Lara Van Alphen

General information Client Mosaic Medical Center 2016 South Main Street Maryville, Missouri 64468 United States +1 - Supervisor Mosaic Medical Center Megan Jennings Development Officer-+1 - Professional framework Dr. Egon Heidendal Assistant Vice President Institutional Research & Effectiveness Northwest Missouri State University-+1 - Bachelor’s degree Zuyd University of Applied Sciences Communication & Multimedia Design Brusselseweg- HB Maastricht the Netherlands Supervisor Zuyd University of Applied Sciences Natasja Peet-- Student Lara van Alphen Student number-- Thesis Mental Health Matters Lara van Alphen 2022 Preface This thesis ‘’Mental Health Matters, Designing a valuable multimedia tool to inform students about mental health’’ has been written to fulfill the graduation requirements of the bachelor Communication & Multimedia Design at Zuyd University of Applied Sciences, Maastricht. In this thesis, the process towards this the end product will be explained based on the knowledge I have gained during my studies. I was engaged in researching and writing this thesis from February till June 2022. The project took place at Mosaic Medical Center with support from staff at Northwest Missouri State University, both located in Maryville, Missouri. My research question has been formulated together with my supervisor at Mosaic Medical Center, Megan Jennings and my supervisor at Zuyd University of Applied Sciences, Natasja Peet. Based on the research question, I created an application that informs college students about mental health, with a focus on prevention. It was a long journey and not always easy, but conducting extensive investigation allowed me to realize a valuable end product. I have experienced this graduation project as very positive and instructive. I would like to thank several people for their support and contribution related to this project. Natasja Peet: First, I would like to thank my graduation supervisor from Zuyd University of Applied Sciences; Natasja guided me throughout the project. By means of weekly coaching sessions, in which she gave me useful feedback and guidelines. Besides the serious part of the meetings, we also had a lot of fun together. Megan Jennings: I would like to thank Megan Jennings as my company supervisor at Mosaic Medical Center. Megan ensured that I encountered the right people during my research phase and our meetings helped me a lot during this project. Egon Heidendal: I would like to thank Egon Heidendal as my professional framework. Egon helped me a lot with getting different insights and was of great help in the completion of the project. Also I want to express my gratitude towards the students and several staff members of Northwest Missouri State University who participated in my interviews and test sessions. I hope you will enjoy your reading. Lara van Alphen Maryville, Missouri, June 9, 2022 Thesis Mental Health Matters Lara van Alphen 2022 Summary Background A growing number of students suffer from psychological problems such as depression, burnout, and anxiety disorders A major contributor to the mental health of young people is the environment in which they live. Young people all over the world experience a lot of pressure to perform at school and they must deal with a lack of support in their environment. All these environmental factors can cause a lot of stress. In addition, students point out challenges of the digital world, which on the one hand makes it easy for them to connect with others, but it also entails risks as the fear of missing out and compare themselves with others. This project has investigated how mental problems can arise, how they get worse, and how to deal with mental problems preventively as well as reactively. The aim of this thesis is to better inform students about mental health through an effective multimedia tool. Leading to fewer mental health issues to arise or getting worse. Methods To guide the research, this thesis has made use of ‘’The Double Design Diamond’’ model. This model exists of four phases: discover, define, develop, and deliver. Besides the Double Design Diamond method, the Design Thinking Model was instrumental during this graduation project. The Design Thinking Model consists of five phases: empathy, determination, design, prototype, and testing. The first part of my thesis was the empathize phase. Field and desk research was used during this phase, these consisted mostly of interviews, literature studies and related projects. The outcome of these findings has been translated into design implications. The second and third phases are determining (define) and designing (ideate). During these phases, several frames in the form of sketches and different fidelity levels (low, medium and high) were created and tested with the target group. In the fourth phase (test & implement) the product is developed into a high-fidelity prototype and has led to a final design. It has been tested with the target group and is corrected were needed based on the test sessions with the target group and their feedback to improve the prototype. Results and conclusion In the evaluation phase of this thesis, the app was tested with the target group. As a result, the app offers various functions and possibilities to inform students about mental health. This is done in a playful way as they can complete challenges, can choose their mood based on the emoji and collected points. This game element was useful because the target group mentioned that this keeps them motivated to use the app. The app also offers help to students who need it; based on the questionnaire they fill in at the beginning of the app. The app offers added value for students who are struggling with mental problems, but also for students without mental issues to give them a better understanding of mental health. A core part of the app is prevention, so that students are more aware of Thesis Mental Health Matters Lara van Alphen 2022 mental health and that hopefully in the future there will be fewer students struggling with mental problems. Thesis Mental Health Matters Lara van Alphen 2022 Table of contents PREFACE 3 SUMMARY 4 TABLE OF CONTENTS 6 1. INTRODUCTION 8 1.1 CONTEXT & CAUSE 1.2 COMMUNICATION PROBLEM 1.3 ORGANIZATION 1.4 RESEARCH STRUCTURE 1.4.1 GOAL 1.4.2 OBJECTIVE 1.4.3 PROBLEM 1.4.4 RESEARCH QUESTIONS: 1.5 DELIVERABLES 1.6 PROJECT COMMUNICATION 1.7 FRAMEWORK THESIS - 2. ANALYSIS 15 2.1 PRIMARY RESEARCH 2.2 SECONDARY RESEARCH 2.3 ARE STUDENTS INFORMED ABOUT MENTAL HEALTH? 2.4 HOW CAN STUDENTS FIGURE OUT THEIR MENTAL HEALTH ? 2.5 WHAT ARE FACTORS THAT CAN INFLUENCE STUDENTS’ MENTAL HEALTH? 2.6 WHAT IS THE BEST WAY TO REACH STUDENTS WHO ARE STARTING TO SUFFER FROM MENTAL PROBLEMS? 2.7 WHAT SORT OF MENTAL HEALTH ISSUES AFFECTS STUDENTS THE MOST ? 2.8 RELATED PROJECTS 2.9 DESIGN REQUIREMENTS - 3. DESIGN PHASE 39 3.1 CONCEPT IDEAS 3.1.1 CONCEPT 1: MINDZ 3.1.2. CONCEPT 2: BUDDIES 3.1.3 CONCEPT 3: FEELING FABULOUS 3.1.4 CONCEPT 4: MOOD 3.2 TESTING & PROTOTYPES 3.3 LOW-FIDELITY PROTOTYPE 3.3.1 SUMMARY 3.3.2 FEEDBACK 3.4 MEDIUM-FIDELITY PROTOTYPE 3.4.1 NAME 3.4.2 STYLE - Thesis Mental Health Matters Lara van Alphen 2022 3.4.3 CONTENT 3.4.4 FEEDBACK & TEST RESULTS 49 51 4. REALIZATION PHASE 52 4.1 HIGH-FIDELITY PROTOTYPE 4.1.1 NAME 4.1.2 STYLE 4.1.3. CONTENT - 5. EVALUATION PHASE 56 5.1 FINAL TEST HIGH-FIDELITY PROTOTYPE 5.2 FEEDBACK & TEST RESULTS 5.3 END PRODUCT 5.4 CONCLUSION 5.5 RECOMMENDATIONS 5.6 SELF-REFLECTION - 6. REFERENCE LIST 64 7. ATTACHMENTS 67 Thesis Mental Health Matters Lara van Alphen 2022 1. Introduction 1.1 Context & cause. Mental health: a worldwide concern To function properly, it is essential to pay attention to your mental health. But what exactly is mental health? The World Health Organization defines mental health as "a state of well-being in which the individual realizes his or her abilities, can cope with the normal stresses of life, work productively and fruitfully, and contribute to his or her community."(WHO) Good mental health enables to cope well with stress, pressure, emotions, disappointments, and challenges. Those are exactly the factors that are important to stay in balance. Mental health among students However, the number of young people who are dealing with mental problems is large. (De Baak, 2022). Research has shown that 35% of all college students struggle with any sort of mental illness. Due to the college students in the United States specific who struggle with mental health, anxiety is their top concern, and it is still rising. ‘’More than half of the college students (51%) who visited their campus counseling centers reported symptoms of anxiety, according to a survey by the Association for University and College Counseling Center Directors’’ (Tate, 2017). Other complaints that college students in the United States struggle with are depression (41%), concerns about relationships (34%), and suicidal thoughts (Tate, 2017). Figure 1: ‘’Most Frequent Presenting Concerns in Counseling Centers 2016 (Tate, 2017) Just as the other states in America, mental health is a major problem and a risk among college students in Missouri. Over the past couple of years universities have detailed a 231% increase in annual visits to counseling centers. As well as a 173% increase in add up to annual clients, this was mostly due to depression, Thesis Mental Health Matters Lara van Alphen 2022 anxiety and stress in a sample of college students. This has been observed at several colleges as mental wellbeing issues bear noteworthy issues for numerous students. Top three concerns were academic performance, pressure to succeed, and post-graduation plans (Beiter et al., 2015). For example, the financial consequences of stopping and switching from a study are a major stress factor for college students because American tuition fees are relatively high compared to other countries. Therefore, remaining in school and graduating on time, is an important financial factor for students and their families. Almost all students work to pay for their tuition fees and living costs. This change of finding the balance between work and school takes time and is difficult, it means that students take longer to complete their studies. This causes a lot of stress and pressure. Up to 80% of students report shouldering the cost for all or a big part of their tuition. Also, freshmen entering college mention that they have concerns about being incapable to complete a degree without any stress about finance (Jones, Park, & Lefevor, 2018). There are some college students already familiar with mental illness in high school or earlier in their life, for those students it is even harder to feel at home once they enter college. In a given year, around one in four adults that reached the age of 18 in the United States struggles from a mental illness that has been diagnosed. The independence of living alone comes with a lot of new challenges and this can especially be hard for students that have been diagnosed with mental illnesses earlier in life (Hejl, 2021). At the universities The presidents of several universities in the United States indicate that mental wellbeing of students is very important to them. On the other hand, researchers have shown that 47% of the students mentioned that they could have used more support from their university, especially during the COVID19 pandemic. The same research has shown that only a very small amount of students received counseling at their university within the last couple of years. Presidents of universities must cover the gap between prioritizing student mental health and giving the correct blend of mental health services and assets that students will make use of to work on their mental health (Hejl, 2021). Hard to reach Additionally, college students are a difficult age group to reach to raise awareness about mental health and prevent the possible consequences of depression or worse. (Chris Dawe, personal communication, March 8, 2022) Students may not always know what to do or where to go when they are facing mental health issues. This is also the case for many college students in Maryville, Missouri who struggle with their mental health. Mental problems such as depression, loneliness, and anxiety are common among this young age group. Thesis Mental Health Matters Lara van Alphen 2022 1.2 Communication problem Mosaic Medical Center Maryville receives around ten suicide reports from college students every year; mental wellbeing is a major problem among students. That is why Mosaic Medical Center is determined to tackle mental wellbeing. Currently, many students are already being treated for their mental problems in the medical center, but they are not offered preventive treatment yet. The problem mainly sits within preventive treatment. There is not yet enough information on ''mental wellbeing'' and what you could do about it before you end up at the stage of, for example, being treated by a psychologist. The communication problem which I will be focusing on is the following: How to inform students preventively within the community of Maryville about their mental wellbeing and possible mental health issues. The clients, Ms. Jennings, the Development Officer within the Marketing & Communications Department, and Mr. Blackford, the President, are both involved with the communication problem. We discussed the problems that exist in Maryville and what problems they experience within Mosaic. They both have a lot of extensive knowledge about this, especially Ms. Jennings, who does a lot with the ‘’St. Francis Hospital Foundation’’. This is a foundation whose purpose it is to ensure the region is equipped with exceptional health care. The foundation made it possible for the area to obtain advanced equipment, technology, and all sort of patient care services. The foundation organizes all sorts of fundraising events during the year. In February 2022 there was a big event about mental health to create more awareness about this topic. There were ten ambassadors, and this was a good opportunity for me to expand my professional network. I obtained more knowledge due to mental health which was a very interesting experience for me. 1.3 Organization Mosaic Life Care is a physician-led healthcare framework serving 35 counties in northwest Missouri, northeast Kansas, southeast Nebraska, and southwest Iowa. Mosaic places the holistic needs of patients first by giving the proper care at the proper time and offers high quality in wellbeing care. The organization serves around 270,000 people and is the biggest within the region with more than 4,000 representatives. I worked at the location in Maryville (Missouri) where around 400 people are employed. I worked closely with the marketing & communication department where five people work in total. Megan Jennings, my project supervisor graduated with a bachelor’s degree in journalism and has been employed by Mosaic Medical Center Maryville several years now. Thesis Mental Health Matters Lara van Alphen 2022 1.4 Research structure 1.4.1 Goal The goal of this project is to make college students in Maryville more aware of mental health and to make them able to work on their mental health themselves when they start to deal with issues. The project’s focus is on prevention (instead of treatment) of mental illness so that fewer students have to struggle with it. 1.4.2 Objective Designing a new effective online multimedia tool prototype that contributes to inform students about mental health issues and what to do when they start to deal with it. 1.4.3 Problem How can students be informed within the community of Maryville about their mental wellbeing and possible mental health issues, so that they can recognize them and know what to do when they start to get them, through an effective multimedia solution? 