Abstract
Queer tertiary students are more likely than their cisgender heterosexual peers to experience mental health difficulties, and more likely to seek help for these challenges. However, there are few mental health interventions tailored to this population. To address this gap, I investigated the experiences of queer tertiary students in Aotearoa to address three key aims: 1) to gain feedback on an generic online mental health intervention, Rel@x, and 2) to inform the development of QRelax, a queer-specific adaptation of Rel@x, and 3) to then undertake an evaluation by queer tertiary student users to determine the acceptability of QRelax among this population. Using reflexive thematic analysis, I performed four analyses on data from queer tertiary students recruited into focus groups and interviews across two studies. In analysis one, there were three themes about mental healthcare experiences: i) I can do this on my own, but others should seek help; ii) you have to be lucky to access mental health care; and iii) “therapists just need to be a bit more like up with the programme”. In analysis two, there were three themes about participants’ challenges being queer: i) “that’s not feminine enough”: the impact of societal ideologies on queer students; ii) “there’s one rainbow person in the room”: tokenism, social isolation, and then finding community; and iii) “you know what it’s like to not be heard”: the transformation of challenges into strengths. In analysis three, there were four themes about developing a queer-specific mental health intervention: i) design features must be relevant; ii) engaging and retaining users; iii) ethics and management of personal information; and iv) marketing of online interventions. The findings from these first three analyses informed the development of QRelax. Queer tertiary students were then invited to trial QRelax and contribute to the evaluation analysis addressing acceptability in another set of focus groups and interviews. The three themes about the acceptability of QRelax were: i) QRelax taught and reinforced lifelong mental health skills; ii) QRelax is safe for queer students, but may not be accessible to all; and iii) QRelax was the start of a mental health journey. This body of research achieves two main outcomes. Firstly, it provides support for QRelax being a helpful tool for addressing the mental health needs of queer tertiary students and highlights the importance of adapting online mental health interventions to this population. Secondly, it also informs mental healthcare services for tertiary students by highlighting systemic issues that negatively impact queer tertiary students and shows how these students apply meaning to their challenges, which can be leveraged in improving the wellbeing of this population. Overall, the research presented in this thesis points to the need for further development of online mental health interventions for queer tertiary students such as by exploring transdiagnostic treatment targets, different treatment modalities, cultural nuances, and addressing user uptake.