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Abstract

Background

This study examines the subjective well-being of school-aged learners in Gauteng, South Africa, and their perceptions of using mobile health (mHealth) tools for digital journaling. The aim of this study was to identify the perspectives of learners with disabilities on the requirements for digital journaling to promote subjective well-being.

Methods

A qualitative descriptive research design was employed. Semi-structured interviews were conducted with 20 learners aged 11 to 14 years from a school for learners with learning disabilities in Gauteng, South Africa. Participants were selected using a purposive-convenient sampling method.

Findings

The findings revealed that subjective well-being encompasses social, cognitive, psychological, and physical well-being. Participants highlighted the potential of mHealth tools to enhance communication between learners and parents. The content for digital journaling preferred by participants included psychological, cognitive, and physical well-being. Desired features for the digital journal included personalisation, advice, dialogue, and reminders. Preferred formats for input were writing, typing, videos, and reading.

Conclusions

Further research is necessary to investigate the implementation and effectiveness of these tools in educational settings.

Keywords

subjective well-being mHealth tools digital journaling qualitative research parental involvement health communication

Introduction

Learners with physical (cerebral palsy, spina bifida, and spinal muscular atrophy) and learning disabilities (dyslexia, ADHD, and ADD) experience various barriers to teaching and learning practices in the classroom.¹ These barriers to learning can be attributed to access to school facilities, the school’s culture of inclusion, policies that promote the participation of learners with disabilities in the school, an inclusive curriculum, teaching methods, seating arrangements, and interaction between learners, peers, teachers, and school management.² Even though these barriers can be mitigated through resources within the school and community (physical, financial, human, and political), these resources are often not applied adequately, which may impact the subjective well-being of learners with disabilities.^2,3

Subjective well-being refers to how individuals evaluate their lives, encompassing emotional reactions and cognitive judgments.^4,5 This multidimensional concept includes (i) psychological well-being which refers to the full engagement in life’s challenges and opportunities, incorporating autonomy, personal growth, navigating the environment, meaning, positive relations with others, and self-acceptance; (ii) social well-being is founded on relationships and assesses the conditions of the community, culture, and individual functioning within society; (iii) cognitive well-being refers to skills such as academic proficiency, collaboration, critical thinking, and application of academic skills to function independently in society; and (iv) physical well-being refers to health conditions, physical exercise, and a healthy diet.^3,5,6

Mobile health (mHealth)-based digital journaling can enhance the well-being of learners with disabilities by providing accessible, multimodal tools for self-expression and emotional regulation.⁷ Features such as voice-to-text, mood tracking, and customisable interfaces cater to diverse needs, while secure data storage ensures user privacy.8 Optional sharing with educators or clinicians enables personalised interventions.⁹ Research indicates that digital health interventions yield positive emotional and cognitive outcomes,⁷ and mental health apps incorporating cognitive behavioural therapy principles have been shown to reduce anxiety and depression.¹⁰

This study focused on using the PicPecc app as an mHealth tool and its potential for digital journaling. The PicPecc app was identified through previous research conducted by Johnson et al.¹¹ and Wiljén et al.¹² This app is an mHealth tool designed to help young people with disabilities communicate their well-being using visual symbols and personalised features, reducing barriers to self-expression and improving care coordination. Research on mHealth-based digital journaling for learners with disabilities is vital because it addresses health disparities and improves access to mental health support. Learners with disabilities often face barriers to traditional care, leading to poorer outcomes.¹³ Evidence shows digital health interventions improve emotional, cognitive, and social well-being, promoting inclusion and quality of life.⁷

Using mHealth-based digital journaling may enhance learners’ autonomy in their person-centred care, allowing them to choose whether to share their stories, monitor their mental and physical health outcomes, and receive socio-emotional support. Learners with disabilities often experience social isolation and struggle to maintain friendships.¹⁴ Digital journaling can facilitate social well-being by providing a platform for joint problem-solving, apology letters, and descriptions of feelings and events that learners can choose to share.¹⁵ Additionally, mHealth-based digital journaling can also facilitate physical well-being. Learners with disabilities often encounter motor, cognitive, linguistic, and sensory barriers to learning, which can impact their reading, spelling, and writing abilities.¹⁶ mHealth-based digital journaling could therefore be used to compensate for learning and physical disabilities by using speech-to-text, videos, pictures or photos to represent their thoughts. This could increase their motivation to continue using the mHealth-based digital journal and reduce device abandonment.^17,18

This study employed Büchi’s Digital Well-Being Framework as a theoretical framework.¹⁹ Digital well-being can be considered an extension of subjective well-being, indicating that digital well-being plays a role in achieving subjective well-being.¹⁹ The Digital Well-being Framework examines how digital media practices impact individuals’ subjective well-being within a socio-technical context. It considers the balance between the benefits (e.g., stress relief, self-awareness, and positive mood enhancement) and harms (e.g., overuse and privacy concerns) of digital media use. The Digital Well-Being Framework advocates for user-centric digital practices that cater to individual needs and promote well-being. Büchi’s framework emphasises the importance of descriptive validity and the necessity of formal theories to comprehend the causal relationships between digital practices and well-being. Figure 1 illustrates an adapted digital well-being framework, which is based on Büchi¹⁹ and Kaya and Erdem.⁵ For this study, the digital framework will be integrated with the conceptualisation of subjective well-being.

