JMIR HUMAN FACTORS
Michel et al
Original Paper
Young People’s Attitude Toward Positive Psychology Interventions:
Thematic Analysis
Toni Michel1, BA, MEng; Franziska Tachtler1, MSc; Petr Slovak2, PhD; Geraldine Fitzpatrick1, PhD
1
Technical University Vienna, Wien, Vienna, Austria
2
King's College London, London, United Kingdom
Corresponding Author:
Toni Michel, BA, MEng
Technical University Vienna, Wien
Argentinierstraße 8
Vienna,
Austria
Phone: 49 1773075023
Email: toni.michel@tuwien.ac.at
Abstract
Background: Digital instantiations of positive psychology intervention (PPI) principles have been proposed to combat the
current global youth mental health crisis; however, young people are largely not engaging with available resources.
Objective: The aim of this study is to explore young people’s attitudes toward various PPI principles to find ways of making
digital instantiations of them more engaging.
Methods: We conducted an explorative workshop with 30 young people (aged 16-21 years). They rated and reviewed 29
common PPIs. Ratings and recorded discussions were analyzed using thematic analysis.
Results: Some interventions were conflicting with young people’s values or perceived as too difficult. Participants responded
positively to interventions that fit them personally and allowed them to use their strengths.
Conclusions: Values, context, strengths, and other personal factors are entangled with young people’s attitudes toward digital
instantiations of PPI principles.
(JMIR Hum Factors 2020;7(4):e21145) doi: 10.2196/21145
KEYWORDS
adolescent; mental health; health resources
Introduction
population-level mental health is best improved by expanding
mental health promotion services [2].
Background
Positive psychology (PP) is the area of mental health research
oriented toward mental health promotion. According to
Seligman and Csikszentmihalyi [6], “PP is the scientific study
of positive human functioning and flourishing on multiple levels
that include the biological, personal, relational, institutional,
cultural, and global dimensions of life.” PP is thus
complementary to the more conventional disease model of
mental health, which is oriented toward resolving mental health
problems [7]. The main goal of PP is to improve on positive
aspects of mental health, such as well-being and optimism,
grounded in the assumption that all human beings have the
capacity to flourish, and existing strengths. Theoretically, PP
is thus a continuation of humanistic psychology [8] and, more
specifically, Maslow’s [9] notions of health and growth
psychology in contrast to low ceiling psychology. In terms of
We are in the midst of an escalating global youth mental health
crisis [1]. Among all age groups, young people are the most
likely to develop mental health problems and the least likely to
have access to support [2]. Suicide has become the most
common cause of death for boys and second most common for
girls aged between 15 and 19 years [3]. The majority of young
people do not have sufficient access to mental health support
[4]. Many who endure unresolved youth mental health problems
consequently deal with them for the rest of their lives [5].
Thus, mental health promotion needs to be more widely
available. Research has indicated that the most efficient way of
confronting the crisis is by addressing mental health on a
population level, as opposed to individual treatment, and that
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intervention mechanisms, PP is a growing ensemble of diverse
evidence-based interventions, which we call positive psychology
interventions (PPIs). PPIs are often low in complexity and do
not require excessive amounts of time or expert supervision
[10]. These are often shared with common intervention
principles such as forgiveness, mindfulness, and gratitude.
Gratitude interventions, for example, have shown to improve
life satisfaction, well-being, and positive affect and decrease
negative affect [11,12]. To illustrate, one common intervention
utilizing the gratitude principles is the Gratitude Letter, a
reflective writing activity that consists of first writing a letter
about all the things a person is grateful for toward another person
and then delivering this letter [13]. According to a report from
the Lancet Commission on Global Mental Health and
Sustainable Development, digital instantiations of existing
intervention principles are the most promising avenue for
making mental health interventions (including PPI) available
to young people because of the wide proliferation of digital
devices and the (in principle) ease of scaling up digital solutions
for large audiences [14]. Consequently, youth health care
providers around the world have started offering them [15,16].
However, despite these ongoing efforts, and despite young
people reporting interest in using digital instantiations of
interventions, young people engage with such digital
instantiations only to a limited degree: research revealed low
uptake, low adherence, and low engagement of young people
with digital mental health promotion [17,18]. A series of focus
groups with young people (aged 15-16 years), which explored
preferences in relation to mental health promotion apps,
highlighted that “content should be made fun and interactive
through the use of pictures, music, videos and games” [19].
Subsequently, another group of researchers investigated the
Michel et al
degree to which the content of mental health promotion apps
aligned with young people’s media preferences, discovering an
overreliance on static content, that is, written text, and
recommended more visual and interactive solutions [20].
Existing research did not investigate the degree to which these
issues are a consequence of how PPI principles are translated
for digital platforms, as opposed to being rooted in the PPI
principles themselves.
Objectives
To explore this further, we conducted a workshop on young
people’s attitudes toward PPI and their underlying intervention
principles, with 30 young people aged 16-21 years. We decided
on the upper end of the young people age range because it
allowed us to have more in-depth discussions, as would
otherwise potentially have been the case.
The research phase consisted of 2 steps: (1) individual reflection
and (2) group discussion. During step 1, young people
individually read, rated, and provided written statements on
instructions for 29 common PPIs (refer to the Methods section
for how we selected them). They received descriptions of the
interventions, on paper, alongside a series of Likert scale
questions to what degree the interventions fit to them personally
and a textbox to express their thoughts in more detail. During
step 2, they discussed the interventions in groups of 6. Both
written and verbal statements were subsequently categorized
by emotional valence, that is, as positive, balanced, or negative
and coded. We assessed valence to allow a systematic overview
of how positive, neutral, or negatively specific PPI were
perceived. All collected data informed the construction of
themes according to thematic analysis [21]. An overview of the
study process is shown in Figure 1.
Figure 1. Overview of the 2-step research phase.
We will differentiate between specific PPIs (eg, Gratitude
Letter), the intervention principles (eg, Gratitude), and their
digital instantiations (eg, an app with which to write a Gratitude
Letter). The differentiation between interventions, intervention
principles, and digital instantiations aligns with the recent calls
to focus on the principles more than specific interventions to
produce long-term, reliable insights [22].
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When analyzing our data, we discovered that the criticisms
young people had for the intervention principles were similar
to the issues that previous research had attributed to digital
translation of the existing PPI. In other words, a common
assumption in digital mental health research has been that—as
research provides us with evidence-based interventions—it only
requires engaging reinterpretations of interventions and (young)
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people would be interested in them. If the issue with
nonengagement was rooted in how we translate interventions
for digital platforms, then we would not expect to find the same
criticism leveled against conventional, nondigital interventions.
