Frontiers in Psychiatry
Volume 10, Issue JAN, 2019

User-centered app adaptation of a low-intensity e-mental health intervention for Syrian refugees (Article) (Open Access)

Burchert S.* , Alkneme M.S. , Bird M. , Carswell K. , Cuijpers P. , Hansen P. , Heim E. , Shehadeh M.H. , Sijbrandij M. , Van't Hof E. , Knaevelsrud C.
  • a Division of Clinical-Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
  • b Division of Clinical-Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
  • c International Federation of Red Cross and Red Crescent Societies Reference Centre for Psychosocial Support, Copenhagen, Denmark
  • d Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
  • e Department of Clinical, Neuro- and Developmental Psychology, VU University Amsterdam, Amsterdam, Netherlands
  • f International Federation of Red Cross and Red Crescent Societies Reference Centre for Psychosocial Support, Copenhagen, Denmark
  • g Division of Psychopathology and Clinical Intervention, Department of Psychology, University of Zurich, Zurich, Switzerland
  • h Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
  • i Department of Clinical, Neuro- and Developmental Psychology, VU University Amsterdam, Amsterdam, Netherlands
  • j Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
  • k Division of Clinical-Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany

Abstract

Introduction: The aim of this study is to describe the initial stages of the iterative and user-centered mobile mental health adaptation process of Step-by-Step (SbS), a modularized and originally web-based e-mental health intervention developed by the World Health Organization (WHO). Given the great need for improving the responsiveness and accessibility of health systems in host countries, the EU-funded STRENGTHS consortium studies the adaptation, implementation and scaling-up of SbS for Syrian refugees in Germany, Sweden and Egypt. Using early prototyping, usability testing and identification of barriers to implementation, the study demonstrates a user-centered process of contextual adaptation to the needs and expectations of Syrian refugees. Materials and Methods: N = 128 adult Syrian refugees residing in Germany, Sweden and Egypt took part in qualitative assessments. Access, usage, and potential barriers regarding information and communication technologies (ICTs) were assessed in free list interviews. Interactive prototypes of the app were presented in key informant interviews and evaluated on usability, user experience and dissemination strategies. Focus groups were conducted to verify the results. The interview protocols were analyzed using inductive and deductive thematic analysis. Results: The use of digital technologies was found to be widespread among Syrian refugees. Technical literacy and problems with accessing the internet were common barriers. The majority of the respondents reacted positively to the presented app prototypes, stressing the potential health impact of the intervention (n = 28; 78%), its flexibility and customizability (n = 19; 53%) as well as the easy learnability of the app (n = 12; 33%). Aesthetic components (n = 12; 33%) and the overall length and pace of the intervention sessions (n = 9; 25%) were criticized in regard to their negative impact on user motivation. Acceptability, credibility, and technical requirements were identified as main barriers to implementation. Discussion: The study provided valuable guidance for adapting the app version of SbS and for mobile mental health adaptation in general. The findings underline the value of contextual adaptation with a focus on usability, user experience, and context specific dissemination strategies. Related factors such as access, acceptability and adherence have major implications for scaling-up digital interventions. Copyright © 2019 Burchert, Alkneme, Bird, Carswell, Cuijpers, Hansen, Heim, Harper Shehadeh, Sijbrandij, van't Hof and Knaevelsrud. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY).

Author Keywords

psychosocial support Refugees Syrian Global mental health User centered design Mobile mental health E-mental health

Index Keywords

Germany refugee motivation mental health human controlled study Internet psychosocial care interview Sweden male female clinical article Article literacy thematic analysis adult scale up human experiment world health organization expectation Egypt
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85065468059&doi=10.3389%2ffpsyt.2018.00663&partnerID=40&md5=c0542c6c6779ab954e26a14a6699c4d7
DOI: 10.3389/fpsyt.2018.00663
ISSN: 16640640
Cited by: 2
Original Language: English