Community cognitive interviewing to inform local adaptations of an e-mental health intervention in Lebanon

Abstract

Background.Lebanon has a need for innovative approaches to increase access to mental health care to meet the country's current high demand. E-mental health has been included in its national mental health strategy while in parallel the World Health Organization has produced an online intervention called ‘Step-by-Step’ to treat symptoms of depression that is being tested in Lebanon over the coming years.Aim.The primary aim of this study is to conduct bottom-up, community-driven qualitative cognitive interviewing from a multi-stakeholder perspective to inform the cultural adaptation of an Internet-delivered mental health intervention based on behavioural activation in Lebanon.Methods.National Mental Health Programme staff conducted a total of 11 key informant interviews with three mental health professionals, six front-line workers in primary health care centres (PHCCs) and two community members. Also, eight focus group discussions, one with seven front-line workers and seven others with a total of 66 community members (Lebanese, Syrians and Palestinians) were conducted in several PHCCs to inform the adaptation of Step-by-Step. Results were transcribed and analysed thematically by the project coordinator and two research assistants.Results.Feedback generated from the cognitive interviewing mainly revolved around amending the story, illustrations and the delivery methods to ensure relevance and sensitivity to the local context. The results obtained have informed major edits to the content of Step-by-Step and also to the model of provision. Notably, the intervention was made approximately 30% shorter; it includes additional videos of content alongside the originally proposed comic book-style delivery; there is less emphasis on total inactivity as a symptom of low mood and more focus on enjoyable activities to lift mood; the story and ways to contact participants to provide support were updated in line with local gender norms; and many of the suggested or featured activities have been revised in line with suggestions from community members.Conclusions.These findings promote and advocate the use of community-driven adaptation of evidence-based psychological interventions. Some of the phenomena recorded mirror findings from other research about barriers to care seeking in the region and so changes made to the intervention should be useful in improving utility and uptake of ‘Step-by-Step’.

Utilization of Mobile Mental Health Services among Syrian Refugees and Other Vulnerable Arab Populations—A Systematic Review

“…However, the single randomized control trial included in the present study found a statistically significant reduction in post-traumatic stress syndrome symptoms in Arab patients from war-torn backgrounds [34]. Additionally, the remainder of the articles showed efficacy of the technologies as screening tools for this population [6,[28][29][30][31][32][33][34][35][36]. It is imperative that mMHealth innovations are compatible with local needs of intended adopters and implementing institutions.…”

“…Barriers discussed primarily included primarily cultural, financial, technical, infrastructural and data privacy limitations and lack of mental health awareness in the study populations. Results and key findings are tabulated in Table 3 [6,[28][29][30][31][32][33][34][35][36]. They preferred telepsychiatry in their mother tongue rather than interpreter-assisted care.…”

“…With regard to the success of mMHealth uptake among vulnerable Arab populations, many barriers exist spanning stigmatization, technological literacy, technological access, general distrust towards healthcare providers and political conflicts [14,28,30,35]. In Arab communities, there is a strong social stigma associated with mental illness as men who seek care are considered weak and women associate it with helplessness and being 'cursed' [12,37,38].…”

Cultural Clinical Psychology and PTSD

“…The process of cultural and contextual adaptation of Step-by-Step in Lebanon is described in Abi Ramia et al (2018). This process followed an (unpublished) WHO draft protocol for cultural adaptation and included several steps.…”

Mobile Angebote für Geflüchtete

“…Qualitative Befragungen mit verschiedenen kulturellen Gruppen, z. B. der lokalen Bevölkerung, syrischen und palästinensischen Geflüchteten, Vertretern religiöser Gruppen und Fachkräften aus der primären Gesundheitsversorgung, zeigen, dass eine Intervention wie Step-by-Step begrüßt und als sinnvoll erachtet wird [8]. Das Gesundheitsministerium sieht Step-by-Step als ersten Schritt in einem Stepped-Care-Modell.…”