However, the findings of this study indicate that the issues young
people see in digital instantiations of PPI are in fact inherited
from their nondigital predecessors. We might not just need to
improve the quality of digital interpretations to make them more
engaging for young people but might need to reevaluate the
appropriateness of their underlying intervention principles.
This paper is structured as follows. We first describe how we
recruited 30 young people from a German school to participate
in the workshop. We then explain how questionnaires and audio
recording during the workshop were used for data collection,
followed by how we analyzed the data using common statistical
methods and thematic analysis. We then discuss the wider
implications of our findings for the design of digital
interpretations of PPI for young people.
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Ethics Approval and Proceedings
We first contacted the Department of Science and Education
for the State of Saxony in Germany to inquire about the protocol
for conducting research in local schools. They provided us with
a series of questionnaires aimed at identifying possible harm
and possible benefits for students, which could result from our
research. On the basis of our answers, we were given permission
to proceed with the study. We then contacted a local school.
The school administration allowed the workshop to proceed.
We then presented the plans for our workshop to the students.
The school administration recommended a specific class for
which they assessed the most potential benefit from attending
the workshop.
This study is part of a project that investigates how technology
may be applied for mental health prevention and promotion in
young people, especially how digital instantiations may be
designed to be engaging for young people. Insights generated
from this study will facilitate applied design research, that is,
the creation of a digital toolkit to support prevention approaches
for young people.
The workshop took place over 3 days before the start of a school
holiday. Students of this class were given the choice of attending
the workshop or continuing with their regular lessons. All 30
students opted to attend the workshop. As part of enrolling them
into the study, every participant received information about the
workshop, had the opportunity to ask questions, was informed
about their rights as participants, and subsequently signed an
informed consent form. For those aged under 18 years, we also
required written consent from their legal guardians. All
documents were presented and collected during the workshop.
Regarding data collection, we decided against video recording
of group discussions because of privacy concerns, given the
sensitivity of the topic, that is, mental health, and the nature of
our participants, that is, young people (a trade-off, which meant
that it was not possible to link participants and quotes during
data analysis).
Selection of Methods and Setting
Participants
We decided to conduct a workshop with young people for the
following reasons. Our goal was to investigate young people’s
attitude toward PPI; thus, young people would be our
participants. Our questions were explorative and open ended;
thus, they would best be addressed by predominantly qualitative
data. We wanted our participants to speak openly and potentially
critically about the subject matter; thus, they should discuss
with their peers, reducing the impact of power dynamics
between researchers and participants. Finally, we wanted to set
up our research in a way that would provide benefits for our
participants. Utilizing the multidisciplinary background of our
research team, consisting of experts for design, technology, and
mental health, we developed a workshop for designing digital
instantiations. This workshop explored young people’s attitude
toward PPI and allowed them to design their own digital
instantiations of intervention principles by learning to apply
common industry design and design research methods, such as
mood boards, personas, and low fidelity (ie, paper-based)
prototypes. As a location for the workshop, we decided on a
rural German high school with a specialization for art and
design. The school we chose prepares students for higher
education in artistic disciplines, anticipating they would act as
creative design partners (as they did). Methods we taught during
the workshop were discussed before with local teachers to make
them suitable for the curriculum.
Our workshop had 30 participants, aged 16 to 21 years, with a
median age of 18 years and variance of 1.9 years. A total of
50% (15/30) of our participants identified as female, 43%
(13/30) identified as male, 3% (1/30) identified as nonbinary,
and 3% (1/30) did not self-identify their gender. In terms of
nationality, 70% (21/30) identified as German, 10% (3/30)
identified as Polish, 3% (1/30) identified as Serbian, 3% (1/30)
identified as Taiwanese, 3% (1/30) identified as Malaysian, 3%
(1/30) identified as Turkish, and 3% (1/30) identified as Chinese.
Methods
Context
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Procedure
The workshop was conducted over the course of 3 days and
consisted of a research phase and a design phase. The research
phase is the focus of this paper and consists mainly of a 120-min
long 2-step activity, that is, individual reflection and group
discussion. During the subsequent design phase (not a subject
of this study), the participants went on to create their own
concepts for digital instantiations of PPI principles. The
workshop took place in a classroom with nonmovable desks
and a maximum capacity of 50. Timeline of the workshop is
given in Table 1, and an overview of the general structure is
shown in Figure 1. The workshop was moderated by one
researcher from our group.
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Table 1. Timeline of the workshop.
Time
Step
Description
10 AM to
10:15 AM
Introduction
Participants were reminded of the workshop’s purpose and informed about the overall structure. They
then received a brief introduction to PPa to improve their ability to process the later stages. At the end
of the introduction, the participants were randomly assigned to 5 groups of 6 participants each.
10:15 AM to Step 1: individual reflection Participants received 4 to 5 descriptions of PPIb (“Intervention sheets”) so that each group had intervention
10:45 AM
sheets for all 29 interventions, randomly assigned to participants within groups. The general structure
of the intervention sheets can be seen in Figure 2. Participants then individually read the intervention
descriptions and answered 4 questions about them:
1.
2.
3.
4.
“How likely would it be that you try this intervention?”
“How well does this intervention fit to you?”
“How much would you expect this intervention to help you?”
“Why?”
Questions (1) to (3) were rated on a 5-point Likert scale, with 1=“not at all” and 5=“a lot.” Question (4)
was answered in writing with space for 2 to 3 sentences (some participants opted to write longer answers
on the backside of the sheet).
a
10:45 AM to Break
11 AM
N/Ac
11 AM to
noon
Participants were asked to discuss within their group how much merit they saw in each intervention.
This consisted of participants first presenting to each other the interventions they reviewed during step
1 and then discussing them. These discussions were audio recorded through recording devices placed
at the center of each group’s table. A moderator familiar with PP was available to answer the questions
in case the descriptions were unclear.
Step 2: group discussion
PP: positive psychology.
b
PPI: positive psychology intervention.
c
N/A: not applicable.
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Figure 2. Intervention sheet template.
Interventions
To assemble a suitable selection of interventions, we consulted
a web-based database for mental health experts, the Positive
Psychology Toolkit [23]. To our knowledge, at present, the
platform is the most comprehensive PP database. In addition,
it allowed us to search by intervention principles, that is, family
of related intervention strategies [24], for example, Mindfulness
and Gratitude, which was useful when looking for representative
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PPI from common intervention strategies. We selected
interventions based on the following criteria, which we derived
from a discussion within our research group:
Youth Appropriateness
The interventions should be applicable to school-aged young
people, that is, not explicitly reference offices, coworkers,
retirement, or other not age-appropriate concerns, to maximize
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the likelihood that the interventions would align with the lived
experiences of our participants.
