Focus group participants (n=7) from a youth advisory board were hosted in person and virtually between June and Oct 2024. Focus groups lasted for 1‐2 hours and were recorded. The in-person focus group was hosted at the youth advisory board’s usual meeting place and the virtual focus groups were hosted on a secure institutional Zoom meeting. One adult leader of the youth advisory board was present for all of the focus groups in addition to the PI and consultants. Inclusion criteria were age 14‐24 years and membership of a youth advisory board. After consent was obtained, youth were asked a few questions and then the digital social media single session intervention (SM SSI) was projected as feedback was requested page by page. Youth were asked questions at the end of the intervention to gather additional feedback. Please refer to Multimedia Appendix 1 for the full list of pre- and post-SSI questions.

The SM SSI was created on Computerized Intervention Authoring System (CIAS)[16]. Figure 1 demonstrates screenshots of the SM SSI. The intervention is a self-guided 30-minute virtual experience. The intervention introduces thinking about social media’s influence on both well-being and ill-being on separate spectrums with examples. Next, users are invited to read two vignettes about a teen’s specific social media experience, quantify and qualify the social media experience’s contribution to the teen’s well/ill-being and devise advice for the teen in the story. Next, users are invited to think about social media’s contribution to their own well/ill-being, positive and negative aspects and what they like and dislike about social media. They are asked what (if anything) they have done anything to change their social media use in the past and why. They are invited to watch 3 short (30‐61 s) videos about how to turn off like and view counts, how to set time limits, and how to change the content they are presented with on Instagram. They are asked if they think they will make changes to their social media settings and why or why not. Development of the SSI was guided by examples from Dr. Schleider’s lab as she was a consultant for this project.

Participants were recruited from a youth advisory board. The advisory board leaders distributed study information and consent and assent forms to group members via email. Members were encouraged to read all the information and ask any questions via email to the study and advisory board leaders. Interested individuals let the advisory board leader know that they would like to participate and arrangements were made for either in person (one total on 6/26/2024) or virtual (two total on 10/22/2024 and 10/27/2024) focus groups.

The University of Michigan Institutional Review Board approved this study (HUM00242288). Parental consent was not necessary due to the minimal risk of the study. Guardians were allowed access to the SSI if they wished, but there were no requests. We reviewed the IRB approved consent form and electronic consent was obtained from all minor participants at the beginning of each focus group. Participants were compensated $100. Measures taken to promote privacy and confidentiality included separate collection of identifying information necessary for compensation purposes and removing identifying information from the transcripts.

Because of our small sample size, we did not use formal qualitative analysis of the transcripts. Transcripts from each focus group were combined and organized in chronological order by question and page of the SSI by the PI (JH). Feedback was further collapsed into key themes using an inductive approach. Topics were discussed among the other authors who attended the focus groups virtually (SED and HR).

A total of 7 youth provided feedback about the SM SSI. The average age of focus group participant was 17.43 (SD 1.62; range 16‐20) years. Our sample was 42.8% Asian (3/7), 28.6% Multiracial (Asian/White) (2/7), 14.2% Black (1/7), and 14.2% White (1/7); 100% female and 100% not Hispanic or Latinx. Feedback was organized into the three following categories.

Youth participants reported that they viewed the SM SSI and its content as helpful and enjoyable. They felt that the stories were realistic, although names should be changed. Participants shared that they would recommend it to all their friends or specific friends. They found the videos to be useful and even learned new information, with participants sharing that the how-to videos encourage change. Focus group participants appreciated that the tone of the SSI was partnership around shared goals rather than it being overly commanding.

Participants wanted one more story exploring comparison with peers on social media and concerns about their “digital footprint.” They wanted additional videos related to TikTok, Snapchat and artificial intelligence. One participant recommended including 988 and crisis information along with a link tree of other resources such as “OK2SAY” and additional videos. They also recommended adding information about the science related to social media and youth mental health. Feedback on smaller details included a less computer-like narrator, smoother transitions between the sections, deleting the captions in the videos (as they could be turned on if needed) and removing the video narrator from the screen.

Some participants said that they might leave the free response questions blank. This led to discussions about how they preferred to go through it in a small group like we did during the focus group, with one participant sharing it was comforting to know they were not alone in thinking about this topic. Participants did not think that people would click on a social media advertisement for the SSI due to the prevalence of false advertising on social media, but would engage if it was assigned by their school. One person thought that it would be a good precollege class registration requirement. A QR code for the SSI on a poster at school or work would be feasible. They suggested that people could earn a certificate to be displayed on their LinkedIn page if it was offered there. One participant suggested SM SSI administration in a clinical setting by a doctor or therapist.