This substudy is part of a large research study examining the Screening and Treatment for Anxiety & Depression (STAND) system of care in a community college setting. The STAND system of care was developed as part of the University of California, Los Angeles (UCLA) Depression Grand Challenge to be a scalable approach to preventing, identifying, and treating anxiety and depression [45]. The STAND study was approved by the institutional review board at UCLA (IRB #22‐0205). Participants were recruited from a local community college (East Los Angeles Community College [ELAC]) and a Transfer Student Center for community college students at a 4-year university (UCLA), enhancing student diversity over that afforded by a single community college site. Recruitment was from the fall of 2022 through the winter of 2023. Participants from ELAC were recruited through a listserv of students interested in participating in STAND-related research studies, and UCLA participants were recruited using outreach through informational presentations and flyer postings at the Transfer Student Center. Study eligibility criteria included (1) currently enrolled at ELAC or UCLA as a transfer student, (2) owning a smartphone, and (3) English proficiency. Eligible students interested in participating were screened on the phone and provided oral consent. Participants then scheduled an interview date with the study staff to complete the semistructured interview and brief surveys. All participants received a US $25 e-gift card for their participation in the study.

To ensure participant safety and confidentiality, participants were informed during the consent process that they could decline to answer any questions or stop the interview at any time without penalty due to the sensitive nature of the study topics (eg, distress, depression, and anxiety). Research staff conducting the interviews were trained to recognize signs of distress and to pause or discontinue the interview if participants became notably distressed. Research staff were also trained to assess the participant’s well-being and offer additional support and mental health resources to all participants. Additionally, limits of confidentiality were clearly communicated to participants, including mandated reporting requirements related to risk of harm to self or others. A safety protocol was activated when participants disclosed current active suicidal ideation, particularly with intent or plan. The safety protocol included a risk assessment and safety planning by a licensed clinical psychologist, although there were no cases in this study that required the use of the safety protocol.

In total, 14 students from ELAC and 13 students from UCLA were eligible to participate in the study and provided oral consent. A total of 4 participants from ELAC and 3 from UCLA were excluded from the study due to failure to attend their scheduled semistructured interviews. Therefore, 20 participants were included in the analysis. Participants (N=20) in the study were between the ages of 19 and 32 (mean 22.8, SD 3.9) years. The sample consisted of both community college students (n=10) at ELAC and transfer students at UCLA (n=10).

College students participated in the study in person or virtually using a secure videoconferencing platform (Zoom, UCLA Health System Protected). Participation consisted of completing a semistructured interview and 2 brief online surveys with a research staff. Semistructured interviews lasted up to 45 to 60 minutes each (average time was approximately 36, SD 12.8 minutes) and were audio-recorded and stored in a secure UCLA Box folder. Prior to starting the semistructured interview, participants were asked to complete the first brief online survey administered via Qualtrics inquiring about their demographic background, mental health use, and previous digital tool use for mental health concerns. Next, participants were introduced to the technology TE-SPI components, specifically (1) the BRITE app, which includes mood and distress ratings, a menu of distress tolerance and emotion regulation skills [25,33], and a coping or safety plan that students can turn to when needed to cope effectively (eg, when distress is high or increasing); and (2) caring contacts (brief nondemanding text messages aimed at providing connection to the intervention team and support [46]). As part of the prototype demonstration, participants were informed that both the BRITE app and caring contacts are designed to be introduced by a mental health provider. Next, the participants were given a study iPad and received a demonstration of how they would be onboarded to get access to the app (ie, after completing a safety plan with a clinician, although the development of a safety plan was not conducted as part of the demonstration). Then, students were given a tutorial on how they could create and individualize their account or profile to use the various features including (1) mood ratings, (2) use of coping activities, and (3) how to activate the support feature. Following this process, participants were given time to explore the app on the study iPad and were encouraged to ask questions regarding app features. After having time to review the app, participants were asked to share their perceptions and feedback on the app features. Next, the concept of caring contacts was presented with various examples, and participants were asked to share their perceptions and feedback on the BRITE app and caring contact TE-SPI components. Feedback for the clinician session to develop a safety plan was not included as part of the feedback, given its already established feasibility and acceptability in college samples [47]. Throughout the interview process, the research staff used a semistructured interview protocol to guide the participant through each of the questions. Following the interview, participants completed the second brief quantitative survey inquiring about their perceptions of the TE-SPI components and overall satisfaction questions. At the end of the study, all participants were sent information regarding campus and community mental health resources and received a US $25 e-gift card as compensation for participating in the study.

