Impact Factor 2.857

Frontiers journals are at the top of citation and impact metrics

This article is part of the Research Topic

Refugee Mental Health

Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Psychiatry | doi: 10.3389/fpsyt.2018.00663

User-centered app adaptation of a low-intensity e-mental health intervention for Syrian refugees

 Sebastian Burchert1*,  Mohammed S. Alkneme1, Martha Bird2,  Kenneth Carswell3, Pim Cuijpers4, Pernille Hansen2, Eva Heim5, Melissa Harper Shehadeh3,  Marit Sijbrandij4, Edith van’t Hof3 and  Christine Knaevelsrud1
  • 1Arbeitsbereich Klinisch-Psychologische Intervention, Fachbereich Erziehungswissenschaft und Psychologie, Freie Universität Berlin, Germany
  • 2International Federation of Red Cross Red Crescent Societies Reference Centre for Psychosocial Support, Denmark
  • 3Département de la santé mentale et de la toxicomanie, Organisation mondiale de la santé, Switzerland
  • 4Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU University Amsterdam, Netherlands
  • 5Klinische Psychologie und Psychotherapie, Psychologisches Institut, Universität Zürich, Switzerland

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.

Keywords: e-mental health, mobile mental health, Refugees, Syrian, global mental health, User Centered Design, Psychosocial support

Received: 15 Jun 2018; Accepted: 19 Nov 2018.

Edited by:

Stephan Zipfel, University of Tubingen, Germany

Reviewed by:

Florian Junne, Universitätsklinikum Tübingen, Universität Tübingen, Germany
Catharina Zehetmair, Heidelberg University Hospital, Germany  

Copyright: © 2018 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). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Mr. Sebastian Burchert, Arbeitsbereich Klinisch-Psychologische Intervention, Fachbereich Erziehungswissenschaft und Psychologie, Freie Universität Berlin, Berlin, Germany,