Moving a digital mental health intervention from research to a national scale in Lebanon.
Digital mental health care reaches thousands of people in Lebanon
A digital treatment for depression and anxiety can be deployed on a large scale even in a country with an overburdened and crisis-stricken healthcare system. This is evident from the doctoral research conducted by Jinane Abi Ramia, a professional in public mental health care, on the implementation of Step-by-Step, a digital intervention guided by the World Health Organization (WHO).
Abi Ramia’s research shows that digital care can increase access to psychological support, especially where such help is scarce or difficult to access. In Lebanon, Step-by-Step has since evolved from a research project into a national service, and more than 6,000 people have used the service. Users can receive free, remote, evidence-based support, guided by a trained care provider.
A key finding is that success does not depend solely on the effectiveness of the intervention itself. Cultural and local adaptation, user involvement in the design, and integration with the existing healthcare system are at least as important. Factors such as internet access, smartphone availability, new crises, and changing personal circumstances also influence usage.
It is also striking that stopping use of an app does not automatically mean that the treatment is no longer effective. Users can continue to apply the skills they learn during the program even outside the app. According to the study, digital interventions should therefore not be evaluated solely based on duration of use or dropout rates, but also through users’ experiences.
The results offer practical lessons for countries seeking to implement digital mental health care on a larger scale. In addition to technological solutions, this requires funding, personnel, laws and regulations, collaboration, and structural integration into the healthcare system.
The findings from Abi Ramia’s research have since been incorporated into new practical WHO guidelines for psychological self-help. Furthermore, the Lebanese approach received international recognition in 2023 with a UN award for digital innovation in addressing noncommunicable diseases.
More information about the dissertation.