Figure 1.

Digital well-being framework (adapted from Büchi¹⁹ and Kaya and Erdem⁵).

Method

The aim of this study was to identify the perspectives of learners with disabilities on the requirements for mHealth-based digital journaling (PicPecc app) to promote subjective well-being. This study employed a qualitative descriptive research design, using semi-structured face-to-face interviews with 20 learners with disabilities. The learners were between 11 and 14 years old and were receiving teaching and learning at a school for learners with learning disabilities in Gauteng, South Africa, during the time of data collection.^20–22

Sample and setting

A purposive-convenient sampling method was employed to select 20 school-aged learners, aged 11 to 14, from a school for learners with learning disabilities in Gauteng, South Africa. This school is a public institution situated in a semi-urban area of Gauteng, serving approximately 800 learners, including those with physical and learning disabilities. Additionally, at this school, a mainstream curriculum is followed from Grade 1 to 12, indicating that all learners, regardless of their disability, demonstrate English language proficiency in speaking, writing, and reading at a Grade 1 level. This school was selected based on convenience, as the first author was employed at the school. The first author was not familiar with the participants, and gatekeepers (teachers) identified potential candidates. Gatekeepers received a checklist consisting of specific inclusion criteria. The inclusion criteria consisted of: English language proficiency in reading, speaking and writing at a Grade 2 level, and ages between 11 and 14 years old. None of the learners experienced communication difficulties or sensory difficulties. The authors acknowledge that the findings drawn from this population may only be generalised to the population from which the sample was conveniently drawn. As such, generalisability to the larger population should be done with caution.²³

Participants

Table 1 presents the demographic details of the participants, who were Grade 4-6 learners at a school for learners with learning disabilities in South Africa. The average age was 12.3 years, with a range of 11 to 14 years. The group consisted of 10 male and 10 female learners. Most participants were in Grade 5 (65%), followed by Grade 6 (25%) and Grade 4 (10%). All participants were proficient in English (n = 20). The first languages of the learners included Afrikaans (40%), English (30%), isiZulu (25%), and Sepedi (5%). Of the sample, most learners had a learning disability (n = 17), specifically dyslexia, and three learners had a physical disability consisting of spinal muscular atrophy (n = 1), spina bifida (n = 1), and Marfan syndrome (n = 1). Among the participants, 18 owned a smartphone, while two did not. One used their uncle’s phone, and the other used their mother’s. Most learners (n = 13) believed that mHealth tools could be used for digital journaling, with six mentioning that these applications could not be used, and one participant was unsure by stating ‘maybe’.

Table 1.

Participant demographic information.

Participant number	Age	Gender	Disability	Grade	First language	Other languages	Digital journaling
P1	12	M	Learning (Dyslexia)	5	Afrikaans	English	No
P2	13	M	Learning (Dyslexia)	5	Afrikaans	English	No
P3	11	F	Physical (Spinal muscular atrophy)	5	Sepedi	Afrikaans, English	Maybe
P4	12	F	Physical (Spina Bifida)	5	IsiZulu	English	No
P5	11	M	Learning (Dyslexia)	5	English	Afrikaans	No
P6	12	F	Physical (Marfan syndrome)	5	Afrikaans	English	No
P7	12	F	Learning (Dyslexia)	5	Afrikaans	English	No
P8	12	F	Learning (Dyslexia)	5	Afrikaans	English	No
P9	13	M	Learning (Dyslexia)	4	Afrikaans	English	No
P10	12	M	Learning (Dyslexia)	5	English	IsiZulu, Sotho	No
P11	12	M	Learning (Dyslexia)	5	IsiZulu	English, Tshivenda, Sotho	No
P12	13	M	Learning (Dyslexia)	6	IsiZulu	English, Afrikaans	No
P13	13	M	Learning (Dyslexia)	6	IsiZulu	English	No
P14	13	F	Learning (Dyslexia)	6	English	Afrikaans	No
P15	13	F	Learning (Dyslexia)	5	English	Afrikaans	Yes
P16	13	M	Learning (Dyslexia)	4	Afrikaans	English	Yes
P17	12	F	Learning (Dyslexia)	6	English	Afrikaans	Yes
P18	12	F	Learning (Dyslexia)	5	IsiZulu	Sotho, English	Yes
P19	11	F	Learning (Dyslexia)	5	English	None	Yes
P20	14	M	Learning (Dyslexia)	6	Afrikaans	English	Yes