Evidence Based
The interventions should be evidence based, that is, based on
peer-reviewed research, to exclude interventions that have not
yet been shown to provide benefits.
Easy Overview
We excluded complex interventions that consisted of multiple
phases or sessions or multiweek programs, to have descriptions
that would be accessible to our participants. Given that there
would be limited time during the workshop for our participants
to understand how these interventions worked and that our
participants did not have professional mental health
backgrounds, we focused on interventions with few steps.
Manageable Amount
We estimated that between 25 and 30 interventions would be
ideal, to keep the overall number of interventions low enough
so our participants would be able to briefly discuss all of them
during a 60-min group discussion. We selected them from 315
PPIs available in the database.
Diverse Content
We included diverse kinds of interventions, spread across
domains (eg, communication, happiness, and mindfulness) of
varying duration (5- to 60-min interventions) and using a variety
of modalities (eg, writing, photos, music, and physical
intervention), to prompt a diverse range of responses.
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Michel et al
After working through the database and applying our criteria,
we arrived at a list of 29 interventions that were considered
suitable for the context of the workshop (Table 2). This process
was subjective; other researchers may have included some
interventions we dismissed and vice versa, especially concerning
youth appropriateness and diverse content. However, although
an objective selection was not possible, we opted for
intersubjectivity through consensus within our group and
discussed extensively which PPI to include. We apply
intersubjectivity in the sense of Heidegger’s use of the term
[25]. As there was no objective answer about which
interventions to select, we instead aimed for agreement between
subjective opinions within our research group.
The interventions offered by the Positive Psychology Toolkit
and PP research in general are strongly influenced by Western
cultures, in particular US culture. Descriptions of interventions
were entirely in English, so was the underlying research, and
so was (likely) the native language of most participants of the
studies on which the interventions were originally validated.
For our context, that is, young people from Germany, one of
the researchers in our group translated the intervention
descriptions into German and into a reading level that was
appropriate for our participants, for example, removing technical
jargons that would not be familiar to readers without a
background in mental health. However, cultural assumptions
and values within the interventions could not be localized, and
it is possible that these cultural assumptions and values have
had an impact on our participants’ responses.
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Table 2. Interventions.
a
ID
Name
Domain
Time (min)
1
Apologizing Effectively
Communication
5
25
Three Loving Connections
Communication
5
17
Nonjudgmental Reflection
Compassion
15
20
Reframing Critical Self-Talk
Compassion
10
21
Self-Compassion Break
Compassion
5
12
Healing Through Writing
Coping
15
15
Initiating Physical Activity
Coping
30
18
Positive Emotion Brainstorm
Emotions
15
26
Using Music to Express Feelings
Emotions
N/Aa
13
Hope Map
Goals
30
22
Self-Contract
Goals
10
6
Gratitude by Mental Elimination
Gratitude
15
7
Gratitude for Important People
Gratitude
10
8
Gratitude Journal
Gratitude
10
9
Gratitude Letter
Gratitude
20
10
Gratitude Meditation
Gratitude
10
14
Increasing Awareness of Complaining
Gratitude
N/A
2
Chasing Happiness
Happiness
5
3
Creating Flow Experiences
Happiness
45
11
Have-a-Good-Day Exercise
Happiness
10
19
Random Acts of Kindness
Happiness
N/A
23
Spending Money on Others
Happiness
N/A
28
Writing About Intensely Positive Experiences
Happiness
10
4
Creating Quiet Time
Mindfulness
5
24
The Best Possible Self
Mindset
10
5
Daily Motivational Awareness
Motivation
5
27
Using Photography to Increase Savoring
Savoring
10
29
You, At Your Best
Strengths
60
16
My Gravestone
Values
12
N/A: not applicable.
Data Analysis
We collected 146 written responses to interventions from step
1, that is, overall 146 statements the participants wrote on the
same sheet of paper on which they rated the interventions. The
transcribed group discussions from step 2 resulted in an
additional 220 statements, that is, 366 statements overall. We
labeled a statement any comment that related to how PPIs were
perceived; we excluded the descriptions of PPIs and off-topic
conversations. Alongside the statements, we also collected
Likert scale ratings for all PPIs, which participants made
individually during step 1.
Subsequently, thematic analysis [21] was led by one of the
researchers, after which the statements were translated into
English by a German native speaker (so as to be easily processed
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by our mostly English-speaking team). The researcher started
by reading the statements without initial codes. They wrote
down candidate codes while working through the statements,
based on what they perceived as the best characterization of the
respective statements. After working through all the statements,
they started again from the beginning, reapplying codes from
the first reading, while extending them with new codes and
merging and splitting codes based on further reflection. In
addition, the statements’ emotional valence was classified as
either positive, that is, the participant seemed to like the PPI
(eg, “What I like about this intervention is...”); balanced, that
is, it was not clear whether the participant liked the PPI or not
(eg, “I don’t know what to think of this intervention”); or
negative, that is, the participant seemed to dislike the activity
(eg, “What I don’t like about this intervention is...”). This
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process was concluded after the fourth iteration because during
this iteration, no further changes to the codes seemed necessary.
The codes were then written out on post-it notes and grouped
by perceived thematic similarities. Over the course of 1 week,
codes were moved through different group configurations in
search for what seemed their most meaningful combination.
The process involved 4 researchers from our group and was
accompanied by many discussions to reduce bias.
The Likert scale ratings from step 1 and the emotional valence
of statements (positive, balanced, or negative) served for
additional sense checking. Likert scale ratings were processed
by calculating the median rating for each PPI and correlated
with certain strategies (eg, Mindfulness). We identified 3 major
clusters, from which the themes were constructed. We
deliberately frame this process as a construction, as we follow
Braun and Clarke’s [21] position that themes do not reside
within codes or are discovered. Instead, they result from the
active decisions of researchers about what to emphasize and
what to deemphasize while purposefully constructing a
meaningful narrative [21].
Results
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(corresponding to the 3 Likert scale questions on the score
cards): inclination (of participants to try the PPI), expectation
(of participants that the PPI would help them), and fit (to our
participants interests). Although there was notable variation in
ratings between PPI, within PPI, the 3 aspects (inclination,
expectation, and fit) were consistently close (a plot of the data
is shown in Multimedia Appendix 1). This suggests that
inclination, expectation, and fit were, to our participants, related,
although further statistical analysis based on a larger sample
would be necessary to make this point with higher confidence.
