JMIR Publications

ABSTRACT

Background:

The gap between mental health need and resources for Aboriginal and Torres Strait Islander people, the Indigenous people of Australia is at its most marked in the prison population. Not only are Indigenous or First Nations people overrepresented in prison in Australia; their prevalence of mental disorder outstrips that of non-Indigenous people in the community and in prison and also Indigenous people in the community. These higher prevalence rates may reflect the increased presence of determinants of poor mental health and wellbeing, poorer engagement in interventions, and/or lower efficacy of available interventions for this population. In community populations, use of digital mental health resources may help to increase access to wellbeing support. However, culturally appropriate digital tools have not been available to Indigenous people in prisons. The absence of feasibility and efficacy studies for these tools needs to be addressed.

Objective:

The aim of this study was to determine the feasibility of the Stay Strong app as a digital wellbeing and mental health tool for use by Indigenous people in prison.

Methods:

Initially, the identification and resolution of dual government agency precondition requirements of implementation were identified and resolved. This was essential, given the Stay Strong app was to be delivered by an external health agency to Indigenous prisoners. Acceptability at a practice level was then determined using post-use qualitative interviews with clients and practitioners of the Indigenous Mental Health Intervention Program (IMHIP). All IMHIP practitioners (n = 10) and client participants who had completed their 2nd follow-up Stay Strong app (n = 27) during this period of the study were invited to participate.

Results:

Due to the innovative nature of this project, identifying and resolving the precondition requirements of implementation were challenging but provided support for implementation of the app at a practice level. Acceptability of the app by clients and practitioners at a practice level was demonstrated, with nine themes emerging across the interviews: 1) satisfaction with current Stay Strong app; 2) supported client goal setting; 3) increased client self-insight; 4) improved client empowerment; 5) cultural appropriateness; 6) enhanced engagement; 7) ease of use; 8) problems with using an Android emulator; and 9) recommendations to improve personalisation.

Conclusions:

The SSCP is a pioneering example of digital mental health tools being implemented within Australian prisons. Implementing the app within high security prison settings by a health service was feasible at both a strategic and practice level. Feedback from both clients and practitioners supporting the use of the app as a culturally safe digital mental health and wellbeing tool for Aboriginal and Torres Strait Islander people in prison.