Instrument

PicPecc is a pictorial mHealth app designed to support children and adolescents, including those with disabilities, in using accessible visual and auditory cues to self-report symptoms and well-being.¹² The interface features universally designed elements, such as a digital ‘Faces Thermometer Scale’ that combines colour, facial expressions, and numeric ratings, alongside optional text and audio prompts to aid diverse communication needs.¹² The ‘Faces Thermometer Scale’ was validated in studies by Castor et al.²⁴ and Höök et al.^25,26 In a South African feasibility study, 20 children aged 7–18 confirmed the app’s usability and relevance for mental health support within under-resourced contexts.¹¹ A subsequent evaluation involving learners aged 11–14 using the Mobile Application Rating Scale (MARS) found high scores for engagement (4.4/5), functionality (4.7/5), aesthetics (4.7/5), and information quality (4.6/5), reflecting strong reliability and user satisfaction across core dimensions.²⁷

Data collection procedures

Ethics approval was granted by the research ethics committee of the relevant institution (2023/08/10/90537122/50/AM). Additionally, permission was obtained from the Gauteng Department of Education and the school principal. The principal and gatekeepers (teachers) identified 11 to 14-year-old learners who met the inclusion criteria as potential participants. The gatekeepers provided the learners with letters of informed consent for their parents to sign, as well as letters of assent for the learners. Letters of informed assent were simplified, including more pictures than text, to ensure learners understood what was expected of them and voluntarily participated in the study. Upon receiving consent, the parents’ contact details were given to the first author, who then scheduled face-to-face semi-structured interviews at times and dates preferred by the parents. Upon assent and prior to the interview, participants completed a pre-interview questionnaire that covered demographic information and their knowledge of mobile health (mHealth) tools. Prior to the interview, the interviewer presented the PicPecc app to the learners, downloaded on an iPad. The learner explored the PicPecc app for 30 min prior to the interview. Kim et al.²⁸ suggest a minimum of 27 min to trial the app, indicating that even brief exposure can yield initial feedback on app engagement. An interview script, included in Table 2, was used, consisting of open- and closed-ended questions that detailed participants’ perspectives on digital journaling requirements to promote subjective well-being. These interviews were conducted with individual learners in a therapy room at the school, and caregivers were allowed to accompany the learners with physical disabilities. The physical layout of the room was wide enough for ease of wheelchair access (only the P3 participant used a wheelchair). Interviews were approximately 30–60 min in length, respectively. If participants grew tired, they were given a break or the option to continue the next day.

Table 2.

Interview questions.

Number	Topic	Content
1	Introduction	Hi my name is …. and I will be asking you some questions today. Thank you for being willing to talk to me about your experience using the PicPecc app.
2	Ethics	I would like to remind you that you are talking to me today out of your own free will and if you feel tired or uncomfortable, please let me know. We can take a break and continue when you feel ready again.
3	Values	What do you think about mHealth tools such as the PicPecc app?
4		How do you think other people think about mHealth apps?
5		What is important for you regarding your health?
6	Reasons for	Why would you want to use an mHealth tool?
7		What are the reasons that you would use the PicPecc app?
8		Why did you keep on using the PicPecc app?
9		What are the features that made the PicPecc app a great app to use?
10	Reasons against	Why would you not want to use an mHealth tool?
11		What are the reasons that you would not use the PicPecc app?
12		Why did you not keep on using the app?
13		What are the features that are missing in the PicPecc app to make it better?
14	Attitudes toward adoption	What is your general attitude toward starting to use the PicPecc app?
15		What feeling do you get when thinking of the PicPecc app?
16		What is your experience with mHealth apps in the past?
17	Intention to adopt the app	What were your thoughts or intentions when thinking about whether to use the app or not?
18	Intention to adopt the app	What was your goal for using the PicPecc app?
19	Trust in the app	What feature did you mostly use in the PicPecc app?
20		What parts of the app did you trust and made you feel safe?
21		How was the navigation of the app?
22		Did you trust the app more or less over time?
23		Why would you not trust the PicPecc app?
24	Diary	Do you think you can use the PicPecc app as a diary or journal?
25	Diary	How would you use the app as a diary?
26	Content	What ideas would you include in the diary?
27	Content	Why would you add these ideas to the PicPecc app in a diary?
28	Representation	What would you use to communicate your thoughts? For example, pictures, voice recordings
29		Do you think you can add these items to the app?
30		How would you change the app so that you can use it as a diary?
31	Closing	Thank you for participating in this study. Please note I will send you a page with your answers to my questions in a week. Please read through it and send it back to me within a week.

Probing suggestions: trust in capabilities of institution, trust in information quality, and trust in the mobile phone’s capabilities, trust in the institutions involvement, trust in the institutional systems, trust in personal technical literacy, and trust in help desk service (Lovatt et al.¹⁸).

The interviews were voice-recorded, transcribed verbatim, and sent to the learners one week later for member checking. The learners provided minimal critique, confirming that their perspectives were accurately reflected.

Data analysis

For the inductive thematic analysis, the six steps outlined by Clarke and Braun²⁹ were followed: (i) the data were assembled and transcribed; (ii) an initial assessment of codes was made without interpreting the data; (iii) after initial coding and collation, the search for emerging themes began; (iv) all themes were critically assessed to determine if further analysis was needed; (v) the themes and their respective sub-themes were compiled and a thorough analysis of each theme was performed; and (vi) the complete report was compiled. Both authors conducted data analysis independently and then organised a joint meeting to determine the level of agreement. To include the themes, a discussion was held to achieve 100% consensus.

