Globally, we face a significant treatment gap in mental health care. Despite the existence of numerous evidence-based interventions, most individuals experiencing mental distress receive little or no formal support [1-3] for reasons including extensive wait times, exorbitant prices, and concerns about their cultural appropriateness for non-Western clients [4-8]. One alternative approach to existing treatment options may be single-session interventions (SSIs). Digital SSIs require less time and fewer resources than traditional psychotherapies and are increasingly—and effectively—being used in the treatment and prevention of various mental health conditions [9-15].

SSIs aim to address underlying, often transdiagnostic mechanisms or skill deficits implicated in broad-ranging psychopathology rather than provide comprehensive treatment for specific diagnoses. At present, SSIs have targeted numerous transdiagnostic mechanisms associated with psychopathology, including negative problem orientation [16], avoidance [12,17], cognitive distortions [9,10,13], and negative self-perceptions [18,19]. Problem-solving skills are another transdiagnostic mechanism linked to psychopathology [20-24] and targeted with digital SSIs [16,25]. In clinical psychology, problem-solving or “social problem-solving” is defined as the “self-directed cognitive-behavioral process by which an individual, couple, or group attempts to identify or discover effective solutions for specific problems encountered in their everyday living” [26].

In their seminal paper, D’Zurilla and Goldfried [27] theorized that individual differences in problem-solving ability are due to variance in two processes: (1) problem orientation and (2) problem-solving style. Problem orientation is the motivational force behind problem-solving, including the individual’s metacognitive beliefs about their problems and ability to solve them. Positive problem orientation views problems as solvable challenges, while negative problem orientation views problems as unsolvable and distressing threats. Problem-solving style refers to the idiosyncratic way an individual attempts to conceptualize their problems and generate effective solutions. Although some heterogeneity exists in stylistic approach, most individuals tend to be rational, impulsive or careless, or avoidant problem solvers. Rational problem-solving is the most adaptive problem-solving style and involves the deliberate and systematic application of problem-solving skills, including (1) defining the problem, (2) formulating multiple solutions, (3) deciding the “best” solution, (4) implementing that solution, and (5) monitoring the effectiveness of that solution.

It has been argued that some presentations of psychopathology are due to underlying problem-solving deficits, and improvements in these presentations require a shift to more positive problem orientations and rational problem-solving styles [26]. Indeed, this literature shows that deficient social problem-solving has been associated with a range of mental illnesses, including depression [20,24], anxiety [21,28], schizophrenia [22,29], and borderline personality disorder [23,30,31].

Adolescents are a group who may particularly benefit from problem-solving interventions. Older adolescents (aged 13 to 14 years) show increased tendencies toward negative problem orientation, avoidant problem-solving style, and impulsive or careless problem-solving style compared to younger adolescents (aged 11 to 12 years) [32,33]. Additionally, marked sex differences have been observed, with rationality being more characteristic of girls in both age groups and impulsivity and avoidance being more characteristic of boys in the younger age group. Adolescence is also a developmental period marked by increases in stressors, which may benefit from problem-solving interventions, including interpersonal challenges, identity concerns, and worries about the future [34-36].

Project SOLVE is a digital SSI developed by researchers at Harvard University [16]. Through a 30-minute self-guided intervention, Project SOLVE provides young people with adaptive strategies to face their everyday problems. Specifically, Project SOLVE aims to foster positive problem orientations and rational problem-solving styles among users: adolescents learn that some of their problems are solvable challenges using the “SOLVE” framework (ie, say what the problem is, one goal to aim for, list some solutions, vote for the best solution, and explore what works) rather than threats to be impulsively dealt with or avoided. A recent school-based randomized controlled trial (RCT) in the United States found that adolescent students who completed Project SOLVE showed significant reductions in internalizing symptoms at a 3-month follow-up assessment, relative to Project Success, an active comparison program focusing on study skills [16]. In addition, participating students reported significantly reduced hopelessness and increased goal-planning confidence from pre- to postintervention, and they rated Project SOLVE as acceptable and helpful.