Across all ratings, if a participant gave a low rating for fit, he
or she would also give a low rating for expectation and
inclination. The same applies to high ratings.
By combining 146 written statements from step 1 and 220 group
discussion statements from step 2, we arrived at 366 unique
statements participants made toward the 29 interventions. As
explained in the Data Analysis section, we coded each statement
and categorized the emotional valence of statements as either
positive, balanced, or negative. Of the 366 statements, 33.1%
(121/366) were positive, 16.7% (61/366) were balanced, and
50.3% (181/366) were negative. An overview of emotional
valence expressed toward PPI is shown in Figure 3.
PPIs
Step 1 produced 145 ratings (next to 146 written statements)—5
ratings for each of the 29 PPI—consisting of 3 components
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Figure 3. Emotional valence expressed toward positive psychology intervention.
Themes
Construction of Themes
We constructed 3 themes from step 1 (ie, individual reflection)
and step 2 (ie, group discussion). The rating of step 1 served
for additional sensemaking, that is, when deciding whether a
candidate subtheme sufficiently reflected trends or majority of
opinions during the workshop. For example, if one group would
have discussed a certain PPI largely negatively, but the overall
rating for this PPI was positive, then we would take this
discrepancy into consideration. Practically, the ratings largely
aligned with the qualitative statements and thus gave us
additional confidence about the appropriateness of subsequent
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themes. The quotes we decided to highlight are canonical
examples of common statements during the workshop.
The first theme deals with points of tension between youth
cultures and values embedded in PPIs. The second theme
addresses the possibility of PPI failing and how it may impact
young people. The third theme is concerned with the impact of
individual differences and preferences on our participants’
attitude toward PPI.
Theme 1: Youth Cultures
It became evident during the discussions that PPIs have a
normative layer and reflect assumptions about desirable
behaviors. Strategies involving, for example, gratitude and
forgiveness are not morally neutral; instead, they have wrapped
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into them assumptions about what behaviors are good and that
lack thereof is thus bad. Forgiveness, for example, may be
viewed as something positive within the moral system within
which PP is situated but has also been described as a trait
symbolic of weakness [26]. These moral assumptions created
tensions to the degree that they were perceived as diverging
from the values and norms of our participants, that is, their
cultures. Especially notable were tensions around the areas of
(1) inauthenticity, (2) docility, (3) pathologization, and (4)
appropriateness.
(1) Inauthenticity: Our participants were critical of interventions
when they pushed toward behaviors that would not have
occurred naturally. Performing certain behavior against one’s
inclinations was perceived as dishonest. These types of
interventions triggered terms related to oppression, such as
forcing, dictating, and pushing (Q1.1 to Q1.3).
Q1.1: Random Acts of Kindness:
I think you ought to be friendly to other people
because you like them, and because you yourself are
a friendly person, otherwise you force yourself into
a shape that is not really you.
Q1.2: Three Loving Connections:
I think you should spend time with people because
you yourself have a personal need for that and not
because some plan dictates that you should.
Q1.3: Gratitude Letter:
For me this definitely wouldn’t work, because, I would
feel pushed to write a letter just to make the other
person happy, not to actually reflect on the things I’m
grateful for.
(2) Docility: A range of interventions was criticized for
promoting docile behavior. Our participants spoke negatively
about interventions that recommended apologizing and being
grateful (Q2.1 to Q2.3). Although they considered that some of
these behaviors may be sensible in a measured approach, they
worried about people being encouraged to lean toward these
behaviors beyond a healthy degree (Q2.1). They also perceived
some interventions as accusatory because the intervention
sounded to them as if they are not already, for example,
apologizing enough (Q2.2).
Q2.1: Apologizing Effectively:
The thing is, when I don’t have confidence anyway,
and then I’m expected to apologize for everything,
doesn’t that do more harm than good? —Seriously,
maybe I apologize already too much. Like, they think
you’re a completely egotistical person and that you
wouldn’t apologize by yourself. (...) For me, this
wouldn’t work.
Q2.2: Gratitude Letter:
I also see a risk in that. Here, with all these Gratitude
things. They say, ok, write up what you are grateful
for. And if you can’t think of anything, are you then
un-grateful? But what if there actually are no things
to be grateful for? Sometimes you just feel bad,
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sometimes you get treated badly, and then you are
supposed to be grateful. It’s like, eat shit and smile.
Do you know what I mean? Maybe it needs an
un-grateful letter—yeah, to emphasize—to just
emphasize all the things that hurt, or that did hurt,
or cause problems—and to show that to someone.
You hurt me, and I’m not fucking grateful. It’s also
easy to say what you are grateful for because people
want to hear that, there is no barrier. Telling
someone, this hurt me, you were unfair to me, you
caused me problems, that is much more difficult. And
if it’s then someone who is above you, like a
teacher—yeah you may be laughing but I really could
write an un-grateful letter like that to one or two
teachers here—but then I only get in trouble.
Q2.3: Gratitude for Important People:
This is like something—I used to go to church as a
kid, I had to, and this sounds incredibly preachy, like
something my pastor would tell me to do. Maybe this
means I’m a bad person, but I actually don’t think I
need to act like that.
(3) Pathologization: Our participants expressed several times
that perceived negative behavior may still lie within the range
of healthy functioning and that it does not necessarily need to
be corrected (Q3.1 to Q3.3). This also intersected with triggers
of negative emotions for some, for example, regarding sports
and weight loss (Q3.2). Triggering negative emotions is
discussed more in theme 2. It was questioned whether happiness
all the time is necessary and said that being happy wouldn’t
mean anything if its rooted in superficial reasons, such as
antidepressants—a category within which the participant
seemingly also placed PPI (Q3.3). (To note, this criticism may
be rooted in us not sufficiently having explained to our
participants the difference between hedonic and eudemonic
happiness and PP’s orientation toward the latter).
Q3.1: Random Acts of Kindness:
You may be mentally entirely healthy, and everything
is fine and you’re still just an asshole. Being an
asshole doesn’t mean you’re sick or need therapy, it
only means you’re an asshole.
Q3.2: Initiating Physical Activity:
I know I’m a bit overweight, but that also means that
I hear all the time that I’m supposed to do more
sports. Weight loss may not be what they have in mind
with this intervention, but the topic is still a major
trigger for me. Some people just do not like to do
sports. It’s ok not to like sports. You don’t need to do
sports to be a normal healthy person.