1.4.4 Research questions: 1. 2. 3. 4. Are students informed about mental health? How can students figure out their mental health? What are factors that can influence students’ mental health? What is the best way to reach students who are starting to suffer from mental problems? 5. What sort of mental health issues affects students the most? 1.5 Deliverables The deliverables will consist of a thesis, frames, and a final prototype. Besides that, it is instrumental to have a summary of the process at each stage of the design process. The interviews will be processed in empathy maps. The low-fidelity prototypes will be shown in a logical continuation of the analysis phase. Furthermore, it must be described which methods have been used and the tested prototypes. The testing will be done with both low-fidelity and highfidelity prototypes. The prototypes will be tested with the target groups, but also with professionals. I will make descriptions about this process, and I will use feedback to come up with revised prototypes. The final product must follow logically from the tested prototypes. It also must be described why certain methods were used and which techniques were used in making the high-fidelity prototype. At the end of my graduation project, there are a number of specific deliverables: - Green-light assessment. Thesis Mental Health Matters Lara van Alphen 2022 - Thesis (PDF format). - Intermediates and end products (research paper, frames, low/med/high prototype). - Instruction document (explanation intermediate and end products + practical explanation). - Form graduation project final assessment company guidance or professional framework. 1.6 Project communication The people which I communicated with during the project were my company supervisor (Megan Jennings), my graduation supervisor (Natasja Peet), and my professional framework (Dr. Egon Heidendal). It was important to have weekly contact to discuss progress and provide myself with valuable feedback. Beyond this, for my research phase, I held interviews with the target group, but also with various employees from Mosaic Life Care. It was very important to communicate during moments when I was transitioning to a new phase, to incorporate the feedback in every phase. 1.7 Framework thesis Double Design Diamant During this project, I worked according to the ‘’Double Design Diamond’. The analysis, design, implementation, and evaluation are the phases included in the double design diamond. This model dissects the design process in a simple and graphical way by dividing it into four different phases all starting with the letter D: (that is why the model is also called 4D model) Discover, Define, Develop and Deliver, as you can see in the picture below. It consists of two “diamonds” each symbolizing a process of diverging (exploring and investigating something) and then converging (making choices and taking action). Thesis Mental Health Matters Lara van Alphen 2022 Figure 2: Double Design Diamond I chose to use the Double Design Diamond because it is a very useful model and to start with a clear structure for my thesis. While in the discovery phase, I learned more about the many aspects that impact the problem and its possible solution. During the define phase I thoroughly evaluated the ideas I had collected. I have analyzed the outcomes of the discovery phase and I have come up with possible concepts to solve the problem, the develop phase helped me with refining my concepts. Design Thinking Besides the Double Design Diamant framework, I also used the Design Thinking model. Design Thinking is an iterative process used to solve complex problems (also known as 'wicked problems'). The user and his needs are central to this; Design Thinking is about understanding the people for whom a product or service is being developed. I've used this method to dig a bit deeper and discover new ways to improve user experiences (Leansixsigmagroep, n.d.). Thesis Mental Health Matters Lara van Alphen 2022 Figure 3: Design Thinking model (NNGroup, 2022) Empathize phase: In this phase I answered my research questions based on of secondary research such as literature study and related projects. Besides that, I worked on primary research such as interviews and questionnaires. I used some research methods that are suitable for this research project using the CMD-Methods-Pack. These helped me a lot during the project. Define & Ideate phase: During these phases, a number of frames were realized by means of the design implications from the analysis phase. These frames are visual concept ideas that show how the final product works in terms of content, which functionalities the final product has and what the product looks like visually on the basis of sketches (low-fidelity prototype). I tested the frames with the target group in order to realize a definitive concept. Prototype phase: In this phase, the end product is developed into a high-fidelity prototype. The professional framework provided regular feedback on this. The tests with the target group made clear whether the product met all requirements and is userfriendly for the target group. In this phase, the end product is displayed visually. Test & Implement phase: The last phase consisted of concretising the end product. This is where the final, definitive user tests with the prototype were performed. After these research methods have been carried out, the conclusion provided answers to the research questions so that I could realize a number of design implications/requirements. Thesis Mental Health Matters Lara van Alphen 2022 2. Analysis Some research methods I used are based on the CMD-Methods-Pack. This is a card set with research methods for design-oriented research developed at the University of Applied Sciences of Amsterdam. Literature study By searching and reading scientific literature within the research field, insight is created into what knowledge people already have about the subject. This provides important, verifiable input for the research Personae With a personae, the target group is given a ''face'' which makes it easier to receive a deeper understanding of the target group. Personae may be fictitious, but they give an honest picture of the target group. Each persona has a different view on life, caused by different motivations and frustrations. They typically have different wishes concerning the thesis topic. Interviews Interviewing the target group is a good way to gather opinions and different viewpoints related to the research. The purpose of the interviews is to gain an indepth understanding of the subject. Due to the direct contact with the target group, the understanding that is developed in this way is easy and effective to collect. I had interviews with ten college students all enrolled at Northwest Missouri State University living in Maryville. Expert interviews In addition to the interviews with the target group, seven experts were interviewed on mental health of students. Interviews were conducted with psychologists, social workers, and counselors from both Northwest Missouri State University and Mosaic Medical Center's Mental Health clinic. Next to this, the director and assistant director of Wellness Services Education and Prevention at Northwest Missouri State University have also been interviewed. Thesis Mental Health Matters Lara van Alphen 2022 Empathy map An empathy map is a useful tool to get to know the personas better. It helps to be able to formulate the description of the persona and to make decisions based on the empathy map. The needs of the target group are mapped out using an empathy map. It is basically a quick overview of what the target group thinks, hears and says. After the interview sessions, empathy maps have been created based on the needs and sayings of the target group, which was helpful with creating the list of design requirements. Co-creation The goal of co-creation is to give people a product that they truly love and that fits their needs. As a participant, you feel that you can influence the product. You contribute to the solution. With co-creation, you create loyal, involved participants. You learn directly from the users and therefore the product can be improved. Several co-creation sessions have occurred with the target group, most of those times with a small group of 5 students to be able to cooperate in a way that everybody was heard. Besides, cocreation sessions have taken place with professionals to gain other insights. Mind map A mind map is a representation of thoughts that branch out from a central subject. The visual organization of the mind map promotes brainstorming, makes notes more efficient, helps to remember everything, and provides a clear overview. Mind maps can be both simple and very elaborate. Requirement list After using the methods mentioned above, a set of findings were made based on the needs from the target group. The most important findings were put together in a list of ‘’design requirements’’. This helps make clear the requirements the product must meet. Thesis Mental Health Matters Lara van Alphen 2022 2.1 Primary research The primary research consists of collecting data based on observations, interviews, and questionnaires. It is important to gain insight and to be able to create an empathic capacity in the target group and the current situation. To be able to find out which difficulties arise in the current situation, a picture has been sketched based on several (expert) interviews and a questionnaire. I have interviewed ten students that struggled with mental health issues, but also students that did not. Besides that, I did some expert-interviews (also ten) with social workers, psychologists, psychiatrist, counselors and the Assistant Vice President, and Assistant Director of Wellness Services from Northwest Missouri State University. Empathy map & mind map I chose to make use of empathy maps and mind maps because it benefits as: seeing the thoughts, feelings, and behaviors of a user group immediately, and it is a great way to summarize more extensive user research into key points. Besides that, it is a very clear overview of the most important findings based on my interviews and obtaining a deeper insight into my target group. Below you can see the mind map and the empathy map with several important outcomes of my interviews. Figure 4:: Mind map with important outcomes from interviews Thesis Mental Health Matters Lara van Alphen 2022 Figure 5: : Empathy map based on interviews Personae Personae were created based on the answers given in the interviews. A persona is a representative version of a real person. Personae are fictional persons, but they are based on real people from the target group. It is important to use personae during the design process and also in the subsequent phases. They ensure that the focus is on what is important to the target group and help at all times to make quick and good decisions. Thesis Mental Health Matters Lara van Alphen 2022 Figure 6: Persona Chris Figure 7: Persona Kendrick Thesis Mental Health Matters Lara van Alphen 2022 Figure 8: Persona Katie 2.2 Secondary research Now that the structure of this thesis and the deliverables of the project are clear we can dive deeper into the research that was done at the start of this project. As a designer, you can only insert successfully with a project if you have gained empathy and insights. This helps it establish features and design requirements related to the final product. To answer the sub-questions, not only primary research is important, but also literature research. Literature research consists of existing research and projects. In academics, this is often referred to as “standing on the shoulders of giants”. This means leaning on those who have done prior research that has been peerreviewed. This provides more insight into the problem statement. Before a solution can be devised for this problem, research has first been conducted into what exactly a user experience entails. A literature search is a systematic, thorough search for all types of literature (e.g., books, peer-reviewed articles, etc.) within a given topic. Literature studies provide insight into quantitative data about mental health. The sources have been selected for reliability and relevance. Some sources have also been compared with each other, which enhances reliability. Thesis Mental Health Matters Lara van Alphen 2022 2.3 Are students informed about mental health? Not much attention for mental health in schools Schools in the United States should have a big role to play in supporting the mental health of their students. The Advancing Comprehensive School of Mental Health Systems report gives an understanding from specialists to assist with efforts from the state and country in progressing mental health systems in schools. Only 3 states (Virginia, New York, and Florida) currently have mental health education incorporated in their curricula. If mental health curricula would be mandatory in all schools in the United States there is a big chance of improvement in positive mental health and well-being among the students (Park & Nakamura, n.d.). Currently, high schools are free in how they include mental health within their curriculum. A poll shows that 85 percent of students enrolled in college have not had a lesson about this in high school. Participants believe that lessons about mental health provide more knowledge and insight (GGZ News, 2019). One way to fight against mental health is to be aware of the symptoms and signs. If children would be instructed in school, they would be able to identify mental issues with their peers but also with themselves. Besides that, teachers would be better prepared to recognize mental health problems in case a student is having issues. Furthermore, identifying mental issues early on is essential to make a treatment for various mental issues more successful. Still too much stigma Nowadays, it seems like mental health is a bit more being talked about than it used to be, but there is still too much stigma around it. Not talking about it, whether this is in school or with family is what leads to more and more shame around it. Having open conversations about mental health in schools will help in having thoughtful conversations about several issues students may face. It will help