Children and young people's mental health has been deteriorating increasingly fast since the COVID pandemic and has become a key area of concern for local authorities.
UNPITCHD was commissioned by the LGA and a consortium of 11 North East England local authorities in July 2022 to develop an intervention to increase access to, and use of, mental health self-help tools for children and young people (CYP) aged 10-15 who may be experiencing low mood and/or anxiety for the first time.
The joint team (councils and UNPITCHD) conducted a rigorous insights gathering phase that included quantitative and qualitative research activities with c.300 CYP in the region.
Using the COM-B model, the joint consortium identified six key behavioural barriers to access to mental health self-help tools amongst 10-15 year olds; including:
- Lack of awareness: not knowing self-help tools exist
- Lack of relevance: CYP don’t feel that self-help tools are for them due to signalling and beliefs/expectations around them
- Effortful to engage: The self-help tools feel like too much work to engage with; choice and information overload around self-help tools
- Leveraging the right messengers: CYP prefer to listen to their friends and trusted authorities
- No triggers: CYP need to be reminded to use self-help tools
- Not accessible to everyone: CYP need the means to use self-help tools.
Following the APEASE criteria, the consortium elected to design and roll-out an intervention on social media to identify the most impactful message to increase awareness and uptake of mental self-help tools amongst the 13-15 year old age group.
A social media campaign, co-created with children and young people, containing four behaviourally informed messages and two creative routes, using Instagram to test their relative attractiveness (over six weeks) to identify the most impactful message to increase awareness of mental self-help tools for the 13 to 15-year-olds in a controlled trial.
Over the six-week trial period, our campaign reached 23,000 Instagram accounts in our target population, which represents over 25 per cent of the 13-15-year-old population in the region.
The testimonial behavioural message consistently and clearly outperformed the control messages on absolute and relative effectiveness metrics (respectively number of clicks and click-through rate), thus making it the clear “winner” of our trial.
The testimonial campaigns (creatives A and B) have indeed driven 2.2 times more clicks to the self-help tools than the control campaigns. The click through rate of the testimonial messages also performed well above control (0.23 per cent for testimonial vs. 0.20 per cent for the control – averages across A and B creatives).
Creative A (‘bright and cheery’) also consistently outperformed Creative B (‘hip and modern’), driving 2.7 times more clicks to the self-help tools than its counterpart.
In addition to the testimonial message, the social proofing messages also consistently outperformed the control messages on absolute effectiveness metrics (it received 1.7 times more clicks than the control campaigns) for both genders.
The other two messages performed in line or slightly worse than the controls. This is mostly explained by gender differences in the appeal.
The campaign has generated 746 visits to Kooth resulting in eight sign-ups, which represents an average conversion rate for the total duration of trial of one per cent. This performance is broadly in line with Kooth’s average conversion rate for social media campaigns in the region.
It is important to note that the conversion rate was 2.4 per cent for the first two weeks of the trial, therefore indicating an above-average performance in the early days of the campaign, followed by a sharp decline in effectiveness over time.
Finally, results from the trial indicate that all messages have performed much better during week days in the hours that precede school than at any other times. Over 40 per cent of weekday clicks have taken place between 7am and 9am, suggesting a higher need for support and anxiety relief just before entering class.
How is the new approach being sustained?
Sharing our findings: UNPITCHD and the councils will share our findings with several stakeholder groups.
Embedding learnings in the councils: Councils will take forward learning around: insights gathering, COM-B, running behavioural trials, data collection, social media campaigns and project roles in behavioural insights trials.
Councils also have access to the UNPITCHD behavioural insights toolkit.
Phase 2 of the intervention (optional for councils): Councils may choose to conduct a Phase 2, and utilise the learnings of our intervention to distribute physical versions of the testimonial communications (with more confidence that the investment will yield adoption).
Adopting an “agile” mindset
No one trial design can enable testing unknowns in perfectly controlled conditions. To mitigate potential downsides of a given trial or campaign, we recommend adopting an agile mindset: the teams move to unlock unknowns successively and build knowledge iteratively, by breaking up key objectives into multiple trials or multiple phases.
Here that has meant isolating our key unknown (identifying the most effective behavioural message) in the first phase and then using this knowledge to create an informed phase 2, where more unknowns and concerns will be addressed (for example, digital exclusion, use of Kooth, and so on) and success will be reached iteratively.
Working in partnership
Partnerships are critical for this work both within councils (across teams) as well as with outside organisations of mental health self-help tools. Partnerships were essential to the completion of this work with communications teams in councils, as well as Kooth. Fostering a collaborative partnership with Kooth allowed for mutual benefit as we shared insights we gathered whilst Kooth was able to provide us with additional data.
Identifying a clear pathway to data early on
It is crucial to ensure data collection methods as early as possible for trials of this nature, due to the sensitive nature of working with healthcare data as well as navigating the institutions and structures of public health. Different interventions will have different data collection needs and methods, but it is important that once the intervention is decided upon that a clear pathway to data collection is established, through a data access group, manual collection (in this case, Meta ads reporting), or via a partner organisation.