Q3.3: Chasing Happiness:
Must I feel happy all the time? They seem to
assume—if you aren’t happy then something surely
is wrong with you, so you better try to be happier.
Right? It may sound strange, but I think its ok that I
don’t feel happy all the time. I may not even feel
happy most of the time. If I wanted to feel happy all
the time, I could just gobble up some anti-depressant
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meds, but that wouldn’t really mean anything, would
it?
(4) Appropriateness: Our participants suggested that the
appropriateness of a PPI is bound by its context and that context
could provide an anchor to normalize an intervention (Q4.2 to
Q4.3). Some interventions made more sense to our participants
when placed in relation to special times. Although, for example,
gift giving without a contextual anchor could appear strange;
the birthday of a friend could constitute such an anchor and thus
normalize the intervention (Q4.2). Similarly, one participant
stated she would feel uncomfortable if given a Gratitude Letter
out of the blue, that is, lacking a contextual anchor, and that she
would feel disturbed by it (Q4.1).
Q4.1: Gratitude Letter:
Imagine you get a letter like that—I’m just saying,
out of the blue a buddy walks up to you and gives you
one of those letters, I’d be seriously wondering what
the hell went wrong with him. I’m always there for
my friends, obviously, and sure I’m happy about the
occasional “thanks,” but if someone would go
through the trouble of writing a letter like that, I
probably wouldn’t feel happy, more disturbed.
Q4.2: Spending Money on Others:
A friend of mine recently celebrated her birthday—I
was feeling a bit down at the time, but I got up and
got her movie tickets—and I noticed that when I gave
them to her, I actually felt better. I thought that was
a bit odd at the time, but now I read this, and I think,
yeah, that does make perfect sense to me.
Q4.3: You, At Your Best:
Yeah, so, with this intervention, “You, at your best,”
I actually did something like this a while back. When
I finished middle school, I noticed that in many ways
I wasn’t really happy with myself. So, before I started
here, I sat down at home, and just sketched out how
I wanted to be—probably didn’t take as much time
for it as they recommend here, but essentially the
same thing.
In summary, our participants highlighted a series of issues
related to tensions between their personal values and norms and
those imbued in PPI. Culture and context seemed to play
relevant roles in determining when an intervention would be
appropriate. Wider implications of this theme are discussed in
the Discussion section.
Theme 2: Conditions and Consequences of Failure
Our participants were concerned that many interventions
harbored the potential to fail and how they would deal with the
setback if that would happen. Related to this, they expressed
concerns over PPI inadvertently, making them feel worse instead
of better. This theme is structured into the subthemes (1)
intrinsic factors, (2) extrinsic factors, and (3) triggering of
negative emotions.
(1) Intrinsic factors: Participants pointed out an inherent degree
of difficulty of some PPIs (Q1.1 to Q1.2). They attributed this
difficulty to either the intervention itself (Q1.1), own perceived
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shortcomings (Q1.2), or a lack of experience with PPIs (Q1.3).
One participant compared PPIs with yoga exercises, in that
experience is necessary for exercises to become easier but that
first starting is the most difficult step (Q1.3).
Q1.1: Creating Flow Experiences:
I also think this is difficult—this is complicated, and
not necessarily something that you can do quickly.
You first must understand all the steps. You almost
have to study in order to understand this.
Q1.2: Nonjudgmental Reflection:
It would be difficult for me to not have judgmental
thoughts.
Q1.3: Gratitude Meditation:
I mean, I’ve never done anything like this, maybe for
someone who does nothing but meditating from dusk
‘til dawn—maybe then that’s easy, but seriously—do
you understand this? This may be something like
yoga, where you get better at doing the poses over
time, but it’s really damn difficult to get started.
(2) Extrinsic factors: This subtheme relates to difficulties that
are not necessarily rooted in the intervention but in some
contingent elements, for example, how other people involved
in the intervention may respond (Q2.1 and Q2.3) or potentially
falling short of overambitious goals (Q2.2). One participant
emphasized that getting a positive response from the receiver
of a gift during the Spending Money on Others intervention
“may actually make you feel better” (it does [24]) but that it
still involved a risk of rejection (Q2.1). Risk of rejection also
came up during another participant’s response to Three Loving
Connections, asking what should be done “if the people don’t
want to meet you though” (Q2.3). Another participant reflected
on negative experiences with the New Year’s resolutions, which
she likened to the Self-Contract PPI and raised the issue of what
to do if one falls short of their own set goals (Q2.2).
Q2.1: Spending Money on Others:
If you get the wrong response after giving someone
a gift then that doesn’t really help you. But if you get
a positive response—A positive response may actually
make you feel better, but it could end up being
disappointing otherwise.
Q2.2: Self-Contract:
This “self-contract” thing sounds like new year’s
resolutions to me—I’ve been through that with my
dad. We planned which grade I should reach in which
subject, and then that didn’t work out. And then that
was just really depressing. So, what happens if I can’t
fulfill the contract? Then I’m just standing there,
disappointed.
Q2.3: Three Loving Connections:
For me, I’d be worried about getting rejected, if I’m
honest. I may not be the most social person, and in
principle that’s ok for me, but if the goal of this
intervention is to meet more people—it says nothing
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what to do if the people don’t want to meet you
though.
(3) Triggering negative emotions: This subtheme relates to PPIs
being a potential cause, that is, trigger, for negative emotions.
Both a focus on negative (Q3.1) and positive (Q3.2) memories
could, according to our participants, become a trigger for them.
Additional risk was identified in relation to Daily Motivational
Awareness, an activity that asks people to reflect on what drives
them. One of our participants worried how to reconcile if
nothing motivated her, saying that “realizing that would be
really depressing for me” (Q3.3). Explicit reference to a PPI
being depressing also came up in response to My Gravestone,
where people are tasked to reflect on what they would want to
be remembered for. The participant noted that this PPI would
“put all the focus on dying,” saying that they “don’t want to
think about that” (Q3.4).
(1) Impact of personality differences: Young people are no
homogenous group with regards to their interests and
preferences, and their individual differences impact how they
respond to PPIs (Q1.1 to Q1.4). In some instances, this was
explained with reference to personality traits, such as a tendency
toward anxiety (Q1.1) or lack of patience (Q1.3). In other
instances, participants just noted that an activity would be
uninteresting for them, without going into details as to why
(Q1.2). One participant who said she was too anxious for
meditation referenced an alternative activity that would work
better for her, playing soccer (Q1.1). Another participant
reflected on a writing-based PPI, saying that she did not have
“a talent to write stories like that” (Q1.3). Participants
commented positively on PPI, which allowed them to use what
they saw as personal strengths (Q1.4).