Like other developed nations, Aotearoa New Zealand is facing a growing mental health crisis, with adverse yearly trends in a variety of youth mental health indicators [37]. Converging systemic inequities contribute to poorer mental health outcomes for rangatahi (young people; a list of translated terms is provided in Multimedia Appendix 1) with 1 or more historically marginalized identities, including Māori youths (the indigenous people of New Zealand), Pasifika youths, and LGBTQIA+ (lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other diverse sexual orientations, gender identities, and sex characteristics) youths [38,39]. One in five rangatahi report difficulty in accessing help for their mental and emotional concerns [38], and the New Zealand mental health care system has been “characterized by long delays, overworked staff, inadequate environments, and a lack of clear information” [7]. Additionally, there have been calls for the current system to be more responsive to the needs of Māori and Pasifika youths, who often have difficulty receiving effective and culturally appropriate care [8,40].

As a low-cost and low-resource digital SSI, Project SOLVE may be an effective means of expanding evidence-based treatment to rangatahi in Aotearoa. To this end, a school-based pilot study explored the perceived acceptability, helpfulness, and appropriateness of an adapted version of Project SOLVE for rangatahi in Aotearoa [25]. Adaptations included changes to the intervention vignettes, avatar, spelling, vocabulary, and overall aesthetic design and elicited overwhelmingly positive feedback from students using a brief qualitative survey (ie, the Program Feedback Scale [41]). However, it is important to note that these adaptations were guided by relevant literature and academic expertise rather than consultation with young people themselves. Indeed, consultation is an important aspect of cultural adaptation, as it provides individuals with the opportunity to “impact, lead, and shape the things that influence their lives” [42]. This process of consultation or “co-design” is particularly important in the context of Aotearoa, as current mental health services do not satisfactorily accommodate the diverse cultural needs, preferences, and world views of our people [7,8], and particular cultural groups (eg, Māori and Pasifika communities) have been historically excluded from and oppressed by Western research practices [43-46]. Ultimately, research methodologies that incorporate co-design allow mental health tools to be developed in collaboration with their intended recipients, which may improve their cultural appropriateness and overall efficacy.

Building on the previous pilot study, we conducted a series of interviews with rangatahi and their teachers to gain a more in-depth understanding of their experience with the adapted Project SOLVE. Additionally, we asked participants about a comparable online activity, Project Success, that could be used as an active control condition in a future RCT of Project SOLVE. The interviews aimed (1) to determine the perceived acceptability, appropriateness, and utility of the SSIs for Aotearoa New Zealand and (2) to identify any further adaptations needed to the interventions prior to a nationwide RCT of Project SOLVE.

All procedures across both the student focus group and the individual teacher interviews were approved by the University of Waikato Human Ethics Committee (HREC[Health]2024#15). Participants were provided with an information sheet about the study, and consent was attained prior to participation in an interview. They were informed that participation was voluntary, that they could decline to answer any question, and that they could leave the interview at any stage. Students and teachers received US $11.56 and US $23.12 vouchers, respectively, as koha (a gift) for their participation.

This study was conducted between October 2024 and March 2025. The student focus group was conducted in collaboration with a public high school in Aotearoa New Zealand with approval from the senior leadership team.

Methods were also guided by Sonja MacFarlane’s Cultural Enhancement Framework [47] (CEF)—a tool that has been used extensively by the New Zealand Ministry of Education to adapt programs originally designed for use overseas and aims to enhance the cultural appropriateness of mahi (work) done in New Zealand (Macfarlane, personal communication, June 2024). The CEF was particularly relevant for this study, as it provided a scaffolding to appropriately and ethically engage with participants, therefore increasing the likelihood of positive participant experiences and effective final products. For example, MTB met with leadership at the participating school to explain the purpose of this mahi and facilitate a kōrero (discussion) around any concerns or questions. We also worked with our school partners to ensure that parents were appropriately informed of the research, the (classroom) setting was conducive to rangatahi engagement, and rangatahi felt safe to express their whakaaro (thoughts and views) without fear or objection.

We conducted a qualitative study using focus groups and semistructured interviews. Focus groups involve a moderated discussion with a predetermined group of people to assess the opinions, beliefs, and experiences of a particular phenomenon [48]. Increasingly, focus groups, or similar style interviews, are being used by researchers to co-design mental health interventions with their intended recipients [49-51]. In this study, student feedback was elicited using focus group discussions, and teacher feedback was elicited using individual semistructured interviews following completion of Project SOLVE and Project Success.

