Background
Digital interventions, such as smartphone apps, have emerged as a promising way to better meet growing population mental health needs. The evidence for many of these digital interventions is currently limited, especially in the context of those adapted from in-person formats. Our team developed a digital depression intervention (VMood) in Vietnam. VMood, adapted from an evidence-based in-person intervention (SSM) developed in Canada, uses cognitive behaviour therapy (CBT) principles with remote coaching by non-specialist providers.
Fidelity-adaptation is a major tension in implementation science. Fidelity is the degree an intervention is delivered as intended. Conversely, adaptations are sometimes made to address specific contexts. This paper aims to identify key elements of fidelity-adaptation – the degree VMood is consistent with the theoretical aspects of the SSM intervention and practical aspects of implementing digitally in the Vietnamese setting.
Methods
This study uses Dimensions from Dane and Schneider’s Implementation Fidelity Evaluation Framework: adherence (D1), quality (D2), participant responsiveness (D3), and program differentiation (D4). Discourse data from team meetings explored elements that must remain intact (D1) and those requiring adaptation to fit the digital modus and local cultural context (D4). Non-specialist providers with SSM knowledge and app users from Vietnam tested VMood. Experts familiar with CBT from Vietnam and Canada provided theoretical feedback. Interviews or focus groups were conducted with all participants to gain insights into (D1-4). All qualitative data were analyzed using thematic content analysis.
Results
Key findings were: Adherence (D1): participants agreed that VMood captures the important theoretical content from SSM, with the same content being delivered in a different format and Program Differentiation (D4): participants presented a variety of adaptation suggestions unique for the digital format to strengthen VMood’s acceptability, including keeping the app simple by reducing the amount of text; incorporating more dynamic content (e.g., animations, videos) to increase engagement; and including more culturally appropriate scenarios.
Conclusions
The updated VMood intervention is currently being implemented in a randomized controlled trial across eight provinces in Vietnam. With the global increase in digital health services adapted from in-person delivery, understanding how to balance fidelity with necessary adaptations is important both theoretically and practically.
