverse backgrounds, they may fail to reach their public health objectives, which potentially exacerbates existing health disparities. How Human-Centered design methods are applied and reported, and whether women from diverse backgrounds are involved in the design and development of Digital Mental Health Interventions (DMHI), is under-researched.
Objective:
This study examined the methods and frameworks used in the design and development processes of DMHIs, whether and how studies include women from diverse backgrounds, and whether they tailor to their diverse needs related to intersectional identities (e.g., race/ethnicity, socioeconomic status, age) in the design and development process.
Methods:
We conducted a scoping review following the PRISMA-ScR guidelines. The databases included are Scopus, PubMed and IEEE Xplore, and the databases are searched from the inception until the 31st of May 2026. We included 77 articles that described the design process of digital mental health solutions for women.
Results:
Among the 77 reviewed studies, 18 (23.4%) did not explicitly state their design methods, and most of them provided limited information on the characteristics of the included populations. Only 16 (20.8%) studies consistently involved users across all design stages. Intersectional identities were considered in only 26 (33.8%) studies. We observed an overrepresentation of research in higher-income countries, an underrepresentation of women from racial/ethnic minority backgrounds, a narrow age range of participants, and a lack of consideration of intersectional identities.
Conclusions:
Our findings reveal critical gaps in the development of DMHIs for women, including the superficial reporting and application of Human-Centered Design methods in the design process, limited user involvement, and a lack of consideration of diversity, inclusivity and intersectionality. Future research should emphasize active involvement of end-users from the earliest design phases onwards and adopting an intersectional lens in their design processes. We propose a research agenda for better reporting and applying HCD methods in future DMHI research, towards designing diverse, inclusive and equitable digital solutions for all women.
Registry And Registry Number For Systematic Reviews Or Meta-Analyses:
A protocol of this study is pre-registered at Open Science Framework (DOI 10.17605/OSF.IO/WC79P).