The majority of student participants were recruited from a large, public high school in New Zealand. This school is coeducational and categorized as “decile 1,” meaning that it is among the 10% of New Zealand schools with the highest proportion of students living in low socioeconomic communities. Additionally, the student population is disproportionately comprised of historically marginalized ethnic groups, with almost 60% and 30% of students identifying as Māori and Pasifika, respectively. (The most recent census reports 17.8% [887,493/4,993,923] of the New Zealand population as Māori and 8.9% [442,632/4,993,923] as Pasifika [52].)

In an effort to align with culturally sensitive practices, we consulted the CEF as well as the participating schools’ deputy principal and head of physical education and health on how to best work with this specific community (eg, methods of gaining parental consent, determining participant compensation, and building positive rapport with students).

From the school partnership, 2 classes of year 9 students (ages 13-14 years) were invited to participate in this study. All students in these classes completed the interventions during a regularly scheduled health lesson. All students were also invited to participate in a focus group interview outside of class hours, which required parental consent.

First, health and physical education teachers from the partner school were invited to participate in this study. Based on these 2 interviews, we then used snowball sampling to recruit additional teachers from schools of other socioeconomic and cultural contexts to gain alternative perspectives on the interventions. Teachers gave informed consent before participating.

Focus group discussions and individual interviews were audio-recorded and transcribed with assistance from Otter.ai (version 3.8.0; Otter.ai, Inc). MTB then anonymized the transcripts to preserve participant confidentiality. After familiarizing herself with the transcripts, MTB coded the data using the “comments” function in Microsoft Word (version Microsoft 365; Microsoft Corporation). These codes were then distilled and organized visually into themes using Miro, a digital workspace for collaborative brainstorming. Themes were reviewed by coauthors and supervisors and consolidated through discussions with MTB. The transcripts were revisited throughout the analysis to ensure that the findings remained grounded in the original data. To illustrate the themes, participant quotations are presented in the subsequent sections, annotated with participant number, self-identified gender, and age (if a student) or years of experience (if a teacher).

This study explored the experience of students and teachers with 2 digital SSIs: Project SOLVE-NZ and Project Success-NZ. Participants reported that the adapted interventions felt relevant for rangatahi in Aotearoa New Zealand, liking the character of Māia, the selection of vignettes, and the inclusion of te reo Māori. Participants also felt that both interventions would be valuable for a broad range of students by building their skills and supporting their mental health and may be especially helpful for youths experiencing socioeconomic hardship. Students and teachers agreed that the interventions would be best delivered in class, with fewer distractions and greater access to technology than most homes or other settings. Teachers provided some suggestions on increasing student engagement with the interventions, namely, through increased cultural and gender representation, visual and literacy aids, whakawhanaungatanga, and teacher guidance. Overall, participants viewed both interventions as acceptable, appropriate, and useful for rangatahi in Aotearoa New Zealand while identifying further adaptations to consider before an RCT of Project SOLVE-NZ nationwide.

At present, the body of literature on digital SSIs is emerging and primarily focuses on their potential utility as mental health support for young people. While the results of these studies have been favorable, the bulk of research has been conducted with American youths, making it unclear whether digital SSIs have utility in other parts of the world. This study sought to adapt existing digital SSIs for use among rangatahi in Aotearoa, using feedback from students and teachers. A similar study was conducted by Wasil et al [51] with students and teachers in India; however, these digital SSIs focused on gratitude, growth mindsets, and behavioral activation. Interestingly, the Indian students and teachers commented on different aspects of their digital SSIs to the New Zealand participants in this study. For instance, Indian teachers largely focused on how the content of the SSIs could be improved (eg, including neuroscience concepts), while our New Zealand teachers were more concerned about optimizing the interventions’ delivery (eg, ensuring that teachers had enough flexibility to accommodate their learners). Furthermore, the Indian students were seemingly forthcoming with ways to improve their digital SSIs (eg, how to make the vignettes more relatable), whereas the New Zealand students made no suggestions for improvement and claimed to be accepting of the interventions as is. On the one hand, this finding may suggest that Project SOLVE-NZ and Project Success-NZ are particularly well suited to the New Zealand context. On the other hand, it is possible that the rangatahi in this study did not feel comfortable voicing their suggestions for or criticisms of the interventions. Indeed, the majority of students in this study identified as Māori or Pasifika, and these communities have been historically harmed by Western psychological research practices and individuals of European descent (of which MTB is) [43-46]. Therefore, it is possible that the rangatahi in this study felt subject to a relational power dynamic in which criticism would be unacceptable.