Current symptoms of depression and anxiety were assessed using the Patient Health Questionnaire 2-item (PHQ-2) and the Generalized Anxiety Disorder 2-item (GAD-2 [47,48]). Both the PHQ-2 and GAD-2 measures were used to descriptively characterize the mental health symptom profile of the sample and were not used for hypothesis testing or subgroup analyses. The PHQ-2 is a self-report measure of depression symptoms over the last 2 weeks. The 2 items from PHQ-2 were the following: “Over the last 2 weeks, how often have you been bothered by having little interest or pleasure in doing things?” and “Over the last 2 weeks, how often have you been bothered by feeling down, depressed, or hopeless?” Response options ranged from 1=not at all to 4=nearly every day. The measure has good internal consistency and concurrent validity [47,49]. The GAD-2 is a self-report measure of anxiety symptoms over the last 2 weeks. The GAD-2 includes the following 2 items: “Over the last 2 weeks, how often have you been bothered by feeling nervous, anxious or on edge?” and “Over the last 2 weeks, how often have you been bothered by not being able to stop or control worrying?” Response options ranged from 1=not at all to 4=nearly every day. The measure has strong psychometric properties and has been found to be reliable [47,49]. Both items from the PHQ-2 and GAD-2 were summed separately, and a score of 3 was used as the cutoff for identifying possible cases of depression and generalized anxiety disorder, respectively [47,48,50]. The PHQ-2 (α=.826) and GAD-2 (α=.928) measures have strong internal consistency in our sample.

Feasibility and acceptability were assessed using both quantitative and qualitative indicators, including participant ratings of usability, satisfaction, perceived usefulness, engagement with app features, and qualitative feedback regarding BRITE app and caring contacts’ relevance, accessibility, and suggested refinement.

To examine participants’ overall technology use, we formulated questions to inquire about their access to a cell phone or smartphone, data plan, how often participants carry their phone, and specifics on how much time they spend on their mobile device (time measured in total minutes per day) for the following activities: texting, talking, emailing, surfing the web, playing games, social media apps, and mental health apps. Sample questions included “Do you have a smartphone?” and “How often do you carry your phone with you?.” Additionally, participants were instructed to list the mobile apps that they frequently use and the type of features they found useful.

The Digital Intervention Barriers Scale-7 [44] was used to assess participants’ perception of the TE-SPI, specifically their perceptions of engagement, motivations for use, and if the digital tool was adequate (not too long or too short). This measure asked students to “Please indicate the extent to which you agree or disagree with the following statements.” Statements included (1) “I didn’t understand the tasks or things I was supposed to do on the app.”, (2) “I thought the app wasn’t engaging.”, (3) “It would be difficult to keep myself motivated to use the app.”, and (4) “I thought the length of the app wasn’t adequate (too long or too short).” The answer choices participants were able to choose from for all 4 questions were 1=totally disagree, 2=disagree, 3=neutral, 4=agree, and 5=totally agree. Participant responses were scored by obtaining a sum, with higher scores indicating more barriers to future use and engagement with the digital tool. Three items from the original Digital Interventions Barriers Scale-7 were omitted, given that students were not asked to download the app during this phase of the study. The omitted items were (1) “I had technical problems with my technology (eg, device, internet, platform).”, (2) “I forgot to use the app.”, (3) “The app didn’t seem to be helping me.” This measure has been found to have high internal consistency and criterion-related validity [44]. The internal consistency of the 4 items was high (α=.783).

Using a questionnaire developed by the University of Pittsburgh [51], we assessed participants’ satisfaction of the digital tool, by administering the following questions: (1) “If you started to feel really stressed and upset, do you think you would use the BRITE app?” with the following answer choice for participants to choose from 1=no, 2=possibly, 3=probably, 4=definitely, and 5=prefer not to answer; (2) “If a friend was in need of mental health care for depression or suicidal thoughts or behaviors, would you recommend the BRITE app to help them cope?” with the following answer choices: 1=definitely not, 2=no, I don’t think so, 3=yes, I think so, 4=yes, definitely, and 5=prefer not to answer; (3) “How often do you think you would use the BRITE app if it were available to you during the month after it was introduced to you?” with the answer choices being: 1=never, 2=once or twice, 3=3 or 4 times, 4=5 or 10 times, and 5=more than 10 times; (4) “Do you think you would be more likely to use the BRITE app if you received messages reminding you of the app?” with the following answer choices: 1=no, I would find these messages annoying, 2=no, but the messages would not bother me, 3=maybe, 4=possibly, and 5=yes. After asking each of these questions, participants could provide additional written feedback or reasoning for their answer choices. The satisfaction with BRITE score was obtained by creating a composite score that summed all 4 questions in the measure.