Trustworthiness

Trustworthiness in qualitative research is often evaluated through four key aspects: credibility, transferability, dependability, and confirmability.³⁰ Credibility was maintained in a study using semi-structured interviews by ensuring accurate representation of participants’ perspectives through member checking. Transferability was addressed by providing detailed descriptions of the research context, enabling others to determine the applicability of the findings to their own settings. Dependability was ensured by maintaining a clear audit trail of the research process, including data collection and analysis methods. Confirmability was achieved by triangulating data sources and techniques to reduce researcher bias. Additionally, the researchers regularly reflected on their biases and assumptions, documented these reflections, and considered the impact of these on the research process and findings. This reflexive practice helped to enhance the overall trustworthiness of the study.

Findings

This section presents the study findings in accordance with Kaya and Erdem’s (2021)⁵ description of subjective well-being. Table 3 summarises the findings on participants’ conceptualisation of their subjective well-being and their comments on mHealth-based digital journaling founded on their exposure to the PicPecc app.

Table 3.

Participants’ conceptualisation of subjective well-being.

Theme	Definition	Participant quote
Cognitive well-being	Comprises learners’ skills and foundational abilities, such as proficiency in academic tasks, collaboration, problem-solving, and academic mastery, which are essential for full participation in society.⁴	• If you are sick, you struggle to focus and can’t learn well (P10).
		• I think my health is good (P20).
		• I think it’s fine (P15).
Psychological well-being	Includes active participation in life’s challenges and seizing opportunities.⁴	• To see how I feel (P1; P2)
		• It just feels like all the negatives go out of you, and like it feels like it’s freedom (P15).
		• So that they can understand my feelings (P3).
		• The child’s too scared to tell the parents about his pain (P7).
		• To open your heart to someone (P17).
Physical well-being	Refers to the general health of the person as well as healthy habits such as exercise and dietary changes.⁴	• You have to look after yourself (P4).
		• If they say they’re in pain, they say to ask someone for medicine that helps the child know what to do (P7).
		• When you are sick, you should drink medicine and stay in bed (P16).
		• So, you don’t have to get sick (P6).
		• When I get stressed, I scratch, and then I don’t get sleep. I need more sleep (P17).
		• He feels pain every day because of his condition. And I think because he experiences pain, he is often nauseous (P6).
		• Let’s say the child has an issue of pain that the child feels every day (P7).
		• What if you don’t know you have a bad condition, and your parents don’t know? Let’s say, for instance, it is too late to cure that condition, which worries me and other people (P7).
		• So, it would help the child and the parents to know if the child has a big disease before it's too late for them to know (P7).
		• My health is important. We need to stay alive (P11).
		• Stop eating sugar and salt. Because I generally do the whole day (P14).
		• I exercise a lot and need to be fit (P12; P13).
Social well-being	Refers to engaging in and appraising relationships with others.⁴	Sibling	• I’ll give my brother an example. So, you think he could use an app to tell them he is nauseous and how he feels (P6).
			• Because of my brother, he does not tell my mom and dad a lot about how he feels (P8).
			• To be honest, I am more concerned about my brother’s health because my brother does not talk to my parents about how he feels (P7).
			• Because of my mom, my health, my dad and my brother’s health. And since I have Marfins then I grow and my brother. And my brother has Charcot-Marie-Tooth disease. He always feels pain (P6).
			• Now you’re saying there’s something like that. My brother! The child’s too scared to tell the parents about his pain. The child’s scared to tell the parents because he’s afraid the parents won’t believe him (P8).
		Peer	• Let’s say the child is five and he doesn’t know what to do. He can look at the pictures and choose how he feels. The app can then tell him (P7).
		Peer	• Especially if it’s a small child, they don’t always tell their parents everything (P7).
		Parental involvement	• And my mom and dad don’t know that he feels nauseous.
			• I think I would want to use the app for my sister, my mom and my dad so that they can talk (P3).
			• They can see the app telling them to get help, then the child will ask their parents for help (P7).
			• Let’s say, for instance, the parents don’t know about the child’s pain the whole day (P7).
			• I don’t know if he has the app, but if he does, he’ll take my mom and dad to the app, so they know how he feels (P8).
			• So, parents know that the child needs help because the child uses the app. This app helps them to tell their parents. He would know to ask his parents for help (P7).
			• The child’s too scared to tell the parents because he’s afraid the parents won’t believe him (P8).

Psychological well-being

Six participants (n = 6) mentioned psychological well-being, with Participant 15 stating, ‘It just feels like all the negatives go out of you and like it feels like it’s freedom’. Participants emphasised the importance of understanding and communicating their feelings through the PicPecc app. They highlighted the need for self-awareness and the relief from sharing emotions, describing it as a sense of freedom. Some noted that participants might be afraid to share their pain with parents, emphasising the value of having someone to confide in and open up to. The participants emphasised how beneficial the PicPecc app could be to promote their psychological well-being.