Based on our participants’ experiences, below are recommendations for researchers and developers of digital interventions for adolescent mental health.

This study provided in-depth qualitative data on the experiences of rangatahi and teachers with Project SOLVE and Project Success. In analyzing participant responses, we were able (1) to deduce the acceptability, appropriateness, and utility of Project SOLVE-NZ as a digital SSI for adolescent mental health in Aotearoa New Zealand and (2) to establish whether Project Success-NZ would be a comparable active control condition in a future RCT of Project SOLVE-NZ nationwide.

Nonetheless, this study has some notable limitations. The sample of participants was gender balanced; however, all students were sampled from one low-socioeconomic school in New Zealand. Consequently, the sample of students consisted mostly of Māori and Pasifika young people, who are presumed to come from low socioeconomic backgrounds. This school partnership was purposeful; we wished to co-design Project SOLVE-NZ and Project Success-NZ with the rangatahi who likely have the most therapeutic need and potential benefits from a low-cost and low-resource intervention. Indeed, some of the students believed that the interventions would be particularly helpful for Māori and Pasifika youths; however, they also endorsed the use of the interventions across schools in New Zealand. The teachers in this study shared a similar sentiment, with some highlighting the applicability of the interventions to Māori and Pasifika youths, specifically, and others citing the potential benefits of the interventions to youths regardless of their cultural identity or socioeconomic status. That said, future research is needed to confirm how other young New Zealand people—of wide-ranging ethnic and socioeconomic identities—experience these interventions.

It is also possible that participants demonstrated social desirability bias in the interviews, concealing their criticisms about the interventions to please the interviewer. Attempts to mitigate this bias were made, with MTB having no prior connection to the students and encouraging honesty throughout the focus groups. However, as mentioned previously, no student made a suggestion on how the interventions could be improved and may have felt voicing criticism was unacceptable. Students may have also had limited insights into improving the interventions, as problem-solving and study skills appeared to be relatively new concepts. MTB knew 2 of the teachers whom she interviewed, but it was noted that these teachers provided constructive feedback and suggestions on improving the interventions going forward. Future research could use anonymous self-report questionnaires to gather additional data on students’ experiences.

MTB checked that all students completed the interventions before their focus group interview; however, there was no assessment of whether the interventions were completed appropriately (eg, checking the quality of a student’s response to the intervention questions). Therefore, it is possible that some students participated in the focus group without engaging with the interventions as the researchers intended. Looking ahead, it will be crucial to examine the quality of engagement with Project SOLVE-NZ and Project Success-NZ in order to obtain a valid indication of their effects on rangatahi mental health.

Finally, there is an opportunity for greater involvement of rangatahi in the development of these interventions and others similar. While this research integrated elements of co-design (ie, attaining user feedback to guide future adaptations), “true” co-design would develop a problem-solving intervention with rangatahi from the ground up. Indeed, earlier involvement of rangatahi may better guide the framing and pedagogy of an intervention, which could lead to greater skill development and mental health outcomes. True co-design with diverse rangatahi may also highlight needs and considerations that are specific to certain groups (eg, accessibility concerns for students with learning challenges).

Digital SSIs are a promising means of closing the treatment gap in mental health care. Our findings suggest that Project SOLVE-NZ, an adapted 30-minute digital SSI that teaches problem-solving skills, is acceptable and appropriate for youths in Aotearoa New Zealand and was perceived to have potential benefits to youth mental health. Additionally, we found evidence that Project Success-NZ, a comparable digital SSI that teaches study skills, was also well received. Overwhelmingly, rangatahi and their teachers endorsed the use of Project SOLVE-NZ and Project Success-NZ in high schools across New Zealand, citing perceived benefits to adolescents from diverse cultural and socioeconomic identities. Teachers also provided suggestions on how to enhance student engagement with the interventions in the future.

Beyond Project SOLVE-NZ and Project Success-NZ, our findings suggest that digital tools for youth mental health may benefit from involving rangatahi and relevant stakeholders in the design process. This involvement could support researchers to build interventions that appeal to rangatahi, accommodate a range of cognitive abilities, represent diverse identities, and overcome the challenges of implementation [42,53-55]. Informed by this study, we look forward to examining the effects of Project SOLVE-NZ and Project Success-NZ on rangatahi mental health outcomes in the future.