Development and Cultural-Contextual Adaptation of a Low-Threshold Digital Psychosocial Service for Refugees Living in Switzerland: Sui App (Preprint)

Abstract

BACKGROUND Upon arriving in host countries, forcibly displaced people face a multitude of psychological, cultural, as well as socio-structural challenges. The urgent need for psychological and psychosocial support remains substantially unmet, impacting practically all asylum seekers and refugees. Beyond the direct impact on individuals, this care gap also affects host countries’ existing structures, necessitating holistic approaches in parallel to an expansion of specialised care. Digital services offer promise in addressing these challenges, given their potential for scalability and accessibility. The latter is particularly relevant for refugee groups as they often face geographical, structural, and linguistic barriers. However, the understanding and implementing cultural and contextual adaptation in interventions remain limited and require systematic processes and reporting. OBJECTIVE This article presents the participatory development process of the culture- and context-sensitively adapted “Sui App”. Sui is a digital low-threshold psychosocial support service tailored to recently arrived refugees in Switzerland, focusing on those from Arabic-speaking backgrounds. The app can be utilised independently or augmented with peer support through an in-app chat feature. METHODS We employed a user-centred participatory approach across the project's preparation, development, and finalisation phases. Cultural and contextual considerations were documented using the RECAPT framework. We conducted a desk review, qualitative interviews, iterative advisory group meetings, and a beta test to finalise a version of the app for a subsequent evaluation in a randomised controlled trial (RCT). RESULTS To enhance the psychological well-being of recently arrived asylum seekers and refugees in Switzerland, both socio-structural and psychological factors should be included. A digital service aimed at meeting their needs in everyday life should incorporate those factors. In the iterative development process, the app Sui evolved. The app contains practical information on nine relevant, everyday life topics and five psychological topics to promote overall well-being in a resource-oriented way. Additionally, users can be supported by trained peers through an in-app chat. Essential for the participatory process was the multi-levelled translation process through which a widely understandable translation could be provided, allowing the advisory groups to focus on the content. The written content is accompanied by illustrations of fictional protagonists, video testimonies from other refugees telling their stories, and various audio exercises. CONCLUSIONS Through engagement with stakeholders and adherence to the RECAPT framework, we carefully considered the cultural and contextual circumstances of Arabic-speaking refugees who have newly arrived in Switzerland. Our iterative development process, spanning a preparation, development, and finalisation phase, highlighted the importance of integrating socio-structural factors along with low-threshold psychological health promotion in a new digital support service. Despite encountering challenges such as technical issues during beta testing, our findings underscore the potential of digital services in bridging care gaps for marginalised populations.