students develop more confidence and assurance starting a conversation with a person that they trust, for example, a good friend, parent, or teacher (Hippe, 2022). Students who suffer from psychological complaints also indicate that such a lesson would have helped them to recognize their mental issues earlier and to deal with them. As that would have allowed them to treat the mental issues earlier. More than half (55 percent) of students with psychological complaints now consider it taboo to talk about it. In addition, four in ten (42 percent) are ashamed of having or had psychological complaints, this was due from a questionnaire for people between the ages of 16 and 34. Young people with psychological complaints who have not sought professional help give the following reasons: 1. ‘’My symptoms weren’t that bad’’ 2. ‘’I was too afraid’’ 3. ‘’I didn’t know where to go’’ 4. ‘’I was too ashamed’’ 5. ‘’I was scared that it would be too expensive’’ (GGZ News, 2019). Thesis Mental Health Matters Lara van Alphen 2022 Time for change and available resources Due to research from JED (the Jed Foundation) that conducted a qualitative and quantitative study with high school students, caregivers, and high school administrators from all over the United States, caregivers and administrators said that they thought it is the school’s responsibility to address the mental health and wellbeing from their students. It seems like a lot of schools don’t perceive information and the caregivers and administrators think this should change, as you can see in the figure below. (JED Foundation, n.d.) Figure 9: School Administrator’s Ratings for School Roles/Priorities in Supporting Student Mental Health (JED Foundation, n.d.) Some universities in the United States developed several types of approaches and ways to support mental health among students, below are given some examples: 1. Introduction- and information sessions There are a couple of universities that already give introduction- and information sessions about the use of drugs and alcohol, sexual prevention, and more lifestyle topics. One of the few subjects that still isn't being talked sufficiently about is mental health (Eva, 2019). For example, Chicago’s Northwestern University came up with brief videos, little talks, presentations, and panel discussions. This type of approach can help students recognize symptoms due to mental health, where to discover assets and find help, and how to start a conversation with a friend that might struggle with mental health problems. 2. Storytelling Another good and useful example of an approach to support mental health is storytelling. Northwest University led alumni of the University to tell their stories in videos describing their mental health struggles and how they searched for help because of their personal stories students felt more related to the details that are shared. Students feel safer because the stories are based on personal experiences from other students or alumni. Thesis Mental Health Matters Lara van Alphen 2022 In this way they know that they are not the only ones that struggle with mental health issues and they will feel less isolated. Nowadays there is still a big stigma around mental health, open talks and stories that normalize mental health are very useful for students and are a way to create less stigma. (Eva, 2019) Another storytelling program offered by Stanford University gives students access to personal storytelling and academic coaching. In a run of video clips, numerous undergraduates and graduates record themselves talking about their first experience while they entered the campus. ‘’One alum admitted, “I remember thinking, ‘I don’t belong here. I shouldn’t be here— like I was an admissions mistake,” while another confessed, “I was not used to working hard and not being successful.” Stories like these help students better prepare before arriving at their new university (Eva, 2019). Besides the benefits that storytelling makes students more engaged, it also has a couple other benefits:-. Stories are remembered better It is easy to make connections It influences emotions and behavior Creates experience Makes communication more personal Stories are more likely to pass on A very large range It has a way to distinguish from other stories (Imagebuilding, n.d.). 3. Mental health screenings Besides storytelling, encouraging students to screen their mental health in the same way they screen their physical well-being is another way of an attempt to tackle the stigma around mental health. A couple of universities started by offering mental health checkups for free. For example, Drexel University’s Recreation Center came up with the idea of creating a ‘’mental-health kiosk’’ where students can do a ‘’checkup from the neck up.’’ Students can stop by at the kiosk to answer several questions about themselves. After the screening, the students receive a result which exists of information regarding additional mental health resources and supports, as needed. 4. Online tools Depression Grand Challenge The University of California – Los Angeles developed an online screening option called the ‘’UCLA Depression Grand Challenge’. Researchers from the university conducted enormous screenings to find out students, staff, and faculty members that suffer from anxiety and depression, as part of an investigation venture to illuminate major worldwide wellbeing issues. All registered UCLA students can take part in the program. Participants of the screening receive an online assessment that takes 15 minutes. After the screening, the outcome will tell them what symptoms or possible illnesses they have and whether they are mild or severe. Besides that, they will receive mental health treatment (if needed) (Eva, 2019). Thesis Mental Health Matters Lara van Alphen 2022 “The purpose of the program is to develop, implement and test a scalable model for the treatment of depression and anxiety, as well as alleviate the burden of other resources on campus and serve our community,” Arnaudova said (Dunagan, 2019). Researchers will screen the participating students throughout 4 years of their college, so when mental issues might develop later in the students’ college life there still would be attention and help for it. This program will help students how to deal with their (negative) emotions and to bring them in touch with a clinician that can help them start with self-care courses that are offered online (Eva, 2019). Dealing with traumas The college of Social Work from Florida State University developed a training tool offered online, which can help students dealing with traumas from the past, this is because universities in the United States are noticing a small decrease in incapacity to return to a normal condition after negative experiences. Research has shown that many freshmen students suffer from ‘’family and community stress’’ which has a big impact on their study habits. The online training tool exists of videos, talks, information, and more. Florida State University requires all incoming students and exchange students to take part in the online training tool, which highlights all sorts of information to cultivate incoming students' qualities and coping strategies (Eva, 2019). 5. Face to face contact With more and more online sources to provide mental health support, students still think that besides the online support, support through faceto-face contact is important as well (Eva, 2019). Workshops An example of a concept of face-to-face contact that worked well is from the University of Wisconsin. The University came up with a program named ‘’The Pruitt Center for Mindfulness and Well-Being’’ The program offers workshops incorporating mindfulness, week after week yoga classes, and besides that well-being resources at the University Library. The Pruitt Center for Mindfulness and Well-Being has a strong vision: promoting and enhancing the science and practice of mindfulness and well-being for students, staff, faculty, and the surrounding communities (University of Wisconsin Superior, n.d.). Conclusion Overall, we can say that students are not enough informed, there have been some ideas and approaches in various universities but not nearly enough. In the past, schools have said: ‘’We are a school, not a care institution’’ (Leraar24, 2021). But since the problems among young people continue to mount, it is clear enough that education is of no use if students are not mentally fit. Of course, some students have more mental problems than others, but it will be useful to inform all students to both counteract mental problems and educate to prevent the development of mental problems in the future. Thesis Mental Health Matters Lara van Alphen 2022 I figured out through the interviews I conducted that high school students hardly receive any information about mental health in class. Due to the lack of this knowledge or insight, they know almost nothing about this topic when they go to college and they struggle a lot with themselves when they start to develop mental health issues because most of them don’t know what is going on and what mental health means. Furthermore, most students that I interviewed didn’t receive any information about mental health from their parents or other family members. The combination of not receiving any information about mental health in high school or from their family, makes most students very unaware of mental health as soon as they start college. 2.4 How can students figure out their mental health? As mentioned in the first research question; there are already some resources due to mental health prevention available, but students aren’t verbalizing their mental health concerns. Besides that, students don’t know how to react if, for example, a friend struggles with mental health and often don’t know how to start the conversation, either because it’s of their own mental health concerns or their friends’ (Eva, 2019). Below I introduce a few examples of ways to tackle this problem and how students start a conversation about mental health: 1. Virtual environment Around 350 universities in the United States use an online program called ‘’Kognito’’. Kognito helps students to learn how to deal with other students in their direct environment that are suffering from mental health issues. Kognito will help them coordinate fitting assets. As soon as students enter the simulation, they will enter a virtual environment and engage in roleplay conversations with several emotionally responsive virtual students. They will have a conversation with a virtual student that is dealing with mental health issues or has dealt with them before. In this way, users learn their competency to lead conversations that are similar to the ‘’real world’’. The goal after spending some time at Kognito is that the students know how to react in a helpful way towards other students and themselves (Kognito, n.d.). KU Leuven, one of the biggest universities in Belgium, developed ‘’Mind Mates’’. This is an online platform that teaches all students and staff to recognize mental problems more quickly. Students can find information about mental disorders and available help on the platform. They can take a ‘’self-test’’ about their mental state. The university encourages students to be aware of mental health, both within themselves and among their fellow students. Mind Mates offers workshops in which students learn to recognize certain signals of emotional problems in themselves and each other. They practice how to address this in the best way and find out where to go for help. Besides that, students can support their fellow students with Thesis Mental Health Matters Lara van Alphen 2022 emotional problems by being a buddy. This often is the first step toward a solution or seeking for more help (Gezondheid.be, 2019). 2. Free texting The University of Sioux Falls is one of the first universities in the United States that came up with the idea to make free texting for support available for their students. In this way, students can have contact with a specific person who they are worried about. But also, if they are having problems themselves. For example, stress about their tests or grades, discouragement, depression, or even people that are suicidal. Trained members of the Helpline Center are prepared to reply to writings 24/7, they will give the student advice on what to do in what sort of situation. They also welcome students to have a look on their Instagram account with the hashtag #sdhopenotes, highlighting notes of support that students put around colleges and colleges all through the state (Eva,2019). 3. Mindful moment Besides those campus initiatives, instructors and professors can also empower students' wellbeing by specifically modeling preventive procedures and adapting abilities in their class, also known as a ‘’mindful moment’’, a teacher at Seattle University started doing this. Mindfulness is a form of exercise in concentration, attention, and awareness and can send students in a certain direction and be aware of their mental health. Learning to stand still in the here and now and pay attention to what you observe. But also observe from an open attitude what is happening around you and experience it without judgment (Eva, 2019). The study of the Mindful Nation Uk has shown that mindfulness-based approaches can diminish the side effects of several mental health issues. A recent review of 114 studies found consistent improvements in mental health and wellbeing, notably reduced stress, anxiety, and depression (Loughton & Morden, 2022). 4. Self-monitoring A result of the predominance of mental illnesses among college students led to the development of several prevention programs. Self-monitoring assists individuals to set objectives, increase self-regulation and give mindfulness of personal struggles in conjunction with accessible support networks (Gatto, Miyazaki and Cooper, 2020). Self-monitoring is well-suited to address the common obstructions to mental healthcare in youthful grown-ups, such as inclination for selfreliance, absence of awareness of symptoms, not enough knowledge of physiological resources, and stigma. Online interventions have appeared to be effective in diminishing stress underneath college students. An example that could be useful would be an electronic-based self-monitoring program. Due to research self-monitoring is depicted as a means to supply a person with the knowledge fundamental to set up objectives and assess advance toward the objective. Self-monitoring leads to superior self-management through ease of recognizing side effects, progressed control, and superior quality of life. Thesis Mental Health Matters Lara van Alphen 2022 A vital perspective of self-monitoring is to set goals, this has shown that behavior can be influenced by coordinating attention towards activities that have set specific goals and expanding assurance. Incorporating feedback related to the progress of goals is critical to include, as it can quicken therapeutic success over and past treatment as regular and improve the effect of self-monitoring. People that use the self-care techniques through setting goals and monitoring feedback are effective in achieving their goals. Self-monitoring would be useful to address several barriers to mental well-being treatment in young adults, counting poor self-regulation, self-reliance, awareness of symptoms, and psychological resources (Gatto, Miyazaki & Cooper, 2020). 