Future Technology Workshops as an Approach for Co-Creating Digital Mental Health Technology: Methodological Reflections

Decisions About Explaining the Theoretical Foundations of FTWs

Entering the process, we were unfamiliar with the method and unsure how it would unfold in practice. Workshop 1 thus afforded many opportunities to learn. To begin, despite careful planning, we quickly realized how much we did not know about the method, the dynamics of facilitation, our own team dynamic, and how young people would respond in a school-based setting. In Workshop 1, we wanted to ensure that participants understood each phase of the method, its background, and the rationale behind the activities. Such necessary objectives created a somewhat rigid atmosphere, driven by our desire to optimize the process as well as legitimize it by stressing its transparency. For example, the pre-workshop briefing became a 45-minute PowerPoint presentation in which we walked students through the methodological background, explained each phase of the FTW step-by-step, and detailed the information and consent materials at length. Several students appeared to lose focus, and we received almost no spontaneous questions, which suggests that our emphasis on transparency may have increased cognitive load instead of reducing uncertainty.

However, as the workshops progressed, the facilitation-focused approach became more relaxed and responsive. It became clear that participants did not need to fully grasp the method’s theoretical underpinnings to engage meaningfully. For many, the workshop simply represented a “different kind of day” at school, so to speak, and an opportunity to explore ideas through creative, supported activities. The shift in perspective allowed for a more enjoyable, authentic experience, both for facilitators and participants, which highlighted the importance of trusting the process instead of overexplaining it. In turn, we reduced the pre-workshop briefing to approximately 15 minutes and focused especially on the value of participants’ expertise and on clarifying participation in the research.

Decisions Shaped by the Role and Responsibilities of Facilitators and Trust in the Team

In participatory workshops, the role of facilitators is shaped by their positionality, their experience, and the setting’s dynamics. Positionality was not uniform within the team of facilitators. Differences in professional background, our own upbringing and experiences as youth, confidence with the FTW method, comfort in working and speaking with young people, and communication styles meant that we did not enter the room with the same authority or ease. Positionality was also produced within the team; configurations of relationships and roles (e.g., project lead–master’s student), age differences, and different levels of familiarity with the workshop setting shaped how we coordinated, supported, and challenged one another during facilitation. In addition, some facilitators occupied overlapping roles in relation to the workshop context (e.g., a mental health professional already known to some pupils), which could have strengthened rapport but also raised questions about boundaries, expectations, and how facilitation was interpreted by participants. Such relational dynamics made reflexivity a practical necessity, not just an abstract principle.

As facilitators, we were not neutral observers; on the contrary, we were active participants in shaping the process, guiding discussions, and creating space for young people’s and adults’ stakeholders’ contributions. Such a multifaceted role repeatedly raised questions about how much to steer the process: when to intervene, when to step back, and how to balance the different personalities in the small groups that we were responsible for. Our inexperience with the method and, for some of us, to research itself added a layer of complexity. Although we brought professional experience from mental health and (creative) youth work, we were still learning how to navigate and balance the dual roles of facilitator and researcher within the method. As a result, tensions sometimes arose between wanting to support participants and needing to collect data, as well as between encouraging creativity and adhering to the workshop structure.

We had to ask ourselves, “Who are we in this space? How do our identities, our lived experiences, and our role in the workshop setting shape how we are perceived and how we perceive the participants? How do we ensure that all voices are heard, especially the voices of people who may be less confident or less engaged?” Reflecting on those questions became part of the research process and reminded us that facilitation is not a neutral guiding act but a relational, situated practice that requires continued reflexivity. In Workshop 1, the team of facilitators was still in the early stages of building trust and clarifying individual roles in the group and in the workshop setting. As a consequence, instead of being shaped and supported by the full team of facilitators, Workshop 1 was largely conducted by one facilitator, which proved to be exhausting for them. On that basis, we decided that subsequent workshops would be both created and conducted by the entire team of facilitators, which afforded a more balanced, collaborative process of facilitation in which each facilitator could contribute their unique strengths, perspective, and style. The shift enhanced the quality and depth of the workshops and strengthened the sense of team unity and mutual trust.