Q3.1: Healing Through Writing:
I personally don’t think this intervention fits to me
because I personally am too anxious for meditation.
I mean, the goal is to relax, right? I can relax better
when playing soccer, or something like that,
afterwards I am calm, relaxed.
Q1.2: Nonjudgmental Reflection:
What hurt me? That sounds contra-productive. You
are supposed to really think deeply about something
that hurt you, and really immerse yourself in that
pain? Fuck that shit. I don’t want that—I really don’t
want to put a magnifying glass on that. If someone
would say, ok, please write this down, then I’d say,
piss off, easy as that.
Q3.2: The Best Possible Self:
I’m just feeling that my memory of my “best self”
from the past could lead to the thought that this good
time is now over and that I’ve lost something positive.
If the response to that would be a clinging to the past,
then I don’t think that would be good.
Q3.3: Daily Motivational Awareness:
What if nothing motivates me? So, what if I do things
only because I must do them, but beyond that I cannot
find a reason for it? Realizing that would be really
depressing for me.
Q3.4: My Gravestone:
It’s as depressing as it sounds. You put all the focus
on dying. I don’t want to think about that. I mean, I
understand—it’s supposed to create perspective, ok,
but—what I would end up thinking about is
dying—and that’s just depressing.
In summary, our participants discussed the risk of interventions
failing them, either because the intervention itself may be too
complicated or because other factors outside of the intervention
may not manifest as they should. They also spoke about the
issue of negative emotions being triggered by PPIs. Wider
implications of this theme are discussed in the Discussion
section.
Theme 3: The Impact of Personality and Modality
This theme deals with individual factors in relation to PPI, that
is, factors that are highly subjective, differ between people, and
are rooted in tastes and preferences. There are 2 subthemes: (1)
impact of personality differences on PPIs and (2) role of
modalities within those interventions.
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Q1.1: Gratitude Meditation:
You know me (name redacted), I don’t need to try this
to know that I wouldn’t enjoy this crap at all. Nothing
about this is even remotely interesting for me.
Q1.3: You, At Your Best:
I didn’t particularly like this, because not everyone
got a talent to write stories like that; I mean, to
formulate this properly (...) I wouldn’t have the
patience to sit down, pick something and write it out.
For other people this could work, if they had the time
and inclination, but for me, or even for most people
maybe, this wouldn’t work.
Q1.4: Gratitude Journal:
Reading an intervention and seeing that it plays off
something I’m already good at definitely makes it
more likely for me to try it out. The intervention itself
may already be difficult, without me having to deal
with something I’m bad at on top of that. For example,
I just don’t like to write, I’m not good at it, and it
frustrates me. So why would I pick an intervention
that forces me to write, instead of doing something
I’m good at and enjoy?
(2) Role of modalities: Participants commented predominantly
negatively on writing-based activities, stating that they would
rather avoid this modality if possible (Q2.1 to Q2.2). Conversely,
music (Q2.2) and photography (2.3) were commented on
positively. In relation to music, one participant stated that “when
(she) feels bad, (she) listens to music anyway” (Q2.2). In relation
to photography, it seemed more important to one participant
that there would be some visual options, “doesn’t matter if
photos or videos, but something visual would be great for me”
(Q2.3).
Q2.1: Reframing Critical Self-Talk:
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What I like about this one—at least you do not have
to write anything—always all this writing with these
exercises. This shows, it doesn’t have to be writing
all the time, you only need to think about it in this
exercise, that’s much more pleasant—and if I want
to write it down, then I can still do that.
Q2.2: Using Music to Express Feelings:
Finally, an intervention that fits to me—When I feel
bad, I listen to music anyway—and usually it ends up
helping me. I was asking myself when finally, an
intervention comes up that I like, most things are just
about writing.
Q2.3: Using Photography to Increase Savoring:
Photography would be fun for me—that seems like a
great way to store positive memories—doesn’t matter
if photos or videos, but something visual would be
great for me.
In summary, attitude toward PPIs seemed predicated on personal
preferences and strengths, partially in relation to personality
and partially in relation to which modalities were dominant in
a PPI. Writing components were especially criticized.
Discussion
Context
As described in the beginning, previous research had identified
a lack of engagement from young people with digital
instantiations of PPI and proposed to explain this through how
PP principles are usually instantiated digitally, that is, with an
overreliance on static context, such as written text. We
investigated whether the lack of engagement of young people
with digital instantiations may also be rooted in the underlying
intervention principles, from which the digital instantiations
PPI are derived. The findings of this study support this
assumption; we will now discuss the findings in more detail.
Principal Findings
Steps 1 and 2 of the workshop both explored participants’
attitude toward PPI, part of which was the quantitative rating
of interventions and part of which were the qualitative
statements about interventions. Both lines of inquiry converged
toward the following notable insights.
Youth cultures may inform participants’ attitudes toward a PPI,
which became visible when values and norms of our participants
came into conflict with values and norms embedded in a PPI.
Special concern was given to authenticity and a notable aversion
toward PPIs that enforced docile behavior or that pathologized
what our participants categorized as normal behavior. Our data
suggest that young people should have a significant choice when
it comes to when to apply which PPI, including how to shape
the PPI to make it more appropriate for their context.
Young people may see PPIs as potential sources of negative
emotions. If they feel that a PPI is too difficult—either
inherently or made too difficult by too ambitious goals—then
that may become a red flag that keeps young people from
engaging with the activity. Further, components in some PPIs
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may become triggers for negative emotions, for example, a
reflection PPI that may bring up negative memories. PPI
instructions so far do not seem to take this possibility into
account, at least not to a degree that our participants saw as
sufficient. Research into how to safeguard PPIs from
inadvertently becoming triggers for negative emotions—that
is, which kinds of components most likely could become
triggers—seems necessary. If we knew which interventions
have a higher likelihood of triggering negative emotions, we
could, for example, amend them with a suitable warning or not
give them out to young people who are, at that point, not stable
enough.
Individual preferences had a major impact on young people’s
attitudes toward interventions. When talking about what they
thought about interventions, our participants did so mostly in
relation to their own preferences and interests. Although some
preferences or aversions were more prevalent than others—for
example, a general disdain for writing-based activities and
preference for visual- and audio-based instantiations—there
was an overall notable diversity in what young people felt
appropriate for themselves. This diversity means that there
cannot be a one-size-fits-all approach to youth mental health
promotion. Instead, choice and customization may be the most
relevant goals in any attempt to proliferate digital instantiations
of PPI among young people. This may be especially relevant
as the cultural context in which an intervention is first validated
may not translate to another context, for example, Gratitude
interventions have not yet been validated with German youth.