5. Adding mental health lessons to curricula As defined in the first research question; adding mental health lessons to curricula in schools would be a good effort to improve the mental health and wellbeing of students. It can be hard to recognize when students are struggling with mental health; for the people around them, but also, they sometimes don’t even know by themselves that they are struggling with mental health issues. Park, Yunsoo and Nakamura (2022), identified the ‘’5 T’s for Mental Health Education in Schools’’, as you can see in the figure below: Figue 10: 5 T’s for Mental Health Education in Schools (Park, Yunsoo & Nakamura, 2022) 1. Talking about mental health Students need open conversations about mental health to decrease the stigma around it. Most mental illnesses already start before the age of 14 years old, and sometimes they stay untreated for many years. The earlier talking about mental health happens, the better. Several strategies such as well-being tips and announcements about mental health during the day do good in promoting productive conversations. 2. Providing appropriate Training for teachers and staff Teachers need to be trained to be able to react to possible signs of mental health issues. Many teachers said that they feel not prepared to support students in a way to help them with their issues or to recognize a student that struggles with mental health. Schools will need resources to give training to teachers and professors to develop those qualities. Thesis Mental Health Matters Lara van Alphen 2022 3. Incorporating mental health into Teaching Integrating mental health into courses, presentations or classwork will help students that are in a younger age group to identify and manage their emotions. Students that are older can learn about social implications and various mental illnesses. This will help them better understand their own mental health. 4. Providing helpful Tools for students ‘’The average student-to-school-counselor ratio is 182:1, nearly double the 250:1 ratio recommended by the American School Counselor Association’’ (Park, Nakamura, n.d). That means that there is not always enough access to school counselors. Other mental-health building tools can be added to the schools as creative/arts, exercising, several relaxation techniques such as mindfulness or meditation, and so forth. 5. Taking care of teachers Besides the mental health of students, the mental health of teachers is as important. The teacher can experience many issues, for example being stressed and overworked. This can have a bad influence on the students and their grades. The same mental-health tools as for students could help teachers, think about mindfulness and workplace wellness programs (Park & Nakamura, n.d.). Conclusion It can be difficult for students to recognize if they have any mental issues. This is mainly because they do not know about it. After all, they are not educated or aware of their feelings. Some universities have set up certain programs that can help students figure out about their mental health and how to take that step toward getting help if needed through health education, self-monitoring, mindful moments in the classroom and virtual environments. 2.5 What are factors that can influence students’ mental health? Social and economic living conditions Mental health is determined by a combination of several factors, known as ‘’social determinants’’. These are social and economic living conditions that together influence the health of the population. The social determinants are defined as the conditions in which people are born, grow, live, work, and age. This includes, for example, social security, inclusion, poverty, and stress caused by the dynamic society, which creates pressure to perform. Such determinants determine the mental health of the population throughout their entire life course. If you compare the determinants between different groups in the society, differences in social inequality can occur, which translates into differences between groups in terms of expected number of healthy life years. This concept sees mental health as a dynamic process that continues throughout the life course and is shaped by social determinants of health (Trimbos Instituut, n.d.). Thesis Mental Health Matters Lara van Alphen 2022 Figure 11: Social determinants of health (Trimbos Insitituut, n.d). The mechanisms by which these social determinants affect both physical and mental health are complex and interconnected. There are two mechanisms that reinforce each other: causation and selection. Social determinants influence mental health (causation) and mental health also influences social determinants (selection). So for example the socio-economic position of a person can influence their mental health at different stages of life and at different ages. Mental health can influence for example education or participation at the job market. Furthermore, the social gradient of health shows that the risk of mental health issues increases with a decreasing social and economic status. The goal of policies reducing the social gradient of health is reducing the risk. This mainly concerns universal approaches, aimed at the total population (Trimbos Instituut, n.d.). Promoting mental health In short, promoting mental health means strengthening the positive factors for mental health and reducing negatives. Positive factors work in two ways: they act as a buffer against what can go wrong, and they help people on their way to a healthier life. However, a significant portion of young people struggle with this and therefore are at risk of developing mental health issues (Elias, 2018). Most literature sources interpretate positive factors from a rather negative approach. For example, literature sources often focus on what we should do to prevent or treat mental disorders. While it would also be useful to look better at what is going well so far, and how to strengthen those positive factors. De Roover’s model De Roover’s model builds upon the social determinants of health. One of the few models that pays attention about those protective factors is developed by The Mental Health Promotion Effectiveness Review (De roover, 2011). De Roover’s model builds upon the social determinants of health. This model exist of a protective factors model and a mental health risk factor model, as you can see in the figure below. Both models can be divided according to the four major stages of life (early years, youth, adulthood, and later age), and the model presented is based on students. Besides the life stage the model is described on the individual (1st level), familial (2nd level) or environmental level (3rd level). Thesis Mental Health Matters Lara van Alphen 2022 Individual Familial Protective (positive) factors Feeling of identity Self-agency Optimism Success in school Active lifestyle Enough education Meaningful leisure activities Respect Good relationships Good connection with family Positive experiences with family Environmental Good relationship with peers Social connectedness, identification with groups Early detection and treatment of (learning) disabilities Supportive school and culture Schools with strong academic and non-curricular capabilities Social support Social participation Good social services Accessible sports- and leisure activities (Vlaams Instituut Gezond Leven, 2022) Risk (negative) factors Learning problems School failure Leaving school early Physical illness Low self-esteem Communication problems Anxiety and depression Alcohol and drug use Unhealthy lifestyle Traumas Parental conflicts and weak parenting skills Physical, sexual or emotional abuse Crime or addiction in the family Taking care of older family member Financial problems Being bullied Poverty Discrimination Unemployment of parents Social exclusion and isolation Conclusion Several factors, as you could read in the model of Roover, can affect students' social and economic living conditions, divided by protective factors and mental health risks. Besides understanding the various models, it is also important to understand certain big risk factors that exist for developing mental health issues.One of the biggest factors that can affect the mental health of students is stress. Students making the move from puberty towards young adults are regularly tasked with unused parts and duties that can increment stress. Stress increments being vulnerable to developing issues with physical and mental functioning, they experience a lot of pressure to perform. Thesis Mental Health Matters Lara van Alphen 2022 2.6 What is the best way to reach students who are starting to suffer from mental problems? Young people are an interesting target group because they are in a phase in which they get to know themselves and in which their brains are still developing. The brain of young people is constantly stimulated by a continuous stream of information. They can be reached anytime and anywhere with their smartphones. 96% own a smartphone where they are busy on all sort of different applications. Understanding them is essential for school marketing and communications staff. It is important to understand the target audience because every generation has its own needs and interests. It seems like a hard target group to reach, but definitely not impossible (Parentcom, 2021). Digitalized generation Generation Z – current or future students – or people born between 1995 and 2015 are true digital natives: they have been exposed to the internet, social media and mobile technology from an early age. This has spawned a hypercognitive generation that is very comfortable collecting many sources of information and integrating online and offline experiences. A number of characteristics are clearly visible in Generation Z (Gen Z). One of the most important characteristics when it comes to consumption behavior is the fact that young people have moved from possession to access. Much value is not placed on possession but on the use and experience that is offered. Selfexpression is also very important to Gen Z, the social media channels are used for this. In addition, Gen Z attaches great value to sustainability, inclusiveness and openness (Yilmaz, 2021). Be trendy Creating an excellent experience where mobile first is central is important. Appearance is essential because the Gen Z has been exposed to websites and social media (via a smartphone) from the very beginning. Getting away with a website, application or other digital product that was last updated 5 years ago is not possible. Plus, it just has to look trendy because this generation's attention span is so short. The device should be fast and mobile-friendly, but also has to have a quick response when Gen Z asks you something. Chatbots and wellorganized customer service would be helpful. Besides that, a genuine social media strategy is needed, otherwise it will not successfully reach college students says Kelli Matthews, social media marketing expert and instructor at University of Oregon (Lane, 2012). Social media Social media is an essential part of reaching Gen Z. Self-expression is very important to them and they use several social media channels for this. The social media channels of most interest to Gen Z are TikTok, Instagram, YouTube and Snapchat. It is essential to have a content and advertising strategy for each channel. Especially with the content creating and distributing content, it is important to create content that fits the platforms. Gen Z is constantly switching between different social media channels, so an ‘’omni-channel’’ social media Thesis Mental Health Matters Lara van Alphen 2022 strategy could help. On average, young people spend around 6.5 hours a day on social media what makes social media a perfect way to connect with them (Yilmaz, 2021). Gamification A game seduces and motivates. Gamification is the use of techniques and elements from the game world in a non-game environment. That way you can motivate people to do or learn something in a fun way. Young people spend a lot of their time playing (video)games. This is interesting for communication to this target group. A message becomes more attractive when it contains playful elements. Experience and emotion Storytelling is another good way to reach young people. They can share experiences and emotions with each other. The brain plays a major role in how storytelling works. A story is easier to remember because it is often told recognizably, without the essence of the message being told. Information also becomes more interesting and fun when it is told in story form. These stories must of course be interesting enough to share and can therefore be exciting, shocking, or funny (Parentcom, 2021). Conclusion Gen Z has never known a world without mobile phones, laptops or the internet. All their lives, these screenagers have been accustomed to being able to easily connect with others, to find all the information they want, and to be constantly provided with new entertainment. So it is important to reach them through their mobile phones and with a certain tone of voice that fits the needs of the users. It is necessary to be trendy and to keep them interested through stay close with their needs and interests. 2.7 What sort of mental health issues affects students the most? Seven out of ten students living in the United States experience some sort of stress and anxiety on an everyday basis. Whereas stress is an inescapable portion of life, it is exceptionally displayed and getting to be more predominant among college students. Within the United States of America, nearly 10% of college students have been analyzed with or treated for any sort of depression over the past 12 months. In any case, as it were approximately half of the individuals in the United States enduring and analyzed cases of sadness are treated for the disorder. Nowadays, getting a college degree considered to be the key to success in life. Going from high school into college is a critical transitionary period related to all sorts of stressors resulting in physical and mental vulnerabilities, during which numerous students don't get the assistance they will need. Numerous students will leave the place where they grew up and they have to deal with a lot of changes (Hunt & Eisenberg, 2010). This transition can be a cause different sort of mental issues as: Thesis Mental Health Matters Lara van Alphen 2022 1. Concentration problems The use of social media and the increasing pressure can result in concentration problems. These concentration problems then lead to even more stress. The lack of knowledge in ways to de-stress means that these concentrations problems can lead to fatigue. 