Engaging LGBTQ+ Youth in Human-Centered Design of a Digital Health Intervention via Discord: Implementation Case Study.

BACKGROUND

Lesbian, gay, bisexual, transgender, and queer/questioning, plus (LGBTQ+) youth experience significant health challenges relative to their peers, including higher rates of HIV, sexually transmitted infections, and mental health symptoms, partly due to minority stressors. Digital health interventions hold promise for addressing these issues, but their effectiveness hinges on human-centered co-design that ensures relevance and engagement.

OBJECTIVE

This study aimed to examine the use of Discord as a platform for conducting human-centered design (HCD) activities to adapt a digital text-based intervention designed to improve HIV testing rates among LGBTQ+ youth.

METHODS

We recruited 21 LGBTQ+ youth (aged 13-18 years) in the United States via social media and participant registries, oversampling minoritized gender, racial, and ethnic identities to ensure diverse representation. Over 9 months, participants engaged in structured HCD activities on a private Discord server, including polls, open-ended discussions, and interactive feedback tasks. Design insights were collected iteratively and used to refine the intervention in real time. We also surveyed participants to examine the acceptability of Discord as a tool for hosting the HCD process.

RESULTS

We identified best practices for integrating HCD methods within Discord, including cocreating the server environment with participants and enabling real-time iteration of intervention components based on youth input. The privacy of the Discord server supported psychological safety; facilitated open and effective communication between participants and the research team; and fostered an informal, familiar atmosphere.

CONCLUSIONS

Discord provides an effective and acceptable environment for conducting HCD processes in the design of digital health interventions. Its structural features, including anonymity, accessibility, and community-driven interaction, facilitated meaningful youth engagement in co-design activities. These insights offer a model for leveraging social media platforms to support participatory intervention development for LGBTQ+ populations.