From leadership research to district action: School nurses’ perspectives on key features of a mobile app to support early identification of adolescent mental health problems: a qualitative study

AI-assisted editorial implementation guide. Proposed district actions are separate from the original authors’ findings and recommendations. Independent peer review of this guide is not asserted.

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Evidence and transfer

Education-related source: verify which participants, institutions and outcomes were actually studied before district adoption. Source publication type: research-article. License and identity checks do not establish study quality or causality.

Original authors’ abstract, reproduced under the source license:

Background Adolescent mental ill health is increasing globally and in Sweden, with rising levels of stress, anxiety, depression, and sleep problems. Many adolescents do not seek help due to stigma, fear of judgement, and limited mental health literacy. School nurses play a key role in early identification and preventive support. Digital tools may complement relational nursing practices and lower thresholds for help-seeking, but little is known about what features school nurses consider feasible and useful in their daily practice. Objective To explore school nurses’ perspectives on key features and content of a mobile app intended to support early identification and management of mental health problems among high school students. Methods An exploratory qualitative study was conducted using semi-structured interviews with ten school nurses working in upper secondary schools. Interviews were held via Zoom, transcribed verbatim, and analysed using reflexive thematic analysis (RTA). COREQ guidelines informed the study’s design and reporting. Results Two overarching themes emerged. First, Fostering mental wellbeing: the school nurse as a trusted ally in a complex world highlighted how early identification often relies on relational continuity, trust, and interpretation of indirect indicators such as somatic complaints or behavioural changes. Second, Nurturing minds: the digital dance of support and solitude reflected nurses’ belief that a mobile app could support time management, self-regulation, psychoeducation, and accessible communication. Feasibility, however, depended on safeguarding confidentiality, maintaining professional boundaries, preventing workload escalation, and managing the “anonymity paradox,” in which anonymity can both facilitate disclosure and hinder safe escalation. Conclusions School nurses perceive that a mobile app could complement face-to-face care by supporting early identification and self-management among adolescents. Successful implementation requires aligning digital features with relational nursing practice, ensuring ethical governance, and integrating clear escalation pathways. Thoughtfully designed mHealth solutions have potential to strengthen preventive mental health support within school health services. Clinical trial number Not applicable. Supplementary Information The online version contains supplementary material available at https://doi.org/10.1186/s12912-026-05302-7. What does this paper contribute to the wider global clinical community? 1. Even though school nurses already use different tools and methods to address mental ill health, they still require more information, tools and methods to be able to meet the needs of today's adolescents 2. A digital intervention in the form of a mobile app with various features, including for example interaction with students, self-management and information about habits was considered a helpful way forward. 3. A digital intervention addressing mental ill health is not a novelty but, as far as we know, there is no other digital intervention available for school nurses in their work with mental ill health that includes interactions with the student and other features to support mental health. Supplementary Information The online version contains supplementary material available at https://doi.org/10.1186/s12912-026-05302-7.

Study methods

School principals were contacted via purposive and snowball sampling to reach upper secondary schools in Stockholm and nearby counties that varied in organisational and demographic characteristics. After principals granted permission, school nurses received written study information and informed consent forms. Ten school nurses agreed to participate.

Limitations

A key strength is the explicit theoretical framing (relational technology; logic of care) and the RTA approach, which clarifies assumptions and supports coherent interpretation [20]. The qualitative, context-bound design (Swedish school healthcare services) may limit transferability, and the study did not assess clinical efficacy or long-term outcomes. Engagement dynamics and the perceived acceptability of digital support may differ across settings, particularly in jurisdictions with varying data protection requirements, service delivery models, and levels of digital infrastructure, which may influence both implementation and use of digital mental health support.

A 90-day district inquiry

Days 1–15 · Appraise. Read the source methods, recruitment, comparator, outcomes and limitations. Record how the study setting differs from your district and which claim the design can support.
Days 16–30 · Design. Choose one school improvement question with teachers. Protect a short shared planning cycle, agree an instructional change and use a common rubric for examining student work. Agree participation, privacy protections, baseline and stopping rules before starting.
Days 31–60 · Observe. Collect the pre-agreed measures, keep a log of implementation changes and invite confidential voluntary feedback. Preserve existing support for staff and learners.
Days 61–90 · Decide. Review implementation fidelity, teacher time and independently scored student work against a recorded baseline. Examine access differences and competing explanations before attributing changes to leadership. Make a dated decision to stop, revise or extend the inquiry.

Board decision brief

Present the local problem, source setting, evidence limits, intervention, responsible owner, total cost, measured changes and uncertainty. Separate staff perceptions, implementation measures and student learning outcomes.

Attribution and reuse

Elin Holmgren Celander; N. Gårevik; Zarina Nahar Kabir; Lisa Ring; Lise-Lott Rydström. School nurses’ perspectives on key features of a mobile app to support early identification of adolescent mental health problems: a qualitative study. BMC Nursing (2026-08-29). https://doi.org/10.1186/s12912-026-05302-7

Prepared 2026-11-07. Source authorship and DOI are preserved. The abstract and source passages are attributed extracts; this editorial guide is offered under the same CC BY 4.0 license.