2. Stress Students experience a lot of pressure including test-taking, the volume of the study material and planning has appeared to be a noteworthy source of stress. A combination of performance pressure can cause this. The pressure from outside is big, and the pressure to perform well are, in some cases, incredibly intense. 3. Fatigue and problems with sleeping A combination of study stress, pressure to perform and social pressure can translate into fatigue and energy problems. Due to this fatigue, the stress and pressure is experienced even more intensely, which can quickly lead to a burnout (Mijnstudentenleven, 2019). 4. Anxiety Anxiety underneath students is common. Students are afraid for a high student debt, fear for disapproval and judgement of others, fear of failure and fear of missing out (for example, social gatherings, parties and so forth) (Gutierrez, 2022). 5. Loneliness Through various social media channels students can look into the lives of others. Those social media channels often give a distorted picture of life. There are many images of the most beautiful trips, coolest parties and luxury products. This creates the image that the life of others consists only of happiness, pleasure and joy and which causes students to develop a distorted picture. Besides that studying itself is often a cause of the increase in loneliness. When students move to another city to study and live, they often leave their friends behind and have to start a new life (Recruitastudent, 2022). Overall, the increasing pressure to perform appears to be the main cause of stress among students on several fronts. In some cases a combination of several mental issues can lead to a burn-out. Students with a burnout feel that they can no longer recharge themselves. In addition, a burnout is also accompanied by sad and depressed feelings (Gutierrez, 2022). In arrange for colleges to treat students with specific needs, it is imperative to understand what other aspects in their lives might cause the big increase in sadness, anxiety problems, and stress. Due to research having a negative body image have been appeared to be connected with an increased probability of depression and anxiety and lower satisfaction, low self-esteem, and sentiments of inadequacy that may result in critical disability of social, word-related, and educational functioning. Thesis Mental Health Matters Lara van Alphen 2022 If students come from a family with the bad financial stability they are more likely to show indications of depression and anxiety. Several studies have shown that financial difficulties are related to higher rates of these mental well-being issues (Beiter et al., 2015). Lots of students that got questioned reported that mental well-being challenges meddled with their studies. In a survey from the American College Health Association in 2015, college students recognized the mental wellbeing issues below as a negative impact affecting their academic performances: - Stress (30%) - Anxiety (22%) - Sleep challenges (20%) - Depression (14%) There are consequences not only for the students themselves, but also for their environment. Peers may be personally affected out of concern and some mental issues can have damaging effects on relationships (Suicide Prevention Resource Center, n.d.). Conclusion Due to the primary and literature research stress and anxiety seems like the biggest mental health issues among college students. Those issues can influence numerous areas of the life of college students, reducing their quality of life, academic performance, physical wellbeing, and fulfillment with college involvement. 2.8 Related projects To gain a better understanding of existing groundwork, related projects have been looked at and compared with each other. The related projects were helpful to come up with concepts and have been a useful source of inspiration. 1. Head space is a website that offers (online) support for young people (12-25 years old). They started with one big mission ‘’to improve the health and happiness of the world’’. They offer online and phone counseling services, and they also go to schools. Besides mental health problems, they also coach young people with work- and study support. It offers a great combination of several features, from daily videos to sleeping exercises which can help with creating healthier habits. Thesis Mental Health Matters Lara van Alphen 2022 Figure 12: Website Head space 2. Besides the website Head space also offers an application which helps to live more mindfully. It is focused on topics as: stress relief, self-awareness, and control of anxiety. The app explains how to meditate in a short period of time and to focus on breathing. The app makes this clear through audio, which is a benefit and makes it more accessible. It is taught to meditate and that this is a nice way to calm down. In addition, students are taught how to get rid of various negative thoughts. Figure 13: application Head space 3. Ease.nl is a Dutch website that offers online support through chatting. Anonymously you can talk about your problems: depression, insecurity, drugs, anxiety, and so forth with a volunteer. They have certain opening times, and you don’t have to make an appointment which makes it very accessible. But they also have a locations in different cities in the Netherlands where you can walk in for free at certain times. Thesis Mental Health Matters Lara van Alphen 2022 Figure 14: Functions platform ease.nl 4. Daylio is an app that is perfect for during therapy process or for people that are very self-reflective. The app asks the same question every day 'How are you feeling?'. Users indicate the answer with a smiley and with the different icons. After a while, users can see how your mood has developed and what has been a good influence and what caused your mood not to be so good that day. Making connections between them can help users learn from them. Figure 15: Screens app Daylio 5. Calm is a meditation app that has a lot to offer for both beginners and those more experienced in meditation to reduce mental health issues. There are guided meditations, stories to fall asleep to, and breathing exercises. Each exercise within this app lasts no longer than 25 and focuses on different aspects such as self-confidence, relationships and mindfulness. Thesis Mental Health Matters Lara van Alphen 2022 Figure 16: Screens app Calm 6. Remente is an application that allows to work on all aspects of the users’ lifes that are not going well. Users can determine their own objectives or choose a number that Remente has already selected for them. Goals can be related to motivation, productivity, relationship, family, friends, physical health, work or study, personal development, hobbies and so forth. Users can split each goal they have into small steps so that your objectives become achievable. They can also keep track of their 'life balance' on a daily basis in order to get an overview of which themes still need some work. Figure 17: Screens app Remente 7. The 'Grow It!' app supports young people by gaining insight into their emotions and helping them to deal with them. The app was developed by a research team of Tilburg University. The app allows children to keep track of how they feel, like a kind of diary. They also get a challenge every day which can help against boredom and with each challenge they earn points. Together with their team, they must grow their tree as much as possible. Gamification is used here, which works well among young people. Thesis Mental Health Matters Lara van Alphen 2022 Figure 18: Grow It app 8. 'Your Brain the Boss?!' is a teaching package that consists of three lesson series to strengthen the mental health of students by talking about it in their daily lives. The program offers three series that mentors can use in their classes. The students are given words so that they can talk about it more easily and new ideas on how to do things, this gives students a better understanding of themselves and others. Conclusion Through the various related projects, I was able to get inspiration and gain various useful insights. One aspect that I found interesting in the Head Space app was the explanation videos: for example meditation sessions which help the user feel more relaxed in combination with exercises to keep the user active while using the app. Something else that sparked my interest was the option that the app Daylio has a personal diary. The app asks the user every day how they are, it makes the reflection on themselves more fun by the use of icons. This is something that can work very well among the target group of students. Lastly, something I thought was interesting about the ’Grow it’ app was the use of challenges to complete within a team, implementing an element of gamification keeps the user entertained and committed as they have something to strive to. 2.9 Design requirements After having identified the literature review, and the needs of the target group, it has become clear which characteristics the eventual product should have. Based on the answers to the sub-questions arising from the secondary and primary research and the needs of the target group through several interviews, the design requirements have been drawn up that are leading in the development of the concept. Thesis Mental Health Matters Lara van Alphen 2022 Figure 19: Design requirements 3. Design phase In the design phase, insight is given into the functional and graphic design of the final solution. This phase provides an answer to what the final product should look like. To achieve a concept that is valuable to the target group, several solutions have been created. Possible concepts have been devised using creative sessions. The final concept will be explained step by step in this chapter. The structure and navigation are explained using a 'user flow'. After that, sketches have made to explain further. After the sketch phase, the low-fidelity prototype (paper prototype) was tested. This is followed by the determination of the visual style of the end product. Each design choice during the conception phase is based on the outcomes of the primary research and the secondary research from the analysis phase. After the low-fidelity prototype had been tested, it was further developed in Adobe XD into a medium-fidelity prototype. This includes all functions of the app that make the concept clear. Approach I reassessed the design requirements before I started brainstorming about the concepts, it is very important to include those to make sure the target group will feel satisfied with the prototype. One of the most important design requirements was that the product must be an application, that can be used on smartphones. This is because college students nowadays are accustomated to using their smartphones for everything. A recent study showed that ‘’college students spend between 8 to 10 hours a day using a cell phone every day. This does not include other devices such as tablets, computers, laptops, or televisions.’’ (Bluetech, 2022). With that design requirement in mind, I brainstormed about possible concept directions and associated themes the application could take. Thesis Mental Health Matters Lara van Alphen 2022 3.1 Concept ideas Several concept ideas have been generated during the concepting phase, they were all based on the design implications established in the analysis phase. The concepts described below are a result of several brainstorm sessions. In addition, a first visual impression was made in the form of low-fidelity sketches (prototypes). The following sketches are simple prototypes that allow for quickly testing ideas of a digital product. They are suitable, for example, to find out at an early stage of the design process what users think of the concept, whether they need it at all and is according to their functional requirements. Besides to test a certain flow before fully working out the visual design. The main purpose of the low-fidelity sketches is to test the idea and functionality, not the visual design. The emphasis is not on details, this will start later in the process. 3.1.1 Concept 1: Mindz Figure 20: Concept Mindz Main element: Application that offers activities that help prevent and/or counter mental health issues Summary The first concept is about solutions to counter depression. Based on the research conducted, I included all the aspects that work well when someone struggles with mental health. Activities can be conducted that are useful for mental health, for example, mindfulness, workouts, yoga sessions, meditation, healthy recipes, Thesis Mental Health Matters Lara van Alphen 2022 sleeping habits, and so forth. This concept includes videos based on the activity to counter depression that the student is working on. Feedback The students liked the idea of the activities and that they can work on them to improve their mental health. They told me a few items were missing, for example, a personal profile. Users also indicated that it was not very personalized yet. They liked the idea that they could see their progress, overall this concept needed some more depth. 3.1.2. Concept 2: Buddies Figure 21: Concept Buddies Main elements: Connect with other students that struggle with mental health to reduce loneliness Students divided into groups and receive group therapy by a mental health provider Groups come together in real life to do a certain activities as workshops or readings Students receive one specific provider to themselves called their ‘’buddy’’ Summary This concept is focused on online therapy through a ‘’buddy’’ system. Students can connect with other students that struggle with their mental health; they are divided into groups. They will receive group therapy through various sessions each week given by a provider. This has the benefit that they are working on their own mental health, but also work on their social skills and can make new friends. Based on the research loneliness is something that many students deal with. Besides the online group sessions students meet once a week to do a fun activity together to feel more relaxed and connected. Thesis Mental Health Matters Lara van Alphen 2022 Feedback The students liked the idea of the group session and connecting with other students and the buddy system, but they said that probably not all the students would feel comfortable with the idea of group sessions because a lot of students already find it hard to take the step to look for help, and if that step includes more people it can even be harder for the students. They also liked the idea of the group activity in real life, but again some of them said they wouldn’t feel comfortable talking about their mental issues with other students. They preferred to just talk about it with one provider. 