Zoturi—Online Story-Based Support for Youth and Families

The benefits pursued with the product

The aim of Zoturi’s Online Story-Based Support for Youth and Families is to support the users’ ability to solve health issues and make better use of health care services. [1] Individual and organisational benefits pursued with the product:

• Early identification, support and improvement of self-care
• Improving users’ ability to solve well-being problems on their own or with the help of people close to them. Promoting social inclusion.
• Increasing users’ knowledge of the significance of their own activities in improving well-being.
• Reducing the burden on health care organisations through preventive measures and improved self-care.

Research evidence related to the product under evaluation

An impact study related to the service was not available at the time of evaluation (2/2025). The company collects customer feedback on the service with the “Did you get help?” -question. At the time of the evaluation, responses have been received from about 12% of all users of the service, 72% of them felt that they had received help from the service. The company also collects data on the number of users of the service, and, for example in 2023, the videos of the service had been viewed slightly over 210,000 times on the enjaksa.fi and normaali.fi websites. The concern assessments of young users have primarily been related to anxiety and health, as well as appearance and diversity. The company will make use of the customer feedback and collected data to further develop the service. [2]

Literature reviews

In a study carried out in 2019 in the United States, Gaudiano et al. examined how storytelling psychoeducation videos can act as a self-care intervention in treating depression. The study developed a video programme called LifeStories based on Acceptance and Commitment Therapy (ACT). In the study, 11 people with a diagnosis of severe depression watched videos for four weeks where actual patients told about their experiences and the survival strategies they had used.

The results showed that the participants found the videos engaging and useful, with 54.5% of the participants achieving a clinically significant reduction in symptoms. In addition, the symptoms of depression decreased significantly during the intervention period, although no change was observed in the symptoms at baseline. This suggests that narrative-based psychoeducation videos can be a promising way to increase the opportunities for self-care of depression by offering an accessible and low-threshold alternative to traditional therapy. [3] Although the results are promising, the small sample size of the study (11 participants) limits its generalisation. [3] A scoping review published in 2021 examined the impact of digital video interventions in promoting young people’s mental health literacy. The review analysed 17 studies in which digital videos were used to:

• improve young people’s understanding of mental health
• reduce stigma
• improve the efficiency of seeking help. [4]

The criteria for inclusion in the review were research in which digital videos were used to promote mental health literacy, targeting adolescents and young adults (ages 15 to 25). A total of 17 studies meeting the criteria were selected for the review, from which information was collected on the type of intervention, its effects, and the follow-up period. [4]

The results showed that digital video interventions are an effective means to improve young people’s mental health literacy. All 17 studies reported positive effects in at least one field of mental health literacy. The review reports the following effects:

• Increased awareness: Eight studies examined the impact of videos on the awareness and recognition of mental health problems. In five studies, video was the only intervention,and three of them reported positive results on the benefits of videos in increasing knowledge.
• Increase in seeking help: Six studies examined the effect of the videos on intentions to seek help. In five studies, video was the only intervention, and all the studies found a significant increase in the intention to seek help before and after the intervention.
• Reduction of stigma: In 13 studies, the effects of video interventions on attitudes and stigma associated with mental health problems were examined. In 11 studies, video was the only intervention. In 9 studies, a positive change in attitudes was observed after watching the videos. In addition, the videos containing expert recommendations increased the participants’ intention to interact with people with mental health problems. [4]

The 2019 study and the scoping review support the goals set by the company Zoturi Oy for its product, especially in terms of early identification of mental health issues, increasing awareness, seeking help, and promoting social interaction. The results suggest that videos can reduce stigma and increase participants’ willingness to interact with other people suffering from mental health problems. [3.4] However, more evidence is needed on the effectiveness of the product being evaluated in order to assess its benefits reliably.

The company bases the safety specifications of its products on practices in accordance with the ISO 9001 standard, but it does not have certification of the standard. The company has comprehensively identified the potential risks associated with the product and its use, also from the end user’s point of view. Risks have been analysed in a risk analysis, which is regularly updated as a part of the risk management plan [1].

The company has a risk management plan in place that defines the processes and notification policies that guarantee the safety of the product [1].

Potential safety risks have been taken into account in the design of the product and efforts have been made to minimise them. Efforts have been made to prevent incorrect use of the product with the help of user instructions and in the design of the user interface. [1]

The company has a designated person responsible for product safety [1].

According to the company’s notification, the service has not caused any safety incidents or other deviations in the safety of patients or clients [1].

The costs are determined based on the population base of the area. The service organisation pays a fixed monthly fee, which will not change as the population changes. There is no start-up fee or separate training costs associated with the use of the product. For end-users, the service is free of charge. Upgrades and integration with other systems will not result in additional costs and deployment will not require changes in the premises, equipment, information systems, or operational processes. The development of the product or the addition of new features will not incur additional costs for the client.