One promising way of approaching the complexities of
individually varying interests and preferences may be found at
the intersection of mental health and games research. Fleming
et al [27] have developed a taxonomy of predispositions with
which young people approach mental health tools, differentiating
between players or gamers, that is, those from whom fun had
the highest priority; engagers, that is, those for whom support
to their well-being had the highest priority but who are open to
gamified approaches; skeptics, that is, those who do not see
value in digital interventions; and Straight-talkers, that is, those
who explicitly do not want any gamified content in their mental
health applications. Building on taxonomies like this would
allow the creation of more focused strategies, such as how to
best address engagers, instead of just aiming at young people
in general.
Several issues brought up by our participants further intersect
with ongoing discussions of PPI and underlying intervention
principles; we have addressed these issues in the following
sections.
PPIs and Failure
Our participants were concerned about PPIs potentially making
them feel worse, not better. Three possible reasons for this were
given: the intervention itself being too difficult, for example,
having too many steps; other people responding negatively, for
example, an apology being rejected; and interventions triggering
negative emotions, for example, by invoking problematic
memories.
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The literature on a PPI backfiring, as other researchers have
called it [28], is sparse. Gratitude interventions were
demonstrated to sometimes trigger feelings of “obligation,
indebtedness, embarrassment, awkwardness and guilt” in a 2017
study in the United Kingdom [12]. There have been concerns
that failing at a PPI may, for people with depression, result in
a feeling of failure and give them “further evidence that they
are defective” [28]. One PPI discussed during the
workshop—Healing Through Writing—asks the person to reflect
on a particularly painful memory. However, a 2009 study in the
Journal of Abnormal Child Psychology has demonstrated that
these types of memories are potential triggers for suicidal
ideations in urban youth [29].
Beyond that, there is limited research on PPI backfiring. There
are 2 possible reasons for this lack of research. First, it could
be that PPI rarely go wrong and that our participants were overly
cautious of something that in reality does not significantly factor
into the application of PPI. If so, then our data at least suggest
that the concern of PPIs backfiring is present among young
people, which in turn means that PPI instructions should address
it. Alternatively, the lack of research into PPI failing may also
be an artifact of publication bias; it is possible that PPI studies
that encounter significant issues only rarely make it to print.
We are not able to say which of those is the case but suggest
that it warrants further investigation.
Faithfully Translating PPIs for Digital Platforms
The shortcomings of PPIs with regard to individual preferences
and modalities line up with the aforementioned study on PP
apps for young people [20], which showed an overreliance on
static text and writing and a lack of customization for young
people to shape interventions according to their own preferences
and strengths, in contrast to what young people expect from
digital instantiations [19]. The researchers attributed these issues
to technology design, saying that “the design of these
technologies needs to be more closely oriented to what young
people are actually interested in” [20]. Although we do not
disagree with this assessment, our study indicates that the issue
is rooted in a deeper level. The overreliance on text and lack of
customization may not per se be a consequence of an
insufficiently ambitious design but instead may be a
consequence of faithfully instantiating PPI principles into a
digital context.
The impact of personal preferences on effectiveness is
increasingly recognized in PP research. The Person-Activity
Fit (PAF) model describes how the overlap between person
features, such as preferences and strengths, and intervention
features, such as dosage and variety, impact how well a PPI is
performed, which in turn impacts the subsequent well-being
increase [13]. Both previous research on digital instantiations
of PPI principles for young people [20] and our research
presented in this paper suggest that PAF between young people
and PPI principles may be overall low, at least with regard to
how PPI are currently being delivered, in both digital and analog
formats.
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Design Implications
Instantiating conventionally text-based PPI for a digital platform
could mean an opportunity to reinterpret these interventions to
better fit with expectations and needs of young people across
various cultures and subcultures. Activities in conventional PPI
are mostly predicated on paper, pens, and the material
constrictions they come with. For example, a conventional diary
entry would not allow a young person to just sit in front of a
piece of paper and talk about what is on their mind. For a digital
diary, however, accommodating verbal speech is trivial, opening
the diary activity to young people who have less affinity to
writing. Furthermore, worksheets accompanying PPIs usually
present one way of approaching an activity, for example,
providing a table and asking the person to fill it in. Digitally, it
is possible to provide a range of options to accommodate
differences between young people and allow them to choose.
As stipulated by Michel et al [20], there is no technological
barrier to replacing writing with audio or video recording and
to integrate more interactive modalities into all types of
evidence-based PPI. Doing so may help to resolve engagement
issues with PP apps for young people. However, we cannot
simply take, for example, Gratitude Journal; replace its writing
components with audio; and assume that its existing evidence
base is not impacted by this translation.
The reason why addressing individual preferences and
modalities in the context of new digital instantiations of PPI for
young people is nontrivial is intimately entangled with one of
the most significant gaps in PP research, as has been pointed
out from inside the field [30] and from outside of it [28]: a lack
of verified mechanisms of action (MOAs). Ideally, MOA would
tell us what aspects of a PPI contribute to its effectiveness,
which in turn would allow us to translate the PPI more
confidently to best fit the diverse audiences and types of
platforms, without the risk of losing the effectiveness of
interventions. Unfortunately, most MOAs for PPIs are only
speculative [24]. For example, Gratitude Letter is the most
effective intervention within PP [24]; the activity usually
consists of writing a letter to a person you are grateful for and
then delivering that letter. However, we do not know if it makes
a difference (1) to write the letter by hand or digitally; (2) to
deliver it in person or via email; (3) to extend the letter with
images, videos, audio recordings, or other multimedia; or (4)
to craft the letter entirely as an audio recording or a video log,
etc. Although Gratitude Letter is a widely used successful
intervention, we do not know enough about it to confidently
instantiate it digitally without losing its effectiveness.
Overall, to address the issue of young people’s lack of
engagement with digital instantiations of intervention strategies,
extensive further research is necessary. This includes facilitating
the creation of culturally appropriate intervention strategies,
exploring risks, and safeguarding strategies relating to PPI and
further research into the MOA of the PPI, for example, via
microrandomized trials [31]. This will allow us to preserve the
evidence base of the established PPI while translating them into
engaging, mental health–promoting digital experiences for
young people. We have seen young people been able to express
their needs and wants very clearly, which further emphasizes
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the role of co-design workshops as a primary mechanism to
create digital interventions [32].
individually and in writing, but the setting may have still
influenced their responses.