The team’s unity and mutual trust also supported us when, on an especially difficult workshop day, we struggled to engage participants. Team-based reflection, which we had established earlier in the process, then served as a way to decompress and identify challenges to adapt our approach in future sessions. In practice, we created a short check-in round with each other at the start of the day to acknowledge how every facilitator was doing and whether anybody had specific logistical or emotional needs that day. Other team-based reflection consisted of short check-ins during breaks and a post-workshop debriefing in which we each shared our impressions of the workshops, including what was demanding, what seemed to support or hinder engagement, and what we would change next time. We reflected not only on our practice but also on the conditions, power relations, and assumptions that produced it. For example, when engagement was low, we first reflected on the activity itself and subsequently examined the setting and our potential role in producing it. As we became more confident and coordinated as a team, we could celebrate our successes together more genuinely.

To create a safe environment in which mental health conversations could be understood and handled with care, we also ensured that all facilitators had backgrounds in either (youth) mental health or teaching. However, meeting young people in the workshops often forced us to confront our own biases, thereby making it crucial to create space for reflection and open dialogue about those conflicts. For example, before Workshop 2, we were alerted by the teacher and mental health workers to social difficulties in the class and therefore increased the number of facilitators. Although we anticipated that students might respond differently to the workshop format versus regular classroom activities, the level of engagement and enjoyment observed throughout the day reassured us that the workshop did not confirm the concerns raised in advance.

Language and accent also played a role in how we experienced facilitating the workshops. One facilitator, a German speaker with a noticeable accent, encountered occasional challenges in communication. Their accent sometimes made understanding instructions difficult for certain pupils, particularly ones with immigrant backgrounds who were used to the local accent only. At the same time, being an immigrant also helped the facilitator to connect with those same participants. The experience underscored the importance of using clear, simple language, as well as visual aids and co-facilitation strategies, to ensure that all participants could follow along and contribute meaningfully. Such strategies informed practical design-oriented decision-making to reduce reliance on spoken instructions by adding written prompts and structured worksheets.

We responded to those challenges in designing the other three workshops, especially by introducing more written materials and structured worksheets. Those tools supported clearer communication and allowed participants to engage more independently with the tasks, which cultivated a more inclusive, self-guided workshop environment.

The most crucial adjustment between Workshop 1 and the other workshops was the decision to assign one facilitator per small group. That adjustment allowed facilitators to forge closer connections with participants, respond more flexibly to group dynamics, and better support pupils who were not confident and/or needed guidance. Unlike in Workshop 1, in which all groups worked in a single large room with fewer facilitators, the setup in Workshops 2–4 created a more contained, manageable environment for both participants and facilitators. It also helped to mitigate challenges related to language, communication, and power, because each facilitator could adapt their personal style to their group’s specific needs.

Decision to Recruit Through Schools: Building on Existing Relationships and Group Dynamics

Recruitment via upper secondary schools presented specific challenges for participation, engagement, and group dynamics. Because participation was mandatory due to the educational setting, students who did not consent to the research component were present nevertheless, which created an imbalance in engagement. The imbalance may not have directly related to the workshop or the research but instead reflected broader disengagement with school activities. If so, then it raises questions about voluntariness and how to create a research environment that supports meaningful participation, even for participants who do not want to engage in the research. Such was especially the case in Workshop 1, which took place entirely in a large room. In response, the subsequent workshops, with larger groups, were held either in two smaller rooms, which allowed the groups to work with fewer distractions, or with a smaller group of participants in a single room. To support group dynamics and inclusive participation, we assigned one facilitator to each group.

Recruiting from a population with a preexisting class dynamic presents both benefits and challenges. In the classroom, preexisting social hierarchies may influence not only who feels empowered to contribute during workshops but also how they contribute. That dynamic can facilitate engagement among confident participants but also stifle the expression of less dominant ones. The presence of peers can encourage participation through shared understanding but also lead to self-censorship, especially when discussing sensitive topics such as mental health. In Workshop 1, we used randomly assigned small groups but soon learned that the teacher’s knowledge about the class dynamics can be applied to promote each group’s workflow. We thus decided to merge one group into other groups after the critique phase in order to enhance the workflow and stabilize group dynamics. In Workshop 2, meanwhile, we were warned that one of the classes experienced social difficulties and included pupils struggling with mental health themselves. We attempted to adjust to those circumstances by asking the teacher to create safe groups with participants who would work well with each other and provided mental health care workers from the area as additional facilitators to support the groups. Last, in Workshop 4, the students were combined from two classes and invited to form groups among themselves, which enriched the general atmosphere in the classrooms and enhanced interaction, trust, and creativity during the workshop.