Based on the information provided by the manufacturer, the costs of using the service appear to be reasonable compared to providing a similar service in other ways [1].

The evaluation has been carried out using the data security and data protection requirement database for social welfare and health care procurements and the response material provided by Zoturi Oy [1.5].

Risk management and data security testing

Data security testing, risk management, and processing of data security incidents are documented.

Security testing is part of the software development cycle and includes automated testing as well as manual testing carried out at least once a year. Testing is carried out internally.

Risk management considers the data security and data -protection of the service.

Log management

The service will collect a wide range of log data from different components, and the data is stored encrypted.

The log data is actively monitored, for instance, by means of real-time alerts.

Usage logs are retained for six months.

User management

System management utilises role-based user management.

The service system administrators have personal user identifiers and the service uses two-factor authentication for the systems.

End users do not log in or identify themselves to use the service, and no personal data or identification information is stored about them.

Equipment

The service consists of two WordPress sites, which are hosted by Seravo Oy on its own servers. The videos available in the service are stored on Vimeo’s servers. The end user uses the browser on their own devices.

Data protection

Only anonymous data is collected from the service, avoiding the use of cookies. The necessary data at rest is stored in a protected manner.

Data under the General Data Protection Regulation (GDPR) is not collected, but the components of the service are located in GDPR-compliant areas. However, the company has carried out a Data Protection Impact Assessment (DPIA) with a focus on other accumulated data. The company has appointed a Data Protection Officer.

General instructions for procurement

During the procurement phase, you should always contact the organisation’s IT management, data security expert and data protection expert. Discuss with them whether the product in question meets your requirements. In addition, we recommend that the wellbeing services counties use the Security Guide for ICT Procurement of the European Union Agency for Cybersecurity (ENISA) to support their procurement [6].

The service is a website for citizens, which is openly available, and does not require a separate login. It has no separate user interface for professionals. The use of the service is not recommended for children under the age of 13, as its content is aimed at older people. [1]

Usability

The ISO 9241-210:2019 and ISO/TR 16982:2002 -standards have served as guidelines for directing design to be interactive, human-centred, and usable. According to the company’s notification, the people who participated in the testing of the product correspond to the actual end users of the product. The company collects feedback from young people and parents of families with children through the online service, at various events, and through cooperation with the Youth Council. In addition, the wellbeing services counties have gathered feedback from young people and their parents through surveys. [1]

Usability testing reports are available for usability testing. Usability testing has detected problems with images, and especially texts. The number of texts has been reduced on the basis of wishes, and the wellbeing services counties, in turn, have requested to have their own texts on the websites. The removal of the signs has occasionally caused misunderstandings, for example, the icons of the worry test have been mistaken for links. In order to improve clarity, the text has had to be restored. [1]

End users have been considered in the design and formatting of the service’s text content [1].

According to the company, developing the usability and accessibility of a product is a continuous process. Accessibility training has been arranged for the company’s personnel, and the training is a part of continuous planning. [1]

The service has a common feedback channel for the end users of the product and professionals, where you can: give a thumbs up or give written feedback. The company takes customer feedback into account in product development. [1]

Accessibility

The product has undergone an accessibility assessment, which the company has carried out itself. The accessibility status is described in the product’s accessibility statement, which is available on the websites en.jaksa.fi and normaali.fi [7]. Our goal is to make our own accessibility assessment and to update the accessibility statement annually. The service and its contents meet the technical accessibility requirements determined by European standard EN 301 549. [1]

According to the company, special user groups have been taken into consideration in the design of the usability and accessibility of the product as follows.

• Persons with low Finnish skills and persons with cognitive challenges.
  • The text is plain language, and complex concepts have been explained in detail.
• Other special user groups
  • The site works smoothly on different devices (computers, tablets, smartphones) and browsers (Chrome, Firefox, Safari, Edge) and supports common aids such as magnifiers and screen readers. [1]

It is possible to give feedback on the accessibility of the product by email of the electronic feedback channel. According to the company, it will respond to feedback within 14 days [1].

Usability and accessibility of the service from a professional’s perspective

Accessibility is the same as for the end-users, including specific groups [1]. The contents and design have been designed in cooperation with professionals in the field, and reviewed by another expert. Although design is based on the needs of the end-user, feedback from professionals is continuously collected, and regular development meetings are held to guide product development. A professional can give feedback electronically in the service, by email during office hours, or by telephone 24/7. [1]

A demo version is available for the client organisation free of charge during the deployment process [1].

General instructions for procurement

The procuring organisation must take into account the accessibility requirements laid down by applicable legislation in force at any given time [8, 9, 10].