3.1.3 Concept 3: Feeling Fabulous Figure 22: Concept Feeling Fabulous Main elements: Only therapy sessions Areas for self-improvement Online profile Give a grade to daily mood In the figure above can see the second concept I developed and tested with the target group. It is an application that especially focuses on online therapy for students. Thesis Mental Health Matters Lara van Alphen 2022 Summary The student will have a profile, which has some basic information about the student itself and simply can adjust the account details and settings. Each day the app will check in on the student and ask how he or she is doing. To make it easier the students can give their mood that day in a range from 1 to 10, and in their profile, they can see the weekly average of their moods by the average grade of that particular week. They can also give a focus on a subject or area where they want an emphasis and choose several themes: for example: starting to love themselves, working on their stress or anxiety, and so forth. While doing my interviews, many students told me that they would like to have help with their problems. They don’t know where to go to receive help and are sometimes too scared to go see a counselor or psychologist. Because of the implementation of online help, it would be easier for the students to access help related to mental health. Each student can receive online therapy based on the focus areas the student has chosen. There is a chat function where they connect with a therapist and can receive help and ask them anything they want. There is a possibility to stay anonymous, this is because some students are ashamed. Feedback I met with a couple of students and showed them the concept and explained to them why I made certain decisions that are available in the concept and explained this to them. The feedback I received was positive, including the idea of receiving online therapy was useful. But students also said it would be useful to have therapy in person if the student wants to. Due to my research students often don’t know where to go to seek help if they want (in person) therapy, this was some useful feedback that I incorporated later on. Students also enjoyed the fact that they could give their mood a grade every day, but they suggested smileys because this comes across a little more friendly and it looks more like a game. Thesis Mental Health Matters Lara van Alphen 2022 3.1.4 Concept 4: MOOD Figure 23: Concept MOOD During the brainstorming session, I decided to add some new elements to my next concept, based on the feedback I received on my prototype and other insights. Main elements: Challenges Reflective moodtracker with emoticons Summary I added a function to the mood tracker: ‘’a reason’’. Due to research and based on the feedback from the students. Reflecting makes you very aware of what you are doing. This means that you can enjoy your successes more, which you normally don’t think about. This is very motivating, on the other hand, you will also learn from the things that are not going well. Besides that, students can now rate their mood by using smileys instead of grades. This decision was also made based on the feedback of the students based on the first concept. The students can express themselves better with images/emoticons than with plain text, as they offer a way to convey nuances and emotion. Thesis Mental Health Matters Lara van Alphen 2022 I also added a game element in the app (gamification?). Students will receive weekly and daily challenges in the app which help them feel better. Examples are going for a walk, doing some coloring, eating 2 pieces of dark chocolate every day, trying to go to bed at 10pm, working some omega 3 fats in your diet, and so forth. To make it a game element (research shows gamification resonates well with students) a function to collect points is added. Feedback: This time I sat down with a bigger group of students and showed them the different updated concept. They liked the idea that now they can choose an emoticon instead of giving themselves a grade and can reflect on why they chose the particular emoticon so they can reflect on themselves, this was a co-creation session. 3.2 Testing & prototypes Each design in the phases from low to high-fidelity is tested by four people, all four individuals were students from Northwest Missouri State University. They are asked whether they want to use 'thinking out loud, where they say aloud what they are looking, trying and thinking. During the test moments, the participants are given several scenarios. The low-fidelity prototype was sketched and the medium- and high-fidelity prototype are more detailed because a design program has been used. 3.3 Low-fidelity prototype For the low-fidelity prototype, paper prototyping is being used. Paper prototyping is a commonly used method to create and test new interfaces in an accessible way. It helps to devise and validate fast. Most feedback is on the content of the prototype and not on the visual looks of the prototype, which is useful in such an early stage of the prototype so much content can still be adjusted. Let’s see why paper prototyping is so useful: - You learn what is really important. - This method helps to find out which functionalities are very important to the target group. - The target group is involved in a very easily accessible way - It is very practical. Even people who do not have design knowledge can participate immediately. It's fast and effective. - It is practical and immediately adds value Thesis Mental Health Matters Lara van Alphen 2022 Figure 24: Mind map based on feedback from previous concepts to create the low- fidelity protoype Figure 25: Elements in low-fidelity prototype Thesis Mental Health Matters Lara van Alphen 2022 Figure 26: Questionnaire in low-fidelity prototype Main elements: Questionnaire Earn points with challenges Reflective mood tracker and mood journal Diary Self-care Online therapy & connection with a therapist 3.3.1 Summary The low-fidelity prototype is a combination of the three previous concepts. Based on the feedback I received from the target group and professionals I created the low-fidelity prototype. A questionnaire was added, so the app will get to know the student and after the questionnaire, the student will receive an ‘’outcome’’. The app gives a result of what possible mental issues/illnesses the student may have, but the outcome can also be that the student is mentally ‘’healthy’’ but he or she can still use the app to work on themselves and their mental health. Students that need it can seek help through the app and a connection can be made with a counselor from the university who can offer therapy both online and in-person, according to the wishes of the student. In addition to the challenges, students can earn points and collect several prizes. For example, by attending an event about mental health at the university, they can also challenge their friends. Besides they can reflect on the challenges by writing a short message what they made them feel that way. In the weekly analytics options students can see the average mood of that week based on the previous chosen moods. Thesis Mental Health Matters Lara van Alphen 2022 3.3.2 Feedback The feedback from the students and professionals was very positive, they liked all the elements in the concept and thought they were all very useful. Below the strengths and points of improvements are listed. - - - - Strengths: The weekly analytics option to see the average mood of that week based on the previous chosen moods. The fact that you will receive an outcome of possible mental illnesses directly after finishing the questionnaire. The possibility to reflect on the challenges. The challenges and that you can earn points with it. The possibility that the app can connect you with providers in the area and to book a session through a chat function in the app. The small overview with all the main elements from the app. Points for improvement: The option to see how many points your friends have. They thought it would be slightly inappropriate in an app like this as it is a sensitive topic and not everyone wants to be visible in the app. The ‘’self-care library’’ was a little bit boring, as the content offered was not specific enough for the target group. Sharing personal stories from students experiencing mental health issues would be more interesting. There is no chat function yet to send a message to a provider. Option to choose the mood from a list of emoji’s instead of the slide bar. 3.4 Medium-fidelity prototype Once the low-fidelity has been tested, we can go deeper into the design of the prototype and add visual aspects. The medium-fidelity prototype has limited functionality however with clickable options with interaction and navigation possibilities of an existing app. Based on the feedback of the low-fidelity prototype, the medium-fidelity prototype was designed and realized in a more detailed way, including all the elements that were tested through the low-fidelity prototype. The mediumfidelity prototype was presented to the professional framework Egon Heidendal, the graduation supervisor Megan Jennings and to the target group; students from Northwest Missouri State University. 3.4.1 Name It was decided to call the medium-fidelity prototype #MHM which stands for Mental Health Matters, the abbreviation was chosen because it rolls off the tongue and the hashtag makes it trendy to attract the young target group. Thesis Mental Health Matters Lara van Alphen 2022 3.4.2 Style While creating the first design for the app, several choices had to be made. Based on previous interviews it became clear that the app must have an easy and logical user interface and a matching color palette was needed. The decision was made to incorporate bright colors as purple, yellow, red, and blue, based on color psychology palettes. In addition, students themselves mentioned they would like to see ‘’happy’’ colors in the medium-fidelity prototype and especially not too ‘’businesslike’’. The decision was made to incorporate bright colors as purple, yellow, red, and blue, based on color psychology palettes. Besides the color palette I decided to use the font Quicksand. This font has rounded forms of letters which radiates a warm and cozy feeling with fits with the needs of the target group. Lastly, I chose to make us of a set of Icons from flaticon.com that looked playful, which matches with the playful elements in the app as you can see in the figure below. Figure 27: Design choices medium-fidelity prototype 3.4.3 Content There are several major differences, compared to the low-fidelity design such as design, giving color to buttons, and the use of icons. As you can see below this gave a better impression of what the product could look like, because the sketches have been further developed and the design program XD has been used. During the sketching and brainstorming, a number of main elements have been thought through, that are included in the medium-fidelity prototype as: the challenges, the questionnaire, information about mental health, the mood tracker, and the connection with a provider. The elements in the medium-fidelity prototype work largely the same as described for the low-fidelity prototype. At this point it has been translated into a digital prototype in which all screens have been developed in more detail and are visually more attractive. Based on the feedback from the low-fidelity, several elements have also been added, such as the chat function with a provider and the use of storytelling through personal stories about students' mental health. Research shows this normalizes the stigma around mental health and make students feel better to Thesis Mental Health Matters Lara van Alphen 2022 know that they are not the only ones that struggle with mental issues. In addition, it is possible to choose from a list of emoticons and it is possible to add a reason why the user chose for that certain emoticon that day. Thesis Mental Health Matters Lara van Alphen 2022 Figure 28: Screens medium-fidelity prototype 3.4.4 Feedback & test results The medium-fidelity prototype was presented and tested by my graduation supervisor Megan Jennings, my professional framework Egon Heidendal and four students. Overall, they liked the prototype and felt that the prototype was clearly designed. But there was also some room for improvement. - - Strenghts: They liked the added storytelling because it gives some education about mental health more fun instead of just listing mental health items as in the low-fidelity prototype. The weekly analytics work well and gives a good overview. Thesis Mental Health Matters Lara van Alphen 2022 - - - - - Reflecting on the completed challenges and chosen moods works well. The fact that the app greets the user in the beginning made them feel safe. Points for improvement: More options to choose from the mood tracker, students can feel more emotions than just the three given options in the app so they would like to see more options to choose from in the high-fidelity prototype. They wondered what to do with the points collected through the challenges, this was not clear to them yet. They found the icons a bit too childish. The colors of the app were a little distractive, they thought it was good to use bright colors, but a little less and calmer than the color palette that was used at this point. They said very bright colors may trigger people that are struggling with mental issues. Instead of listing the emoticons it would be more fun to put them in a circle. They liked the idea and explanation of #MentalHealthMatters but didn’t think it worked well because people wouldn’t know the abbreviation of it. Instead, would be better to fully write it down. While reflecting on the mood it would be helpful to choose from a list of reasons first before reflecting on the mood because sometimes it can be hard to directly come up with a reason. 4. Realization phase The design discussed in the previous chapter is converted into prototypes during the realization phase. A high-fidelity prototype is being worked on via a mediumfidelity prototype. The time that is normally invested in the actual development of a product is used in this project to promote functionality and experience. In this way, it can be tested with the target group to find out the added value of the product. The most important design choices are explained and substantiated in this chapter. Adobe XD Just as the medium-fidelity prototype, Adobe XD, a program within the Adobe Creative Suite, was used to design the high-fidelity prototype. The reason to make use of Adobe XD is because of the benefits it offers. Adobe XD is a great design program for User Interface Design, User Experience Design, prototyping, and so forth. In addition, Adobe XD makes it possible to create a more detailed sketch and test version of the design. It is possible to export the test versions so that the design is clickable which makes it useful to test it with the target group. The test group can click on buttons in the design and go to linked pages, such as in an existing application. First, the basic functions can be included, with or without conditions. The prototype can then be further developed with a visual identity. Thesis Mental Health Matters Lara van Alphen 2022 Flow chart The following flowchart provides insight into the structure of the application. You can see how the different functions in the application are related to each other. Figure 29: Flow chart 4.1 High-fidelity prototype To make the transition from the medium-fidelity prototype to the high-fidelity prototype, all points for improvement have been implemented based on the feedback from the previous test sessions. At this point, all screens have been designed, more details have been added, and all screens are connected. This makes the app prepared for the last user tests. Due to the high-fidelity nature, this phase can test in more detail and discuss specific areas, such as more detailed usability issues and how users experience the interactions within the application. To test the final prototype, a high-fidelity prototype was again designed by using Adobe XD, that is fully functional in terms of interface. The tests with the highfidelity prototype must be set up differently than in the previous test rounds. The app has been developed a lot further at this point, so a lot of new functions needed to be tested. Several changes have been made due to the feedback received after testing the medium-fidelity prototype, in this chapter I will explain the content of the app and how it works. 