To obtain more information regarding participants’ experience with the TE-SPI components, they answered items from the Poststudy System Usability Questionnaire [42]. The Poststudy System Usability Questionnaire has been used in previous suicide prevention trials for adolescents after a hospitalization [34]. The questionnaire consists of 6 items that identify system usability. Participants rated questions on a 7-point Likert scale, ranging from 1=strongly disagree to 7=strongly agree. The following questions were asked: (1) “Overall, I am satisfied with how easy it is to use BRITE app.”; (2) “The information provided in the BRITE app such as on-screen messages, and other documentation like links or pictures for the topic activities, was clear.”; (3) “The information provided in the BRITE app, such as notifications to rate my distress or mood with emojis, was clear.”; (4) “I like interacting with the BRITE app program.”; (5) “I needed to learn a lot of things before I could get going with the BRITE app.”; and (6) “The information provided, such as the coping plan for BRITE users, was clear.” This measure is reliable with a Cronbach α that spans from 0.83 to 0.96 [51,52]. A composite sum score was created, such that a higher score indicated higher satisfaction and perceived usability. An additional question was added to assess participants’ perceptions of caring contacts. Specifically, participants were asked “Do you think you would be more likely to use the BRITE app if you received text messages from your mental health provider?,” with the following answer options: 1=no, I would find them annoying, 2=no, but the messages would not bother me, 3=maybe, 4=possibly, and 5=yes.

Descriptive analyses were conducted using SPSS (version 25; IBM Corp) software. We carried out descriptive statistics to obtain frequencies and percentages, means, and medians along with SDs and ranges for all quantitative measures.

For the qualitative analyses, all interview audio recordings were auto-transcribed using Microsoft Word software, and the transcripts were then reviewed individually by 2 independent researchers (NJ and JLM) to verify accuracy. Errors from the transcripts were fixed, and any identifiable participant information was removed. Additionally, the supervising researcher (NJ) checked each transcript for errors. The transcripts were then used for data coding.

A rapid qualitative coding approach was used from the health services literature [53], which prioritizes the efficient delivery of information to guide decision-making, particularly during preimplementation phases. First, the team developed a codebook with domains that were identified by the TAM framework. Then, using deductive and inductive strategies, coders identified additional codes and themes beyond the predefined TAM domains. After the codebook was finalized, 2 trained members independently applied domain analysis and created a summary template for each transcript. After all transcripts were coded and summarized, a matrix method was used to efficiently summarize and explore themes across all interview transcripts [54]. Themes were derived through comparison across structured summaries and matrix-based synthesis. This approach generates contextually rich information while being time efficient, and it facilitates continuous improvement and adaptation of intervention development [53].

The qualitative team did not use qualitative coding software, as the rapid matrix method was conducted using structured summary templates and team-based synthesis. The team conducted weekly meetings to review interview content, compare coding decisions and interpretations, resolve discrepancies through discussion, and refine the analytic approach. Using a rapid qualitative analysis process, each interviewer independently completed a standardized summary template following each interview (Multimedia Appendices 1 and 2), which included structured domains, initial content summaries, preliminary codes, and interpretive reflections [49]. These completed templates were compiled and reviewed by 2 researchers (NJ and JLM), who collaboratively synthesized responses across participants using a matrix method approach to identify key patterns and emerging themes. These themes were iteratively refined through weekly team discussions to compare summaries and interpretations and solve discrepancies to ensure consistency and representativeness across participants. Disagreements in coding were resolved through consensus-based discussion among the qualitative research team. A second review of the interviews for supporting quotes and thematic consistency was also carried out by the research team. Themes were finalized through iterative team discussions and comparison across structured matrix summaries to ensure consistency and alignment with participant responses. Throughout this process, analytic memos documenting observations and methodological reflections were completed after each interview and integrated into final thematic interpretation to enhance rigor and contextual grounding. Given the exploratory aims of the study, the sample size was considered sufficient to identify preliminary patterns in participant perceptions and inform future refinement of the TE-SPI. The data findings were considered sufficient to identify preliminary patterns relevant to intervention refinement. Furthermore, the analysis prioritized identification of salient patterns in participant feedback rather than quantification of theme prevalence.