Interoperability

The service has integration with other software or services, such as the client organisation website [1].

The service makes use of various interfaces for data transfer, offering at least REST API and PHP Hook -interfaces. The service supports common web technologies for websites, such as HTML links, iFrames, and JavaScript. You can add desired components and links to the customer-specific section as well as embed videos, for example, from the Vimeo service. [1]

The service does not contain customer data, but otherwise its data is stored in a relational database. The company uses export and import tools (CSV and JSON) that can be used to transfer data to other systems in common file formats (text, images, videos, or HTM). [1]

Technical functionality

All source code and configuration files are subject to version management and auditing processes [1].

The service testing processes have been determined, and they will be implemented as part of product development [1].

The company’s customer service receives and processes any service-related error messages by e-mail [1].

If necessary, it is possible to revert to the earlier version of the service [1].

The company monitors the service’s operation and the server proactively to detect potential faults. The monitoring includes [1]

• automatic updates
• scheduled automatic backups
• monitoring the error logs
• alerts, for instance, the administrator receives notification of a site crash
• server security and update monitoring.

According to the notification of the company, there have been no significant interruptions in the service and it has not been out of use due to failures in the last six months. Updates to the website components are made so that downtime is less than 10 seconds. Videos are replaced by new versions directly in place of the previous URL to ensure uninterrupted access. During the interruption, a notice of the interruption will be displayed on the site. The client organisation will not be separately informed, because the interruptions are short. The user will experience the interruption in such a way that the page will not load on the first attempt. [1] The company has a plan in case the service is decommissioned [1]. The service requires an internet connection to function properly [1].

Training and product support

Completed instructions are available for the client organisation to support the deployment. According to the company, separate training is not required for deployment, as the service is designed to be easy to use. [1]

Short instructions for use are available on the service’s website and they are directly integrated into the events. The instructions for use are available in Finnish and Swedish. [1]

The company provides product support by email during office hours and by telephone around the clock [1].

Distribution of the product

The service is used in the Wellbeing Services Counties of Kainuu, Central Finland, Lapland, Ostrobothnia, Päijät-Häme and Satakunta. Terveystalo has acquired the service for its municipalities that are under total outsourcing. [1]

1. The Digi-HTA questionnaire filled out by the company, not public information. 
2. Zoturi. Annual Report 2023 – The story of young people and families – Helping young people and families, non-public information
3. Gaudiano BA, Davis CH, Miller IW, Uebelacker LA. Development of a Storytelling Video Self-Help Intervention Based on Acceptance and Commitment Therapy for Major Depression: Open Trial Results. Behav Modif. 2019 Jan;43(1):56-81.https://doi.org/10.1177/0145445517738932  
4. Ito-Jaeger, S. et al. (2021) Digital video interventions and mental health literacy among young people: a scoping review’, Journal of Mental Health, 31(6), pp. 873–883. https://doi.org/10.1080/09638237.2021.1922642  
5. National Cyber Security Centre: Information security and data protection requirements for social welfare and healthcare procurements. Available at: https://www.kyberturvallisuuskeskus.fi/en/ncsc-news/instructions-and-guides/information-security-and-data-protection-requirements-social Accessed on 25.2.2025 
6. The European Union Agency for Cybersecurity Procurement Guidelines for Cybersecurity in Hospitals. Available at https://www.enisa.europa.eu/publications/good-practices-for-the-security-of-healthcare-services. Accessed on 25.2.2025 
7. Enjaksa.fi and Normaali.fi accessibility statement. Available at: https://enjaksa.fi/yksityisyys/ ja https://normaali.fi/yksityisyys/. Accessed on 6.2.2025 
8. Act on the Provision of Digital Services 306/2019 (Available only in Finnish). Available at: https://www.finlex.fi/fi/laki/alkup/2019/20190306. Accessed on 25.2.2025 
9. Requirements of the Act on the provision of Digital Services. Available at: https://saavutettavuusvaatimukset.fi/fi/digipalvelulain-vaatimukset/digipalvelulain-vaatimukset-toimijoille Accessed on 25.2.2025 
10. Act on public Procurement and concession contracts 1397/2016 (Available only in Finnish). Available at:  https://www.finlex.fi/fi/laki/alkup/2016/20161397. Accessed on 25.2.2025 

Jari Haverinen, Senior planning officer, FinCCHTA 

Raija Järvinen, Senior planning officer, FinCCHTA 

Teemu Mustola, Senior planning officer, FinCCHTA 

Tommi Hanhela, Information security expert , University of Oulu 

Jere Kinnunen, Information security expert, University of Oulu 

Antti Koskela, Information security expert, University of Oulu