PP and the Tyranny of the Positive Attitude
Furthermore, although PP is generally considered useful for
anyone regardless of underlying mental health problems,
previous experience with mental health problems may skew
someone’s opinion toward PP. We did not evaluate the mental
health status of our participants. As they all have been from the
same class and thus share an environment for long periods, it
is possible that shared stress factors may have impacted their
attitude as a whole in a way that would not show up in another
sample from another school.
Some criticism during the workshop was directed at what our
participants felt was too much focus on positive emotions within
the PPI they were shown. This criticism mirrors a larger
discussion of what has been coined Tyranny of the Positive
Attitude [33,34], a perception that PP attempts to ignore negative
emotions despite their importance to a well-balanced psyche.
It is not entirely clear how justified this perception was. In 1990,
around the time the modern school of PP was born, Seligman
[35] wrote about the importance of negative emotions and the
dangers of overly focusing on the positive. In 2016, PP’s
(current) second wave made an explicit effort to conceptually
integrate negative emotions, trauma, suffering, mortality, and
adversity into a larger positive framework [36]. Thus, there
seems to be some disconnect between the theoretical
underpinnings of PP, which long recognize and appreciate the
nuanced relevance of negative emotions, and the perception
that negative emotions are pushed aside in PP, as in our
workshop. A possible explanation could be that our participants
responded to individual PPIs, not PP overall. Although the field
of PP integrates negative emotions, individual PPI may appear
to be overly focused on positive emotions. Our workshop
suggested that some young people may respond distinctly
negatively to those PPIs. Meanwhile, some PPIs that did have
their focus on integrating negative emotions, such as Healing
Through Writing, were criticized as potentially triggering
negative emotions (theme 2). Preference toward one or the other
may be a matter of individual differences. We suggest that
similar future studies with young people include an explicit
discussion of happiness to prime aspects of the (presumably)
less intuitive notion of eudemonic happiness.
Limitations
We will now address some limitations of this study, with regard
to the role of our setting (ie, a school), our participants (ie,
classmates from largely shared environments), and how we
exposed them to PPI (ie, through descriptions of activities, not
the activities themselves).
This paper is based on one workshop with 30 young people
from a specific area in Germany; both the number of participants
and their cultural context limit the extent to which our findings
generalize. Instead, our data serve as a starting point for future
explorations into other groups and cultures of young people.
Our specific setting (ie, in-class workshop) may have been
impacted by peer pressure, for example, of not speaking too
positively about some kinds of PPI. As the individual ratings
from step 1 aligned with opinions expressed during the group
discussion in step 2, we do not expect peer pressure to have had
a big impact; however, it could have skewed the group
discussions. Responses to intervention principles such as
kindness, gratitude, and forgiveness, while being around
classmates, could have been skewed by teenagers attempting
to manage their identity within their social group, for example,
trying to conform to gender stereotypes. To alleviate the impact
of this, we started with participants responding to PPI
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In addition, we noticed during the analysis that many of our
participants criticized interventions for not taking negative
emotions into account. PP overall recognizes the importance of
negative emotions, and when we introduced the topic to our
participants, we explained this. However, they still evidently
felt that the specific interventions they discussed did not
sufficiently account for negative emotions. A different selection
of interventions with an explicit focus on negative emotions
may have resonated better with our participants.
Finally, our participants responded to instructions for PPI, not
to first-hand experiences of applying the PPI. It is almost certain
that actively applying the PPI would have impacted our
participants’ opinions, although it is less certain in which way.
For example, when our participants reflected on whether they
expected a PPI to help them, their answers were speculative and
not necessarily rooted in experience. The attitudes they
expressed may not predict if and how they would perceive these
interventions in a real-world setting; they might, however,
indicate the willingness to try or reject similar intervention
strategies outright.
Conclusions
To make PP useful for young people, we need to find ways to
present the interventions as being suitable for the culture and
context of young people, be aware of their degree of difficulty,
and find ways of aligning interventions with young people’s
personalities and strengths. These adjustments seem to be
necessary if we expect young people to engage with digital
instantiations of PPI principles. Across all our findings, there
was a need for customization and choice. It is possible for young
people to select and choose which interventions they feel are
most useful to them and to further shape these interventions to
their own needs, strengths, interests, backgrounds, values, and
context in general. Digital technologies are uniquely suitable
to facilitate this kind of freedom; but, as past research has
shown, they are not yet delivering on it. Future research needs
to identify on a more granular level how components of PPI
interact with different types of young people’s personalities,
interests, and strengths, to allow the design of useful and
engaging platforms, which offer young people both the
necessary freedom and scaffolding to create individually ideal
PPIs. Specifically, we would like to see more research
identifying the MOA of interventions and how these
mechanisms may be expressed on digital platforms. If these
insights would exist, it would become possible to systematically
create digital interpretations of interventions, flexible to
JMIR Hum Factors 2020 | vol. 7 | iss. 4 | e21145 | p. 15
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individual needs and preferences of young people, while
Michel et al
preserving their validated effectiveness.
Acknowledgments
This research has been funded by European Union’s Horizon 2020 research and innovation program under the Marie
Skłodowska-Curie grant agreement No. 722561.
Conflicts of Interest
None declared.
Multimedia Appendix 1
Data showing the relationship between fit, expectation, and inclination, as indicated by the Likert scale rating during step 1 of
the research phase.
[XLSX File (Microsoft Excel File), 15 KB-Multimedia Appendix 1]
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Abbreviations
MOA: mechanism of action
PAF: Person-Activity Fit
PP: positive psychology
PPI: positive psychology intervention
Edited by B Price; submitted 06.06.20; peer-reviewed by G Wadley, A Fitzgerald, H Thabrew, M Brown; comments to author 07.07.20;
revised version received 29.09.20; accepted 06.10.20; published 09.11.20
Please cite as:
Michel T, Tachtler F, Slovak P, Fitzpatrick G
Young People’s Attitude Toward Positive Psychology Interventions: Thematic Analysis
JMIR Hum Factors 2020;7(4):e21145
URL: http://humanfactors.jmir.org/2020/4/e21145/
doi: 10.2196/21145
PMID: 33164908
©Toni Michel, Franziska Tachtler, Petr Slovak, Geraldine Fitzpatrick. Originally published in JMIR Human Factors
(http://humanfactors.jmir.org), 09.11.2020. This is an open-access article distributed under the terms of the Creative Commons
Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction
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