Most participants (n = 16) expressed a desire to incorporate content on psychological well-being into their mHealth-based digital journals. Content included participants’ feelings (n = 11), trauma (n = 1), Disney (n = 1), likes or dislikes (n = 1), wants (n = 1), and secrets (n = 1).

Social well-being

Social well-being was mentioned by most participants (n = 14) and was related to relationships with siblings, peers, and parental involvement. Participants frequently mentioned concerns about their siblings’ well-being (n = 5), emphasising the need for using mHealth-based digital journaling to promote parent-child communication. The participants mentioned that the PicPecc app could be used to improve communication between parents and learners, as learners can use the voice-to-text option, type their message or use visual symbols to express their feelings and show the message to parents on a device. They noted that siblings often do not share their feelings with parents, leading to worries about their well-being. For instance, one participant said, ‘I’ll give my brother an example. So, you think he could use a digital journal to tell them he is nauseous and how he feels’ (P6).

Peer well-being was mentioned less frequently (n = 3), and participants also discussed the role of peers in health communication. They pointed out that younger children may not always express their feelings to their parents, and tools like the PicPecc app used as an mHealth-based digital journal can help facilitate this process. One participant stated, ‘Especially if it’s a small child, they don’t always tell their parents everything’ (P7). The PicPecc developers are creating opportunities for social connectedness as learners registered on the app can access other learners with similar conditions through the database.

Parental involvement was mentioned the most (n = 6). Participants suggested that mHealth-based digital journals could help bridge the communication gap, ensuring parents are informed about their child’s condition. One participant mentioned, ‘So, parents know that the child needs help because the child uses the digital journal. This journal helps them to tell their parents’ (P7).

Participants mentioned that mHealth-based digital journals should provide advice (n = 6) based on the information added by the user, as well as offer a dialogue (n = 3), with some even suggesting that it should sound like someone talking to them.

Cognitive well-being

Participants mentioned cognitive well-being least (n = 3), with Participant 10 stating, ‘If you are sick, you struggle to focus and can’t learn well’. Participants noted that illness can significantly impact their ability to focus and learn effectively. Despite this, some individuals expressed confidence in their current health status, with statements such as ‘I think my health is good’ (P20) and ‘I think it’s fine’ (P15) indicating a general sense of well-being.

Cognitive well-being (n = 7) was also mentioned as an important topic that learners wanted to include in their mHealth-based digital journals. The content included participants’ daily life (n = 4) and school routine (n = 3). Additionally, participants requested that mHealth-based digital journals should allow features such as personalisation (n = 7), reviewing the information participants added to the app (e.g. reading through content) (n = 2), using the PicPecc app as a diary (n = 2) and receiving daily reminders (e.g. notifications) to add content to the mHealth-based digital journal.

Physical well-being

Most participants (n = 13) also mentioned physical well-being, with Participant 11 mentioning ‘My health is important. We need to stay alive’. Taking care of oneself is crucial, as highlighted by participants who emphasise the importance of seeking medicine when in pain (P7), resting when sick (P16), and maintaining healthy habits to prevent illness (P12-14). Stress management and adequate sleep are also vital for well-being. Chronic pain and undiagnosed conditions are significant concerns, underscoring the need for early detection and communication with parents. Maintaining good health through a balanced diet and regular exercise is essential for staying healthy and fit. To compensate for the physical or learning disabilities of learners, they requested that the input for the mHealth-based digital journal include writing (n = 6), typing (n = 6), videos (n = 6), and reading (n = 6). Some participants believed that not all learners can read and write, and the option to draw (n = 4) should be included in a notebook format (n = 3). Participants also requested the inclusion of pictures (n = 2), voice notes, photos (n = 1), and emojis (n = 1).

Discussion

The aim of this study was to identify the perspectives of learners with disabilities on the requirements for digital journaling to promote subjective well-being. The findings highlight the multifaceted nature of subjective well-being, encompassing psychological, social, cognitive, and physical dimensions.^5,19 Additionally, the findings also included participants’ requirements for digital journaling.

Psychological well-being

Psychological well-being was mentioned by participants with a specific emphasis on understanding and communicating feelings. Participant 15 stated, ‘It just feels like all the negatives go out of you and like it feels like it’s freedom’, illustrating the therapeutic potential of mHealth-based digital journaling (PicPecc app). This relief and sense of freedom from sharing emotions align with Büchi’s Framework, which emphasises the emotional benefits of mHealth-based digital journaling (PicPecc app).¹⁹ Psychological well-being was the most desired content for digital journaling, with participants wanting to write about their feelings, trauma, likes, dislikes, wants, and secrets.

Participants highlighted the value of self-awareness and emotional expression in achieving psychological well-being. This suggests that the participants possessed emotional intelligence, enabling them to perceive, manage, and plan their emotions effectively in response to life’s stressors.³¹ A fear of sharing pain with parents was noted, emphasising the need for supportive environments where learners feel safe confiding in others. This is supported by Nukulkij et al.³² who suggest that creating a physically secure environment can have a positive impact on the psychological well-being of learners.