The identified category themes were organized according to the TAM [41]. These themes helped focus the analysis, ensuring that key aspects of the data were systematically examined and aligned with the research questions. The research team defined and named the themes based on TAM (ie, perceived ease of use and perceived usefulness), then connected relevant quotes to these codes and organized them according to the model. The final step of the data analysis process was to produce a concise summary to address the research questions.

This study examined initial user perceptions of the TE-SPI components using the TAM framework. Most participants perceived the BRITE app prototype as easy to interact with, with 75% (15/20) strongly agreeing and 5% (1/20) agreeing that they understood how to engage with it. Additionally, 85% (17/20) found the app features engaging (totally agreed: 13/20, 65% and agreed: 4/20, 20%). Potential motivation to use the app varied, with 50% (10/20) strongly agreeing, and 20% (4/20) agreeing that they would stay motivated to use it if they downloaded the app on their phone, while 15% (3/20) remained neutral, and 15% (3/20) disagreed. Regarding the app’s feature set, 65% (13/20) strongly agreed, and 15% (3/20) agreed that it provided an adequate number of resources. See Table 2 for additional information on participant ratings.

Participants also rated their initial satisfaction with the app’s ease of use: 35% (7/20) strongly agreed, 40% (8/20) somewhat agreed, and 20% (4/20) agreed that the app features were easy to use, while only 5% (1/20) remained neutral. Interaction with the app was well received, with 35% (7/20) strongly liking it, 40% (8/20) somewhat liking it, and 5% (1/20) disliking it. Regarding clarity, 60% (12/20) strongly agreed, and 30% (6/20) somewhat agreed that on-screen messages and activity links were clear. For distress and mood rating notifications, 45% (9/20) strongly agreed, 40% (8/20) somewhat agreed, and 10% (2/20) remained neutral about their clarity. Similarly, 70% (14/20) strongly agreed, and 20% (4/20) somewhat agreed that the personal coping plan information was clear, while 5% (1/20) found it unclear. See Table 3 to see more student feedback that was received on the app’s perceived ease of use.

During the semistructured interviews, participants were asked to provide qualitative feedback on the TE-SPI components. They shared their opinions on the BRITE app prototype aesthetic elements, such as the font, color scheme, and navigation (see Table 4for sample quotes and Multimedia Appendix 3 for images of the app prototype) as well as feedback on caring contact messages that they would find helpful and useful. The overall consensus we obtained based on student feedback was that the BRITE app was perceived as user-friendly, though some students expressed a desire for a broader range of emotions in the mood and distress rating scale. Some participants noted difficulty in identifying and connecting with the emotions represented by the tool’s emojis. One student mentioned:

To address this, several participants suggested changing the scale by incorporating numerical values or descriptive labels for the emoticons, which would help users more accurately select their current emotions. For example, one student shared:

Participants also recommended additional features to enhance the app’s functionality. These recommendations included a calendar and journal feature for tracking mood, distress, and customization options, such as adding an avatar. The app’s lack of a dark mode, which is a visual display setting that changes the light background and dark text of an interface to a dark background with light text, was another point of concern. Participants expressed the importance of this feature for nighttime use to reduce eye strain. Their comments included:

Another student noted: “Absolutely, these days, maybe like a dark mode interface could help.” Overall, results on perceived ease of use highlight that this sample of students reported a high level of ease in using the BRITE app. They recommended that adding features like a dark mode and expanding the emotion rating scale would significantly enhance the tool’s perceived ease of use.

Participants were also asked broadly about any sociocultural and developmentally related considerations of the BRITE app. In general, participants expressed that the overall feel of the tool felt culturally congruent and relevant to the college student context. Participants felt that young adult users could easily connect and relate to the content in the app. College students expressed that the language was straightforward and easy to understand; however, a few participants recommended adding a feature that allows users to translate the language in the app to the language they prefer to speak so that it could be more inclusive, especially for international students. Concerning this topic, a participant noted the following:

In addition to language, some participants discussed that the BRITE app was appropriate for college students, as it was easily accessible. A participant shared the following: “I would use the[app] because it’ll be more accessible and since I already carry my phone on a daily basis, I could use it while waiting for transportation, a class gap ...”

