Challenges and mitigation strategies in the development, usability testing, and implementation of a digital mental health intervention for depression (VMood) in Vietnam: A feasibility study (Preprint)

Abstract

BACKGROUND Worldwide, the COVID-19 pandemic has contributed to further gaps in mental health care, particularly in low- and middle-income countries such as Vietnam, where care is inaccessible for 83% of those who need it. In response, there has been an explosion of digital mental health interventions, such a s smartphone apps. Presently, the evidence for such interventions is limited, especially where they have been adapted from evidence-based in-person formats. Implementation science aims to promote the uptake of scientific findings into practice. A key determinant of implementation success is an intervention’s usability. Hurdles to usability include an intervention being too confusing or time-intensive to use. Facilitators include incorporating a greater number of engagement features and integrating human support. OBJECTIVE The aim of this implementation science feasibility study is to describe the challenges and mitigation strategies used in the development, usability testing, and implementation of a digital depression intervention (VMood smartphone app) developed in Vietnam. VMood was adapted from an evidence-based in-person intervention originally developed in Canada that is grounded in principles of Cognitive Behavioural Therapy, with supportive coaching by a nonspecialist provider. The research team is currently testing the effectiveness and cost-effectiveness of VMood in a randomized controlled trial (RCT) across eight provinces in Vietnam, informed by results from this feasibility study. METHODS This mixed methods feasibility study was informed by Proctor et al.,’s Implementation Outcomes Framework, focusing on acceptability, adoption, appropriateness, and feasibility. This study involved three data collection components: 1) usability testing (interviews and focus groups with app user and provider participants who tested VMood in one Vietnamese province; 2) app metrics (from the early phase of the RCT in the same province but from different municipalities); and 3) discourse data (notes from various team meetings, communications, and reports on VMood’s development and implementation). Qualitative data were analyzed using thematic content analysis. App usage data were analyzed using basis descriptive statistics. RESULTS Findings from the three data components showed there were seven main challenges that fell within Proctor et al.,’s Framework: 1) challenges with recruitment and uptake of the app; 2) challenges with utilization and engagement; 3) screening challenges; 4) digital divide; 5) limitations to digital applications for mental health; 6) technological challenges; and 7) funding and policy constraints. Various solutions to help mitigate the challenges were utilized by the team. CONCLUSIONS Adjustments based on recommendations critical to VMood’s usability and implementation were made to the VMood intervention that is currently being tested in the RCT. Findings from this study have applicability for others looking to develop and implement similar digital interventions. CLINICALTRIAL The larger RCT is registered at ClinicialTrials.gov, identifier [NCT05783531].