Social well-being

Social well-being emerged as a significant aspect, with most participants emphasising the importance of parental involvement. Participants suggested that using the PicPecc app could bridge communication gaps between parents and learners, ensuring parents are well-informed about their child’s condition. Gahler³³ notes that technology can interfere with parent-child relationships, as both parents and children spend more time on their mobile devices rather than engaging in face-to-face communication. To manage this, Anjum et al.³⁴ mention that mHealth tools can enable parents to manage their children’s screen time and maintain a balance between technology consumption and mindful parenting. Additionally, Tadpatrikar et al.³⁵ mention that maximum family communication occurs through digital tools, but also caution that parents should engage with their children in face-to-face communication and limit technology use to prevent feelings of isolation in their children.

Children place a high value on parental involvement, as this is one of the most important social bonds a person experiences.³⁶ This aligns with Büchi’s Digital Well-Being Framework, which suggests that mHealth-based digital journals can enhance social connectedness and support networks, thus positively influencing subjective well-being.¹⁹ The PicPecc developers are creating opportunities for social connectedness as learners registered on the app can access other learners with similar conditions through the database. For example, Participant 7 remarked, ‘So, parents know that the child needs help because the child uses the app. The PicPecc app can help them to tell their parents’. Shin et al.³⁶ also note that digital technology can enable children to share their stories and feelings with parents, thereby supporting the parent-child relationship regardless of location. Johnson and Rogers³⁷ also mention that digital technology can create communication opportunities for children and parents who are not in the same vicinity.

Siblings’ well-being was prevalent, highlighting the need for communication tools to facilitate emotional sharing within families. PicPecc, an mHealth application employing visual scales (faces, colours, icons), facilitates emotional expression among children who may struggle with verbal articulation. By providing a structured, child-led format for reporting feelings, the tool enhances parental understanding, reduces miscommunication, and fosters empathic engagement. Routine use of PicPecc promotes reciprocal emotional disclosure, normalises affective dialogue, and supports collaborative coping strategies. Longitudinal patterns in reported emotions further enable families to anticipate stressors and engage in proactive communication, thereby strengthening relational closeness and resilience.¹²

According to Bražinová and Caletková,³⁸ sibling relationships are the longest-lasting relationships as siblings spend time together, share living spaces, and have a common history, providing opportunities to develop social-cognitive and behavioural skills that enhance the quality of their relationships. The study participants emphasised their empathy for their siblings and suggested the PicPecc app may improve parent-child communication. This is supported by Bražinová and Caletková,³⁸ who suggest that mHealth-based digital journaling can have a positive influence on family relations. To promote social well-being, participants suggested that mHealth-based digital journals provide advice and dialogues (conversational interface), emphasising the need for social inclusion and interaction.¹⁵

Cognitive well-being

Cognitive well-being was the least mentioned theme, yet it remains an important component of subjective well-being. Participants noted that illness can significantly impact their ability to focus and learn effectively. For example, one participant stated, ‘If you are sick, you struggle to focus and can’t learn well’ (P10), indicating the need for supportive digital interventions, such as the PicPecc app. The Digital Well-being Framework suggests that mHealth-based digital journaling can enhance cognitive well-being by offering resources and strategies to manage health-related challenges¹⁹. Barnett et al.³⁹ suggest that children with health conditions may face challenges in their functional, social, and cognitive capacities. As such, Barnett et al.³⁹ suggest that health conditions can lead to increased school absenteeism, which may impact learning and academic performance. Despite this, some expressed confidence in their current health status, indicating a general sense of cognitive well-being.

Participants expressed a need for personalisation and interactive features for mHealth-based digital journaling. Other requested features included reviewing added information, using the PicPecc app as a diary, and receiving daily reminders to add content. These preferences align with the Digital Well-Being Framework, which advocates for user-centric mHealth-based digital journaling that caters to individual needs and promotes well-being.¹⁹

Physical well-being

Physical well-being was one of the primary topics discussed, with participants emphasising the importance of maintaining good health through a balanced diet, regular exercise, and sufficient sleep. As Participant 11 stated, ‘My health is important. We need to stay alive’, reflecting the critical role of physical well-being in overall life satisfaction. Participants emphasised the importance of early detection of health issues and effective communication with parents. The Digital Well-being Framework supports the latter by emphasising the role of mHealth-based digital journaling in promoting healthy behaviours and facilitating access to health information.¹⁹ Participants further emphasised the need to address chronic pain and undiagnosed conditions. This is supported by Richardson et al.⁴⁰ who suggest that chronic pain can have an impact on social, emotional, and behavioural factors for the child and family. Participants emphasised the necessity of self-care practices, such as seeking medical attention when in pain, resting when sick, and maintaining healthy habits to prevent illness. Stress management and adequate sleep were also highlighted as vital components of physical well-being. According to Skinner et al.⁴¹ coping strategies (stress management, self-care, and healthy habits) may indicate school success and academic functioning through self-control, competence, self-perception, and autonomy.