The BRITE app’s accessibility and convenience appeared to be particularly appealing to this student population. Participants shared examples of how the app could fit naturally into their college life routine, making it easy to use during gaps of time, such as waiting for transportation or between classes. This convenience factor highlights a significant advantage of mental health mobile apps, as they can be well integrated into daily habits without requiring students to set aside much dedicated time. It is possible that the app can increase use frequency by turning typically unproductive periods into opportunities for digital mental health content interaction. Overall, this participant feedback emphasized the potential advantages of digital tools available on phones as an avenue to promote mental health engagement among community college and transfer students.

Participants completed a usability questionnaire that provided valuable insights into their perspectives on the perceived usefulness of the TE-SPI components. In terms of use during moments of distress, half of the participants (10/20, 50%) indicated that they would definitely use the app if they felt distressed or upset. When asked if they would recommend the BRITE app to a friend needing mental health care for depression or more severe distress (ie, having thoughts of suicide), 50% (10/20) responded, “yes, I think so,” and 40% (8/20) responded “yes, definitely.” Regarding potential use in the first month of availability, 45% (9/20) of participants stated they would use the app 3 to 4 times, 35% (7/20) would plan to use it 5 to 10 times, and 15% (3/20) would expect to use it more than 10 times. When participants were asked if they would engage more with the BRITE app if they received caring contact messages, 55% (11/20) said “yes,” 25% (5/20) said “possibly or maybe,” and 20% (4/20) stated that the messages would not increase their overall motivation to use the app. When asked to elaborate on their ratings, one student mentioned:

Another participant said: “If I was reminded, then I would have an inclination to return [to the app] since it gave me a reminder to go on,” while another stated: “I tend to forget things, it [text messages] would help to keep on track.” During the qualitative interviews, participants were also asked to elaborate on their perceptions of caring contacts by providing suggestions of caring contact messages that they would find useful (see Table S1 in Multimedia Appendix 4 for additional suggestions provided by participants). Overall, the survey feedback from students suggests a varied perception of the TE-SPI’s perceived usefulness, with a clear indication that caring contact messages could enhance user engagement, although with some reservations regarding the frequency and content of the caring contact messages. See Table 5 to see more students’ input on the perceived usefulness of the app.

Participants offered insights into the usability of the app, particularly highlighting its potential as a support mechanism during times of emotional distress. One participant explained: “When I am at the point of you know getting down emotionally, I’d want to use it right before getting to that point.” Another student shared how there can be distressful moments in life and how the TE-SPI could help her get distracted from unhelpful and negative thoughts:

Another theme to emerge involved perceptions that the BRITE app can serve to augment and/or replace traditional treatment contacts and/or other forms of social support. For example, one participant noted:

Another student stated:

However, other students felt differently. Some stated that they would not want to engage with the tool if they were having low mood. One student stated:

Another participant explained that they would not choose to use the app during joyful moments, as it would be a reminder of times when they weren’t happy, stating: “I guess I wouldn’t want to use it when I’m happy because it would remind me of all the times, I was not happy.”

Overall, students highlighted various reasons as to when they would feel more inclined to use a digital mental health tool, with some students reporting that they would use it during moments of distress, while some reporting that they would avoid the tool when their mood and levels of distress improved. The consensus among participants suggests that they would use the tool sporadically, primarily as a tool for managing negative emotions. To exemplify this topic, a participant stated the following:

The student feedback suggests that the TE-SPI components, including the BRITE app, may be a valuable tool when traditional social support is unavailable, as it helps reframe negative and unhelpful thoughts. However, the tool’s utility appears to be situational, with students reporting that they would be less inclined to use it when they are in a positive state.

Participants expressed a willingness to use the app to explore and engage with suggested coping activities such as practicing mindfulness, including an affective savoring the moment activity and breathing exercises, as well as tracking their mood and distress. A participant noted the following: “Yeah, I think this could be good, like a daily check-in and like resources here but I think I would be more inclined to use it if I could customize it more.” Another participant highlighted the significance of the activities, stating:

Overall, most students reported that they would use the tool primarily to practice coping skills to reduce distress, with a special interest in activities focused on meditation or mindfulness and improving sleep quality.