Feasibility and uptake of a digital mental health intervention for depression among Lebanese and Syrian displaced people in Lebanon: a qualitative study
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Introduction: Digital interventions are increasingly regarded as a potential solution for the inaccessibility of mental health treatment across low-and-middle-income settings, especially for common mental disorders. Step-by-Step (SbS) is a digital, guided self-help intervention for depression found effective in two Randomized Controlled Trials (RCTs) in Lebanon. For research implementation and further scale-up, this paper reports the results of a qualitative evaluation of SbS among the Lebanese and others and displaced Syrians in Lebanon. Methods: Thirty-four Key Informant Interviews (KIIs) were executed with participants of the RCTs, SbS staff members, and external stakeholders. Questions garnered feedback about the feasibility, acceptability, enabling factors, and barriers to adhering to the research, implementation, and the SbS intervention. A thematic analysis was conducted using NVivo, and key themes, topics, and recommendations, on research methods and the intervention itself, were generated and reported. Results: Results showed a high level of acceptability of SbS among Lebanese and Syrians and identified sub-groups for whom acceptance or use might be lower, such as older adults and people with limited access to the internet or smartphones. Furthermore, interviews identified the main enabling factors and barriers to adherence related to the research design, content, and delivery approach. Barriers related to feasibility included lengthy assessments as part of the RCTs, and mistrust related to delays in study compensations. Other common challenges were forgetting login credentials, poor internet connection, being busy and competing needs. Enabling factors and best practices included motivating participants to use the intervention through the weekly support provided by helpers, setting an oral contract for commitment, and dividing the compensations into several installments as part of the RCTs. Recommendations regarding sustainability were given. Discussion: The findings show that overall, SbS is feasible, acceptable, and much needed in Lebanon among the Lebanese and Syrians. This assessment identifies reasons for low adherence to the research and the intervention and presents improvement solutions. Recommendations generated in this paper inform the upscale of SbS and the planning, design, and implementation of future digital interventions in research and service provision settings in the mental health field.
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A recent qualitative study with SbS users from Lebanon reported slow internet, forgetting passwords, technical issues on older devices, and busy lifestyle as reasons for low adherence.
“Similar findings were reported in a recent qualitative study with SbS users from Lebanon, who reported slow internet, forgetting passwords or technical issues on older devices as reasons for low adherence, but most importantly stated that their busy lifestyle prevented them from continuing to use SbS [68].”
From Effects of a self-guided digital mental health self-help intervention for Syrian refugees in Egypt: A pragmatic randomized controlled trial (2024) · cites this paper as [68]
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- Authors
- Abi Ramia, J., Abi Hana, R., Noun, P., Cuijpers, P., Carswell, K., van't Hof, E., Heim, E., Zoghbi, E., Sijbrandij, M., & El Chammay, R.
- Affiliations
- Ministry of Public Health (LB)
- Babeș-Bolyai University (RO)
- World Health Organization (CH)
- University of Zurich (CH)
- Venue
- Frontiers in Public Health
- Publisher
- Frontiers Media SA
- Published
- 2024-01-22
- Volume
- 11
- Pages
- 1293187-1293187
- ISSN
- 2296-2565 (ISSN-L)
- PMC
- PMC10840138
- OpenAlex
- W4391103668
- Cited by
- 15
- References
- 33
- Citations by year
- 2026: 6 · 2025: 8 · 2024: 1
- FWCI
- 5.93
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Public Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- SERVAL (Université de Lausanne) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- IRIS (submittedVersion, cc-by)
- VU Research Portal (submittedVersion, other-oa)
- Funders
- World Health Organization
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Keywords
- digital mental health interventions, depression, guided self-help, Syrian refugees, displaced persons, feasibility, acceptability, research compensation, internet access barriers, older adults, scale-up, Lebanon
- MeSH terms
- Middle Eastern People, Digital Health, Aged, Depression, Feasibility Studies, Humans, Lebanon, Mental Health, Refugees, Syria, Qualitative Research
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