Regarding digital input methods, participants preferred writing, typing, videos, and reading. Some participants highlighted the need for alternative input methods, such as drawing, especially for those who struggle with reading and writing. Additional inputs, such as pictures, voice notes, photos, and emojis, were also mentioned, indicating a desire for a versatile and inclusive digital journaling tool. This diversity in format preferences emphasises the necessity for flexible and inclusive mHealth-based digital journals that cater to various user abilities and preferences, as highlighted in Büchi’s Digital Well-being Framework.

Limitations

This study, while providing valuable insights into the conceptualisation of subjective well-being and the requirements for mHealth-based digital journals among school learners, has several limitations. The small sample size of 20 learners may not fully capture the diversity of experiences, and the specific geographical and cultural context of the participants may limit the generalisability of the findings. Self-reported data can be subject to biases, and the qualitative nature of the study means interpretations are influenced by researchers’ perspectives. Additionally, the study captures perspectives at a specific time, and the focus on mHealth-based digital journals may not encompass all relevant mHealth digital journaling. Future research should consider larger, more diverse samples, comparative studies across different contexts, triangulation of data sources, involvement of multiple researchers in data analysis, longitudinal studies, and exploration of a wider range of digital tools.

Conclusions

A study on learners with disabilities using PicPecc as an mHealth-based digital journal advances inclusive education by demonstrating how accessible mHealth tools foster emotional expression and self-reflection, supporting Universal Design for Learning principles. These findings inform policy on equitable technology integration and guide developers toward user-centred design that prioritises accessibility, privacy, and engagement. Future research should continue to explore these dimensions and the effectiveness of digital interventions in promoting overall well-being.

Footnotes

Acknowledgements

The authors thank the participants and management of the public school where the research was conducted.

ORCID iDs

Ariné Kuyler

Ensa Johnson

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Declaration of Generative AI and AI-assisted technologies in the writing process

Co-pilot was used to write the abstract of this manuscript.

Data Availability Statement

Authors elect not to share data.*

References

Fernández-Batanero

Montenegro-Rueda

Fernández-Cerero

, et al. Assistive technology for the inclusion of students with disabilities: a systematic review. Educ Technol Res Dev 2022; 70(5): 1911–1930.

Oliva

. Barriers and resources to learning and participation of inclusive students. Psicol USP 2016; 27: 492–502.

Karibaev

Zhumabayeva

Kurbonova

, et al. Subjective well-being among students with disabilities in Kazakhstan: an exploratory study. J Curric Stud Res 2024; 6(2): 88–103.

Diener

Suh

Lucas

, et al. Subjective well-being. Psychol Bull 1999; 125(2): 276–302. https://labs.psychology.illinois.edu/∼ediener/Documents/Diener-Suh-Lucas-Smith_1999.pdf

Kaya

Erdem

. Students’ well-being and academic achievement: a meta-analysis study. Child Indic Res 2021; 14(5): 1743–1767.

Edwards

Byrne

Grace

. Enabling pupils to flourish: six evidence-based principles of whole-school wellbeing promotion. Front Public Health 2024; 12: 1335861.

Kandeel

Morsy

Alkhodair

, et al. Digital health interventions for individuals with disabilities and their impacts on health, quality of life, and social participation. Digit Health 2024; 10: 1–14.

Aji

Gordon

Peters

, et al. Exploring user needs and preferences for mobile apps for sleep disturbance: mixed methods study. JMIR Ment Health 2019; 6(5): e13895.

Turchioe

Myers

Isaac

, et al. A systematic review of patient-facing visualizations of personal health data. Appl Clin Inf 2019; 10(04): 751–770.

10.

Shahsavar

Choudhury

. Effectiveness of evidence-based mental health apps on user health outcomes: a systematic literature review. PLoS One 2025; 20(3): e0319983.

11.

Johnson

Masuku

Nilsson

, et al. The feasibility of the PicPecc application as an mHealth tool: reflections from South African children. Rehab Adv Develop Healt Sys 2024; 1(1): 11.

12.

Wiljén

Chaplin

Crine

, et al. The development of an mHealth tool for children with long-term illness to enable person-centered communication: user-centered design approach. JMIR pediatrics and parenting 2022; 5(1): e30364.

13.

Jones

Morris

DeRuyter

. Mobile healthcare and people with disabilities: current state and future needs. Int J Environ Res Publ Health 2018; 15(3): 512.

14.

Koller

Stoddart

. Approaches that address social inclusion for children with disabilities: a critical review. Child Youth Care Forum 2021; 50: 679–699.

15.

Lara

. Benefits of journal-writing for students in the emotional/behavior disorders classroom. J Poetry Ther 2020; 33(3): 187–193.

16.

Svensson

Nordström

Lindeblad

, et al. Effects of assistive technology for students with reading and writing disabilities. Disabil Rehabil Assist Technol 2021; 16(2): 196–208.

17.

Bauer

Freitag

. Measuring trust. In: The Oxford handbook of social and political trust. Oxford University Press, 2018, p. 15.

18.

