Using Discord to Engage LGBTQ+ Youth in Human-Centered Design of a Digital Mental Health Intervention: A Methods Case Study (Preprint)

BACKGROUND Background: LGBTQ+ (i.e., lesbian, gay, bisexual, transgender/gender diverse, queer) youth experience significant health challenges relative to their peers, including higher rates of HIV, STIs, 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 to ensure relevance and engagement. OBJECTIVE Objective: This study examines the use of Discord as a platform for conducting human-centered design activities to adapt a digital text-based intervention aimed at improving HIV testing rates among LGBTQ+ youth. METHODS Methods: We recruited 21 LGBTQ+ youth (ages 13–18) in the U.S. via social media and participant registries, oversampling minoritized gender, racial, and ethnic identities to ensure diverse representation. Over 10 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 Results: We identified best practices for integrating HCD methods within Discord, including co-creating 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, open and effective communication between participants and the research team, and fostered an informal, familiar atmosphere. CONCLUSIONS Conclusions: Discord provides an effective and acceptable environment for conducting HCD processes in digital health intervention design. 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 enhance participatory intervention development for LGBTQ+ populations.