Decisions to Facilitate Mixed Groups: Creating Space for all Voices

When combining adult stakeholders and young people in workshops, the group dynamic is shaped by differences in age, authority, and lived experience. We observed groupwork consisting of only young people who worked very well with little support from the facilitator, as well as one group that could not perform any work together, which we thus merged into other groups. Meanwhile, a mixed group of immigrant youth and adult stakeholders initially seemed dominated by adults, which influenced the flow of conversation and limited the youths’ contributions. Over time, however, the dynamic shifted, and the youth began to assert their perspectives more confidently. Another group struggled with unclear role expectations, such that adult participants were unsure whether to act as experts, facilitators, or co-learners. That balancing act shaped the group dynamic in subtle ways and occasionally resulted in hesitation or overcompensation, which subsequently affected the flow of dialogue and co-creation. All those observations were made in Workshop 1, in which facilitators were shared between the groups. In Workshops 2–4, however, each small group was supported by the same facilitator, and we thus remained wary of possible power imbalances due to, for example, institutional hierarchy and/or class dynamics.

Across all workshops, the adult stakeholders approached the space with caution and care and actively attempted to create room for young people’s voices. Including the main teacher of each class in the workshops supported the facilitators both in creating safety and assuming authority for the class, although some teachers struggled with relinquishing their role as teachers during group work and presentations. The direct support from facilitators in Workshops 2–4 better allowed the adult stakeholders to contribute as equal participants.

Decisions to Simplify the Informed Consent Process

The ways in which participants participate in workshops are shaped long before the workshops begin, especially by how the organizers invite, frame, and prepare the workshop spaces. In Workshop 1, we observed that some young participants consented to the research before fully understanding what participating would entail, possibly due to language barriers, inattentiveness during the informational meeting, or peer pressure. Others chose not to participate because they could not grasp what it entailed. In response, we implemented strategies to streamline the informed consent process—for instance, by simplifying the language of the information letter, offering a video version of it, and maintaining ongoing dialogue during the day of the workshop. Moreover, all participants were informed that they could withdraw from the study at any time.

Decisions for Inclusive Framing: Inviting Expertise and Designing Welcoming Spaces

In all four workshops, some pupils chose not to attend school that day. One told their teacher that the prospect of an uncertain workshop day frightened them. Following the informational meeting with participants in the week before the workshops, we decided to be less specific about each workshop day and humbler in inviting them to participate. We made it abundantly clear that the young people were the experts, that we needed their expertise, and that, as facilitators, we were interested in what they had to offer. Shifting from “We’re doing research on you” to “We need your expertise” helped to reduce pressure and drove engagement.

We also aimed to create a welcoming, creative environment that fostered curiosity, expression, and a deep sense of appreciation for the young participants’ contributions. To that end, we held the workshop in their usual classroom or an often-used multifunction room, which ensured a safe, well-known space that nevertheless felt distinct and meaningful for the occasion. Entering the space, participants found a welcome-and-registration table, as well as a food-and-beverage station and an arts-and-crafts station, all arranged to be aesthetically pleasing. The food-and-beverage station was supplied with homemade cakes, cookies, fresh fruits, and chips, and we served pizza during the break. All efforts intended to communicate that we valued the participants’ time and contributions, with the goal of making the day a pleasant experience for everyone. We also made it clear at the informational meeting that we would provide food and a fun day for all workshop participants, regardless of whether they consented to participate.

Added to some language barriers for facilitators, language difficulties within the multicultural groups sometimes caused uneven participation, misunderstandings, and/or a reliance on nonverbal cues and/or the support of adult stakeholders and facilitators. In one of the groups not participating in the research, we frequently relied on tools such as Google Translate or a classmate who translated. In that case, the arts-and-craft materials offered a nonverbal way to ideate together, despite also revealing that FTWs work more efficiently with shared language proficiency.