Lovatt

Bath

Ellis

. Development of trust in an online breast cancer forum: a qualitative study. J Med Internet Res 2017; 19(5): e175.

19.

Büchi

. Digital well-being theory and research. New Media Soc 2024; 26(1): 172–189.

20.

Canha

Simões

Matos

, et al. Well-being and health in adolescents with disabilities. Psicol Reflexão Crítica 2016; 29: 32.

21.

Chen

Ebrahimi

Cheng

. New perspective on digital well-being by distinguishing digital competency from dependency: network approach. J Med Internet Res 2025; 27: e70483.

22.

Philippe

Sikder

Jackson

, et al. Digital health interventions for delivery of mental health care: systematic and comprehensive meta-review. JMIR Ment Health 2022; 9(5): e35159.

23.

Andrade

. The inconvenient truth about convenience and purposive samples. Indian J Psychol Med 2021; 43(1): 86–88.

24.

Castor

Höök

Nilsson

. Psychometric evaluation of the electronic Faces Thermometer Scale (eFTS) for pediatric pain assessment: protocol for a mixed-methods study. JMIR Res Protoc 2023; 12: e123456.

25.

Höök

Nilsson

Castor

. Content validity of the electronic Faces Thermometer Scale for pain self-report in children aged 8–17 years. J Pediatr Nurs 2024; 72: 45–53.

26.

Höök

Castor

Nilsson

. Construct validity of the electronic Faces Thermometer Scale in postoperative pediatric care: a Swedish study. Pain Manag Nurs 2025; 26(1): 12–20.

27.

Kuyler

Johnson

. Learners’ perspectives on evaluating the PicPecc mHealth app using the Mobile Application Rating Scale. Inter J Tech Knowl Soc 2025; 21(2): 179–197.

28.

Kim

Baek

Kim

, et al. User engagement with a Mobile health app for people living with HIV: observational study based on an engagement evaluation framework. J Med Internet Res 2025; 27: e78810.

29.

Clarke

Braun

. Thematic analysis. J Posit Psychol 2017; 12(3): 297–298.

30.

Nowell

Norris

White

, et al. Thematic analysis: striving to meet the trustworthiness criteria. Int J Qual Methods 2017; 16(1): 1609406917733847.

31.

Ghahremani

Ostovar

. The contribution of emotional intelligence and achievement motivation on psychological well-being. Global J Health Sci 2017; 9(3): 1–88.

32.

Nukulkij

Trakulkasemsuk

Hataiyusuk

, et al. “Safe Zone”–The environmental and psychological safe space for student well-being in Thai schools: a qualitative investigation. Int J Interdiscipl Educ Stud 2024; 19(1): 115–140.

33.

Gahler

. Parental technoference and the impact on familial relationships. Mob Medi Commun 2024; 13(2): 281–294.

34.

Anjum

Hasan

Jahan

, et al. Early digital engagement among younger children and the transformation of parenting in the digital age from an mHealth perspective: scoping review. JMIR Pediatr Parent 2025; 8: e60355.

35.

Tadpatrikar

Sharma

Viswanath

. Influence of technology usage on family communication patterns and functioning: a systematic review. Asian J Psychiatry 2021; 58: 102595.

36.

Shin

Rheu

Huh-Yoo

, et al. Designing technologies to support parent-child relationships: a review of current findings and suggestions for future directions. Proc ACM on Human-Comp Interact 2021; 5(CSCW2): 1–31.

37.

Johnson

Rogers

. Strengthening and supporting parent–child relationships through digital technology: benefits and challenges. Fam Relat 2024; 73(3): 1550–1567.

38.

Bražinová

Caletková

. Digitisation of sibling and social relationships of vulnerable children in the Czech Republic: implications for digital social work. Child Fam Soc Work 2024; 30(3): 453–463.

39.

Barnett

Tollit

Ratnapalan

, et al. Education support services for improving school engagement and academic performance of children and adolescents with a chronic health condition. Cochrane Database Syst Rev 2023; 2023(2): CD011538.

40.

Richardson

Harrison

Heathcote

, et al. mHealth for pediatric chronic pain: state of the art and future directions. Expert Rev Neurother 2020; 20(11): 1177–1187.

41.

Skinner

Pitzer

Steele

. Can student engagement serve as a motivational resource for academic coping, persistence, and learning during late elementary and early middle school? Dev Psychol 2016; 52(12): 2099–2117.

Learners with disabilities’ perspectives on the requirements for mHealth-based digital journaling to promote subjective well-being

Abstract

Background

Methods

Findings

Conclusions

Keywords

Introduction

Method

Sample and setting

Participants

Instrument

Data collection procedures

Data analysis

Trustworthiness

Findings

Psychological well-being

Social well-being

Cognitive well-being

Physical well-being

Discussion

Psychological well-being

Social well-being

Cognitive well-being

Physical well-being

Limitations

Conclusions

Footnotes

Acknowledgements

ORCID iDs

Funding

Declaration of conflicting interests

Declaration of Generative AI and AI-assisted technologies in the writing process

Data Availability Statement

References