Carswell K, Harper-Shehadeh M, Watts S, et al. (2018). Step-by-Step: A new WHO digital mental health intervention for depression. mHealth. 4(34). doi: 10.21037/mhealth.2018.08.01
Step-by-Step is a digital intervention based on behavioral activation for depression being developed by the World Health Organization (WHO) for use in a number of countries. Step-by-Step consists of 5 30-minute sessions delivered weekly for 5 weeks.
Sessions use spoken narrative, illustrations, and interactive skill practice to deliver content focused on psychoeducation, behavioral activation, social support, and relapse prevention. Each session features 2 characters: a patient who describes their experiences seeking help for depression, and a trusted figure teaching the user about the session’s therapeutic component and assigning activities. In the initial version, the trusted figure is a healthcare professional, but could be modified based on setting. Assessments of mood and functioning are integrated into the narrative. Step-by-Step is designed to allow for minor adaptations (e.g., character gender and appearance, role of the trusted character) to tailor Step-by-Step to specific settings, but content (e.g. narrative examples) is purposely vague to ensure content is relatable for a wide audience. Step-by-Step can be delivered with or without support from “e-helpers” who provide structured guidance about previous intervention sessions, assigned skill practice activities, and identified issues in weekly 15-20 minute discussions online or by phone. Step-by-Step is currently delivered using a mobile-enabled website, but an app is in development. Results from a pilot in Lebanon will be reported in an upcoming paper. WHO will conduct trials evaluating Step-by-Step with varying levels of support and different delivery methods (e.g., app and website) and will make it publicly available, pending demonstrated effectiveness.