JMIR Publications

ABSTRACT

Background:

Developing a digital health innovation can require a substantial amount of financial and human resource investment before it can be scaled for implementation across geographical, cultural, and health-service contexts. As such, there is increased interest in leveraging eHealth innovations developed and tested in one country or jurisdiction and using these innovations in local settings. However, limited knowledge exists on the processes needed to appropriately adapt digital health innovations to optimize their transferability across geographical, cultural, and contextual settings.

Objective:

We report on the results of an adaptation study of Horyzons, a digital health innovation originally developed and tested in Australia. Horyzons is designed to prevent relapses and support recovery in young people receiving services for a first-episode psychosis (FEP). Specifically, our objectives were to assess the initial acceptability of Horyzons and adapt it in preparation for pilot testing in Canada.

Methods:

This research took place in two specialized early intervention clinics for FEP, located in 1 urban and 1 urban-rural setting, in 2 Canadian provinces. A total of 26 participants were recruited: 15 clinicians (age range 26 to 56) and 11 patients (age range 19 to 37). Following a digital health adaptation framework developed by our team, we use a mixed-methods approach, combining descriptive quantitative and qualitative methods across three stages of data collection (focus groups, interviews, and consultations), analysis, and adaptations.

Results:

Overall, patients and clinicians appreciated the strengths-based approach and social media features of Horyzons. However, participants expressed concerns related to implementation, especially in relation to capacity (eg, site moderation, crisis management, Internet speed in rural locations). They also provided suggestions for adapting content and features, for example, in relation to community resources, volume of text, universal accessibility (e.g., for individuals with limitations in vision), and optimization of platform accessibility through mobile devices. Additional aspects of the innovation were flagged for adaptation during the final stages of preparing it for live implementation, these included: terms of use, time zone configuration to reflect local time and date, safety and moderation protocols, need help now feature, and list of trigger words to flag posts indicative of potential risk.

Conclusions:

In the context of the COVID-19 pandemic and public health guidelines for social distancing, there is an increasing interest and need to leverage Internet and mobile technologies for delivering youth mental health services. As countries look to each other for guidance on how to navigate changing social dynamics, knowledge on how to utilize and adapt existing innovations across contexts is now more than ever, important. Using a systematic approach, this study illustrates the methods, processes, results, and lessons learned on adapting a digital health innovation to enhance its local acceptability.