In the classroom dynamic, various needs became apparent. Some students needed more breaks, whereas others needed more movement despite the breaks. To accommodate different learning styles, we offered time-outs and the possibility to walk around during small-group work.

Co-creating a digital tool benefited from a certain amount of digital literacy among the participants. In our workshops, the adult stakeholders and facilitators had less digital literacy than the youth participants, such that the youths’ expertise became essential. That understanding helped to straighten out potential power imbalances due to adult stakeholders’ different professional roles and expertise, as well as fostered a more collaborative atmosphere in which participants could contribute based on their strengths, not their status.

Decisions to Use Low-Threshold Creative Tools and Games

Having a workshop day that builds on co-creation means having the chance to explore one’s creativity. To include individuals who did not consider themselves to be creative, we offered a range of arts-and-craft materials and openly stated that everyone was welcome to use whatever they wanted to whatever end. Many pupils expressed appreciation for the variety of creative materials, and every group’s work likewise included a range of materials, thereby demonstrating their curiosity and willingness to experiment with unfamiliar creative tools. Surprisingly, the most-used material was Play-Doh, which the pupils decorated their prototype posters with, used to create logos, used to visually support functions that they wanted in their DHIs, and often just played with in their hands. The same applied to the use of various types of stickers among the creative materials.

In each workshop, we included physical group-based games to lighten the atmosphere and foster group connections, all while remaining mindful of participants who may have felt uncomfortable with such activities. In that context, accessibility meant designing a workshop for diverse preferences and emotional needs while not assuming that playfulness is universally welcomed. We chose games that were brief, low-pressure, and adaptable and that allowed each participant to choose how much they wanted to engage. We also prioritized games focused on group-level interaction instead of individual performance in order to ensure that no one felt singled out for a long time or obliged to participate in the games beyond their comfort zone.

Working on a Sensitive Topic With a Vulnerable Group

Our overall reflections on balancing innovation and ethics in our youth-focused mental health research project (Ørjasæter et al. 2026) include safeguarding measures taken against harm while enabling meaningful participation. In this article, we have reflected on numerous decisions influenced by working with a vulnerable group on a sensitive topic. This section therefore focuses on decisions made to keep the co-creation processes trustworthy, especially from the perspective of participating youth.

Decisions that Foster Trust, Respect, Value, and Transparency in Participation Processes

In conducting the workshops, we followed the core principle of ensuring that every facilitator understood and communicated that participants’ perspectives were central, which we called “practicing humble facilitation.” We consistently reinforced the idea that participants’ voices were the foundation of our co-creation process and acknowledged that their lived experience outweighed our own and that their input was essential for making the DHI a meaningful intervention. We also emphasized that all feedback was valued and invited constructive criticism, for we knew that such feedback would teach us the most. We also clearly stated that agreement was not required, that all perspectives were equally valuable, but also that not all ideas would end up in the final version of the DHI. To build trust, we explained how previous workshops had shaped the DHI and offered to return to share our progress.

Another important principle was showing gratitude and giving positive feedback as facilitators. We were incredibly thankful for the participants’ input. We wanted their expertise and sought to learn from them, and we dedicated time and effort to verbalize our gratitude in the small-group work, during presentations, and at the end of the day, as well as in actions such as providing snacks, pizza, and beverages.

Utility and Outputs of the FTWs

Along with informing ways to refine the facilitation and delivery of the workshops, the FTWs generated outputs that were applied directly to developing the DHI. Through workshops, participants’ contributions shaped the intervention’s content, features, structure, language, and safeguarding. Outputs included (a) proposals for engaging and psychoeducational content, (b) preferred formats and topical framing for recovery narratives, (c) functionality and interaction features (e.g., diary/mood tracking, avatar-based elements, and music), (d) support and escalation options (e.g., help chat, emergency button, and clearer routes to human contact), and (e) recommendations to improve accessibility, safety, and credibility (e.g., language, sensitive framing, and transparency).