To increase access to evidence based interventions, WHO is exploring the feasibility of delivering scalable psychological interventions using information technology to communities affected by adversity. Lebanon, a middle income country with reasonably good internet coverage, high literacy rates, and a new mental health plan supportive of e-health, is the pilot site for this e-intervention. The project is led by WHO in close collaboration with the Ministry of Public Health in Lebanon and is funded by Fondation d’Harcourt.
Step-by-step adopts a predominantly behavioral activation therapeutic approach that is delivered in the form of a five session illustrated story with an interactive component. It also uses psychoeducation, relaxation techniques, positive self-talk, and garnering social support. Step-by-step was inspired by the existing WHO face-to-face intervention Problem Management Plus, but it has minimal emphasis on problem solving.
Step-by-involves a narrative story of an individual who has undergone treatment for depression and who shares their experiences and techniques in overcoming their depression. Each weekly session lasts for around 25-30 minutes and the user is encouraged to practice techniques in their own life. The intervention is minimally guided, whereby participants will receive weekly support by trained non-specialists called “e-helpers” for around 15 minutes per week using email or telephone. It has been adapted to be suitable for Lebanese, Syrian, and Palestinian communities living in adversity in Lebanon and showing depressive symptoms as screened by the PHQ-9. The intervention is not designed to be used with clients at imminent risk of suicide.
The intervention is fully computerized; the sessions (story and illustrations) can be accessed through smartphones, computers, or tablets that are connected to internet. The study information, consent forms and pre-post tests and all content will be available in Arabic and English electronically through the website. All content has been systematically translated, reviewed and adapted to the cultural setting of Lebanese, Syrians and Palestinians residing in Lebanon. Diverse stakeholder groups were engaged and informed the adaptation process.
The intervention will be pilot tested, recruiting through the wider community, several primary health care centers across Lebanon, and in the family medicine departments of two Beirut hospitals. 200 participants diverse communities will be able to participate in the feasibility study. Participants can use the intervention at home from their private devices, or in private rooms equipped with tablets and wifi in some of the participating health centers. The intervention will be tested through two large randomized controlled trials in 2018.