4.1.1 Name I changed the name #MHM to MentalHealthMatters, this is because the test group was very vocal on the issue and they mentioned that it wasn’t clear and it was better to fully write it out. It is a strong statement and people will easily remember, as it is a sticky name. Thesis Mental Health Matters Lara van Alphen 2022 4.1.2 Style Feedback asked to make of calmer colors, yellow, pink blue and one more bright color that is green/blueish. Based on the psychology of colors those colors bring calmness but also happiness. This decision was based on the received feedback from the last test session where the test group mentioned the colors where too distractive. Also the font was changed, it was similar to the one used in the medium-fidelity prototype, but this one was more playful. Also a less childish set of icons is used, it is still playful but in a more mature way. Figure 30:Design choices high-fidelity prototype 4.1.3. Content The screens are worked out in more details and a lot of new screens and changes have been added in the high-fidelity prototype as described below: - Questionnaire: The app starts with a list of 16 questions to get to know the student regarding their mental wellbeing state. After finishing the questionnaire, the app shows a personal outcome based on the previous answered questions. The outcome can either be that the student is struggling with mental issues as depression and anxiety, or not. Even if the student is not struggling with any mental issues at that moment, it is still useful to use the app. Although he or she may not need the function to connect with a provider, they still can use a lot of the other options within the app. Because the app is not only designed for receiving help if needed, but also to prevent the development of mental issues. - Therapy: as just discussed, users will receive an outcome after finishing the questionnaire. If the outcome is worrying, the student has the possibility to connect with certain providers in their area, based on the needs from the questionnaire. The user will enter a screen with a list of providers where they can choose from and send them a message to set up a meeting, either online or offline based on their preference. Thesis Mental Health Matters Lara van Alphen 2022 - Mood tracker: the app offers a mood tracker, users can choose through emoticons which represent the moods. In total there are eight moods to choose from. Starting with fantastic, very happy, happy, not that good, sad, very sad, depressed, and angry. After a certain emoticon is being chosen the user can choose from a list of ‘’mood reasons’’ and after that can reflect what made them feel like that certain chosen mood that day. After finishing the reflection, the user will come to a screen that shows some analytics based on that certain month, as a graphic that shows the ‘’mood flow’’ and a short list with their top picks of mood reasons which made them have a good day, based on mood reasons they chose in the past. - Challenges: within the app several challenges can be completed. At the home page it starts with the challenge of that particular day that needs to be completed in order to obtain points. The challenges are all about activities that can make the user feel better, such as: going for a walk, making a painting or as simple as ‘’write someone a thank you note’’. After finishing a certain challenge and reflecting on it (with adding a picture) the user will receive points for it in order to collect and they can be used for certain events in their area. The challenges are acquired as a game, there is a ‘’Challenge Roadmap’’ where the users can find their completed challenges and the statistics of that week. They can also look back on their reflections on the completed challenges in the ‘’Challenge dairy’’. - Top picks: Besides the regular everyday challenges the user can complete other challenges which exist mostly of watching videos about several topics or working out- and meditation videos. After watching them the user can again fill in a reflection and it is possible to collect extra points. - Storytime: Here stories from either other students, influencers or celebrities are listed. They tell stories about their own experience dealing with mental issues. Thesis Mental Health Matters Lara van Alphen 2022 Figure 31: Impression high-fidelity prototype 5. Evaluation phase This chapter describes the final test of the end products, recommendations, and design process evaluation. 5.1 Final test high-fidelity prototype For the final tests of the project, four people of the target group and my professional framework Egon Heidendal were asked to test the app. A shareable link was made in Adobe XD to send to the test group. They shared their screen with me while using. The target group was asked to share their thoughts out loud as they went through the prototype and make comments on anything they either found good, bad or was missing. The following questions were asked to the testers: Thesis Mental Health Matters Lara van Alphen 2022 - What do you like about the style of the app? - What feeling does the app give you? - Are there any ambiguities? - Are there any parts you are missing? - Are there distractions in the app? 5.2 Feedback & test results There was a unanimous positive reaction to the app. A number of useful findings, as listed below, emerged from these last set of tests; the strengths of the app and also findings to improve the app. - Strengths: They were very enthusiastic about the calm but cheerful color palette and found that the colors complement each other perfectly. - They were a fan of the drawn style, which makes the app look a little bit like a game. They didn't think it was too childish, but it suited the target group exactly and gave it a cheerful and calm atmosphere in terms of the colors and icons. - The tone of voice of the app cheered them up, they liked how friendly the app communicates with the user and calls the user by name. - They thought it was a good option to start with the questionnaire, and that it was at the beginning so that they must fill it in first. They indicated that otherwise there will probably be students who would skip the questionnaire. - They found it helpful that after completing the questionnaire immediately various options from care providers were given. - They thought it was a very good implication that it is possible in the app to reflect on the challenges, activities, and the chosen mood. Besides they liked the ‘’challenge dairy’’, so that they were able to look back at their reflections. - The challenge roadmap was very fun and playful and nice that you can see the progress made for that week. - The possibility to choose from multiple emoticons and moods is nice. Besides they are placed in a circle now, this makes it more enjoyable. - The homepage was clear and there is an easy navigation between the different screens. All functions and buttons are easy to use. - Points for improvement: The test group wondered when the providers they were matched with would be available to chat, this was not entirely clear in the app yet. Thesis Mental Health Matters Lara van Alphen 2022 - Adding a timeframe to the challenges so that users must finish a certain challenge within a predefined period of time. - Adding statistics in the profile screen so that users can see how many points they have collected, the average mood of that week and how many challenges they have completed. - In the screen where you can see your moods every day of the month, make the emoticon bigger for that certain day to make it stand out more. - It would be helpful to change the color of the screen when the options to choose from are different as the screen before to reduce possible confusion. - Adding a button ‘’not facing any issues’’ in the questionnaire so that users that don’t struggle with mental issues can choose that option. - Replace the most recently finished challenge to the front instead of the bottom at the challenge roadmap screen. - Add a nothing specific button as a reason to choose from at the mood reason screen, sometimes users may feel happy or sad without a specific reason. 5.3 End product While testing the high-fidelity prototype, several important areas for improvement were listed. After the final test sessions these were implemented in the new version of the prototype. This is the last version of the prototype where all previous feedback is included, and all screens are finalized, which makes it ready to use for the target group. Below you can have an impression of the high-fidelity prototype. The final product can be viewed via the following link. Here you can walk through the prototype as it would also work as a real mobile application: https://xd.adobe.com/view/a27e23e3-bc2d-4c10-85e2-684bdd75f844-f72d/ Thesis Mental Health Matters Lara van Alphen 2022 Figure 32: Impression end product Figure 33: Impression end product Thesis Mental Health Matters Lara van Alphen 2022 5.4 Conclusion Conclusively it can be said that nowadays there is still a big stigma around mental health, students are not aware of it or not informed by the school they went to or by their families. This information allowed me to formulate the problem statement at the beginning of this project. The aim of this graduation project was to develop an accessible platform for students to inform them better about mental health and offer help to students who need it. In order to achieve this objective, five research questions have been formulated. This chapter describes the main conclusions of the study. In order to achieve this objective, a main question and five research questions have been formulated of which will briefly be repeated, including the main findings, below. Are students informed about mental health? No, students are not informed enough. Through my interviews students mentioned that they never received any information in their previous high schools or from their family members. Because of this most students barely know anything about mental health which makes them struggle a lot when they start to develop symptoms related to a mental illness or other mental issues. How can students figure out their mental health? It’s hard for students to recognize if they have mental issues by themselves, because of their lack of knowledge on the subject. So that makes students struggle a lot with figuring out their mental health. Some universities developed learning programs that help students figure out their mental health and to make the step in the right direction to ask for help through various program such as: self-monitoring and virtual environments. What are factors that can influence students’ mental health? Several factors affect a student’s mental health, these are divided into protective factors and risk factors, based on the model of Roover. Examples of protective (positive) factors are feeling of identity, an active lifestyle, and good relationships. Risk factors are learning problems, low self-esteem, an unhealthy lifestyle. Stress is the biggest factor that can influence the mental health of students. The most important cause of stress is the transition moment in moving from high school to college, in which students find themselves. The life of a student changes and more is demanded. They have little control over that situation. What is the best way to reach students who are starting to suffer from mental problems? Nowadays, all students have one thing in common: they all have a smartphone, and they all have access to the internet. That offers the mobile phone an excellent opportunity to reach and involve students, by using an application that they can download in the app store. Online, this group can be easily reached via socials such as YouTube, Instagram, Facebook and TikTok and to make use of storytelling. Information becomes more interesting and enjoyable when it is told by a person they could identify with. Thesis Mental Health Matters Lara van Alphen 2022 What sort of mental health issues affects students the most? Almost all students experience stress. The most important source for students if they experience stress is because of their studies. They experience a lot of pressure to perform from themselves or others. Both stress and pressure to perform are important factors that influence mental health and students. In addition, anxiety is a major factor that can influence the mental health of students, which is partly related to the stress they experience. Anxiety disorders often develop around young adulthood. This is because of the responsibilities and new challenges that students must learn to deal with. Does the designed tool meet the requirements? Based on these insights, several design and functional requirements have been defined which aspects for the end product. The design requirements have led to valuable concepts. After exploring and presenting different sorts of concepts to users, the app ‘’MentalHealthMatters’’ was developed. The app gives a solution to the main task on hand ‘’how to inform students about mental health through a multimedia tool’’. The app can be used to inform, support, and refer students with (or without) mental issues. The general, stigmatization surrounding mental health, and the barrier to seeking professional help among students is aimed to be overcome by this app. This is because the app normalizes mental health issues by the use of storytelling and makes it easy for students to connect with providers in their area to receive the help they need. Students can learn about mental health through this app in a playful way, reflect on themselves, and plan online or offline therapy sessions with providers. The final test sessions provided final feedback on the high-fidelity prototype. The feedback was about small adjustments to statistics, color choices and a time frame. With this feedback added, the app was presented to the target group where they were very pleased with the end product. 5.5 Recommendations The high-fidelity prototype can be used to enhance the app with future development based on existing feedback and new insights. This will bring the app to the next level to be completely user-friendly. - - - - The app must be mandatory for freshmen students. If the app will be mandatory for freshmen that just start college it will prevent them from mental issues later on in their college experience. For certain challenges as ‘’going for a walk’’ or ‘’run 2 miles’’ a pedometer can be inserted in the app so that it can be checked if they reached the mile or step goal before they earn the points from the challenge. An automatic system which filters certain chats for serious matters as suicidal thoughts and the student will receive a notification to call the emergency number 911 or a suicide prevention line. A social media account can be created to promote the app. Storytelling, in the form of videos, can be used to normalize mental issues among students Thesis Mental Health Matters Lara van Alphen 2022 - - A filter system for the shown post in the app, for example if a student don’t want to read about a certain subject, for example anxiety, can filter this. Possibility to share the challenge dairy with other students. This has to be an option, because some students might find it uncomfortable sharing their dairy. A function with a list of events in the area where they can use their earned points to attend the event and ‘’pay’’ with their points. A function where the student can have an online meeting with a provider through the application and where exactly the provider is located. Contact details of emergency helplines that are reachable outside of the providers’ office hours. An introduction video that starts automatically while starting the app. To tell the students about mental health and to explain how the app works and what it offers. Storytelling works very well among students and it will give them a safe feeling. 5.6 Self-reflection Looking back on how the process went, I can say that I am satisfied with the results. It’s not always easy, for example, sometimes I couldn’t stick to my schedule the way I wanted, and writing in professional English for the first time was a challenge for me. But overall, I can say I’m proud of myself. Analysis The analysis phase went very well. It was easy for me to find the needed students to interview, and I was able to speak with many experts at Mosaic Medical Center and Northwest Missouri State University. Every time I received new advice or was told ‘’Oh, you should talk to that person too!’’. So I ended up getting even too many interviews from experts and I spent too much time on that in the beginning of this project. But the advantage of this is that I could understand the needs of the target group very well. Above all, it was motivating to know that there was a lot of interest and demand for the project from the target group and experts. Design Right from the design stage, I realized early on that the final product would be an online application, which was a key point in the design requirements and feedback. At first, I had a bit of trouble generating the concepts. I had too many ideas in mind and sometimes I wanted to put too many elements into one concept. I had to filter my ideas more and to be more decisive, I learned a lot from that. Also, the test went well, because due to the interviews it wasn’t hard for me to find students and professionals to test with. They liked working with me. Realization Now the most exciting part of this project had come, I enjoyed this phase a lot. I had a good understanding of the target group. I presented the various concepts and finished several tests in a good way so that I could get a good start in designing the high-fidelity prototype. Sometimes I found it difficult to what extent I wanted to develop elements in the app. Because it is a prototype it is Thesis Mental Health Matters Lara van Alphen 2022 important to make smart choices in that, because it is not possible to work out everything completely. I learned a lot from this. Evaluation Before writing this thesis, I have had experience with mental health, because I struggled with it myself. I knew how difficult this topic is to talk about, and that this needs to change. There should be no more stigma. Because of this I knew in advance that there would be benefits from a platform with information and prevention about mental health. Now at the end of the project I can say that I am very glad that an application has been created that the target group needs and cares about. I’m sure the MentalHealthMatters app will bring value and reduce the stigma around mental health. Overall, I am glad and thankful that I had the opportunity to step out of my comfort zone and complete this thesis in the United States and was able to learn from so many new people and experiences. Thesis Mental Health Matters Lara van Alphen 2022 6. Reference list 1. De Baak. (2022). Mentale gezondheid: hoe zorg je voor een goede energiebalans? Accessed at the 28th of April 2022, from https://debaak.nl/inspiratie/artikelen/2022/03/mentale-gezondheidhoe-zorg-je-voor-een-goede-energiebalans/ 2. GGZ nieuws. (2019, 5th of April). Meerderheid jongeren mist les over mentale gezondheid op school Accessed at the 29th of April 2022 from https://www.ggznieuws.nl/meerderheid-jongeren-mist-lesover-mentale-gezondheid-op-school/ 3. Leansixsigmagroep. (n.d.). Wat is Design Thinking? Accessed at the 2st of May 2022 from, https://leansixsigmagroep.nl/lean-agile-en-sixsigma/design-thinking/ 4. Gibbons, S. (2018) Empathy Mapping: The First Step in Design Thinking Accessed at the 5th of May 2022 from https://www.nngroup.com/articles/empathy-mapping/ 5. JED Foundation. (n.d.) Understanding and Addressing the Mental Health of High School Students Accessed at the 15th of April 2022, from https://www.jedfoundation.org/high-schoolresearch/?gclid=Cj0KCQjw1N2TBhCOARIsAGVHQc5_YHHZ4eQSqXfb 9lyo4paUybNOJLHGJHm3KOT9ImIuCAgk7S4i8VkaAvelEALw_wcB 6. Hippe, H. (2022). Why Mental Health Should Be Taught in School Accessed at the 5th of May 2022 from https://www.nystromcounseling.com/school/why-mental-healthshould-be-taught-inschool/#:~:text=Mental%20health%20in%20school%20can%20include %20helping%20to%3A,day%20(like%20deep%20breathing%20exercis es) 7. Eva, A. (2019, 11th of January). How colleges today are supporting student mental health. 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Accessed at the 7th of May 2022, from https://www.themindfulnessinitiative.org/Handlers/Download.ashx?I DMF=1af56392-4cf1-4550-bdd1-72e809fa627a Thesis Mental Health Matters Lara van Alphen 2022 12. Tate, E. (2017, 29th of March). Anxiety on the Rise. Accessed at the 1st of May 2022, from https://www.insidehighered.com/news/2017/03/29/anxiety-anddepression-are-primary-concerns-students-seeking-counselingservices 13. Imagebuilding. (n.d.). Dit is de kracht van Storytelling. Accessed at the 2st of May 2022, from https://www.imagebuilding.com/daaromstorytelling/ 14. Dunagan, S. (2019, 16th of October). Mental Health Tracker debuts as part of Depression Grand Challenge Accessed at the 1st of May 2022 from https://dailybruin.com/2019/10/16/mental-health-trackerdebuts-as-part-of-depression-grand-challenge 15. University of Wisconsin Superior. (n.d.). Pruitt Center for Mindfulness and Well-Being Accessed at the 2th of May 2022 from https://www.uwsuper.edu/mindfulness/index.cfm 16. Hejl, L. (2021, 26th of August). Supporting Mental Health in College Students On & Off Campus, Accessed at the 24th of February 2022, from https://timely.md/blog/mental-health-in-college-students/ 17. Elias, M. (2018, 14th of August). Pros and Cons of Mindfulness in SEL. Accessed at the 5th of May 2022, from https://www.edutopia.org/article/pros-and-cons-mindfulness-sel 18. Vlaams Instituut Gezond leven. (2022) Hoe positieve geestelijke gezondheid bevorderen Accessed at the 29th of April 2022, from https://www.gezondleven.be/themas/mentaal-welbevinden/hoepositieve-geestelijke-gezondheid-bevorderen 19. Gatto, A., Miyazaki, Y., & Cooper, L. (2020, 13th of November) Help me help myself: examining an electronic mental health self‑monitoring system in college students. The International Journal of Higher Education Research. 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Accessed at the 8th of May 2022, from https://recruitastudent.nl/studenten/eenzaamheid-onder-studenten/ Thesis Mental Health Matters Lara van Alphen 2022 24. Gutierrez, R. (2022). Burn-out onder studenten: waarom vallen steeds meer studenten om. Accessed at the 10th of May, from https://conciencia-coaching.nl/onderwijs/burn-out-onder-studentenwaarom-vallen-steeds-meer-studenten-om/ 25. Beiter, R., Nash, R., McCrady, M., Rhoades D., Linscomb, M., Clarahan, M., Sammut,S. (2015, 1st of March). The prevalence and correlates of depression, anxiety, and stress in a sample of college students. Journal of Affective Disorders. Accessed at the 1st of March 2022, from https://pubmed.ncbi.nlm.nih.gov/-/ 26. Suicide Prevention Resource Center. (n.d.). Consequences of Student Mental Health Issues. Accessed at the 10th of March 2022, from https://www.sprc.org/colleges-universities/consequences 27. P. Jones., S. Park., G. Tyler Lefevor. (2018, 1st of October). Contemporary College Student Anxiety: The Role of Academic Distress, Financial Stress, and Support. Journal of College Counseling. Accessed at the 1st of March 2022, from https://www.semanticscholar.org/paper/Contemporary-CollegeStudent-Anxiety%3A-The-Role-of-JonesPark/723aa9641e541e6295ee994ac7c6f0b74bd4fd66 28. Leraar24. (2021, 15th of October). Praat met leerlingen over hun mentale gezondheid. Accessed at the 1st of March, from https://www.leraar24.nl/-/praat-met-leerlingen-over-hunmentale-gezondheid/ 29. Trimbos Instituut. (n.d.). Mentale gezondheid en preventie. Accessed at the 4st of March 2022, from https://www.trimbos.nl/kennis/mentale-gezondheid-preventie/ 30. Parentcom. (2021, 24th of September). Jongeren: hoe bereik je ze vandaag de dag?. Accessed at the 14th of March 2022, from https://parentcom.nl/jongeren-hoe-bereik-je-ze-vandaag-de-dag/ 31. Hunt, J., Eisenberg, D. (2010, January). Mental Health Problems and Help-Seeking Behavior Among College Students. Journal of Adolescent Health. Accessed the 13th of March, from https://www.sciencedirect.com/science/article/pii/S-X-?casa_token=h4scKIEuKnYAAAAA:cPslnf87rTPw8RwfUlvq3BkdwTZ ZMSuQO9hq55wI2WY0n7_x26bRSjmwsTYMnv5tE8dK4wR1p_4 Thesis Mental Health Matters Lara van Alphen 2022 7. Attachments 7.1 Interviewed people Below the interviewed experts are listed: - Madison Emery Job: Counselor at Mosaic Medical Center - Ben Moran Job: Green Dot Coordinator Wellness Services Northwest Missouri State University) - Nikita Alimohammad Job: Assistant Director Wellness Services Northwest Missouri State University - Amy Law Job: Counselor Mosaic Medical Center - Dr Midiri Job: Psychiatrist Mosaic Medical Center - Courtney Koch Job: Counselor at Wellness Services Northwest Missouri State University - Lauren Dozier Job: Nurse practioner, Mosaci Medical Center - Clarence Green & Anthony William’s (the interview was held with both at the same time) Job: Chiefs at University Police Northwest Missouri State University - Chris Dawe Job: AVP, Health & Wellbeing Wellness Services - Joy Heastan Job: Director of the Mental Health Unit Mosaic Below the interviewed students are listed: - Derek Guerrero Student at Northwest Missouri State University, 19 years, leader from Active Minds group and psychology student - Emily Sward - Student at Northwest Missouri State University, 21 years - Madison Cutsinger Student at Northwest Missouri State University, 20 years, member of Active Minds group - Avery Biga Student at Northwest Missouri State University, 20 years, assistant leader from Active Minds group and psychology student - Samantha Serantes Student at Northwest Missouri State University, 21 years - Silvia Alberti Student at Northwest Missouri State University, 21 years Thesis Mental Health Matters Lara van Alphen 2022 7.2 Questions interview experts-. Tell me a bit about yourself please. What exact work do you do and where/target group? What skills should you have to be effective in helping students with mental health issues? How does a typical day of mental health provider look like? Did you always work at Mosaic or also somewhere else/ another state? Did you see differences? What is your experience with patients specific students suffering from mental illnesses? Do you have the idea that students have the most mental problems? How do you think students deal with mental problems? Do you think an application where students receive information about mental health and work on themselves would be useful? Do you feel that students are enough informed about mental health? If they are being informed, do you know where that is and how? Through which way? Some students are of course already being treated for their mental health. But do you have the idea that they are also treated preventively? Do you know some students or other experts from the University that I can come in contact with and ask some questions? 7.3 Questions interview students 1. 2. 3. 4. 5. Tell me a bit about yourself please. Do you struggle with mental health? Or have you ever struggled with it? When did this start? What age? Do you have the feeling that it was easy to talk about it or find help? Did you already know about mental health issues before you dealed with it by yourself? (if so) 6. If you were informed through which way? Family, friends, school? 7. Do you think an application where students receive information about mental health and work on themselves would be useful? 7.4 Questions interview leader Active Mind group (Derek Guerrero) Derek is the leader from the Active Mind group at Northwest Missouri State University, this is a student organization that talks open about mental health and organizes events related to mental health. 1. Tell me a bit about yourself please. 2. Where does Active mind group stand for? 3. What is the main focus of the active mind group? 4. What is your experience with students suffering from mental illnesses? 5. Do you have the idea that students have the most mental problems? 6. How do you think students deal with mental problems? 7. Do you feel that students are enough informed about mental health? 8. If they are being informed, do you know where that is and how? Through which way? 9. Some students are of course already being treated for their mental health. But do you have the idea that they are also treated preventively? Thesis Mental Health Matters Lara van Alphen 2022 10. Do you know some students from the University/High school that I can come in contact with and ask some questions? 7.5 Spoken text introduction video Thesis Mental Health Matters Lara van Alphen 2022