Accepted for/Published in: JMIR Mental Health
Date Submitted: May 14, 2025
Date Accepted: Feb 26, 2026
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Piloting a digital application for depression in Palestine: Inuka Coaching based on the Friendship Bench
ABSTRACT
Background:
The burden of mental disorders is high in conflict-affected populations. In Palestine, we piloted Inuka Coaching, a digital intervention adapted from the Friendship Bench delivered by trained and supervised lay coaches. We aimed to assess the effectiveness and acceptability of the method in order to determine the best approach for broader implementation.
Objective:
This pilot aimed to demonstrate effectiveness of Inuka Coaching in reducing symptoms of common mental health disorders and to determine the fidelity and acceptability of the method by the trained lay coaches in the highly volatile context of Palestine.
Methods:
Palestinian adults in Gaza and West Bank were recruited primarily through social media. SRQ-20 and PCL-5 assessments were collected at baseline, immediately after the first coaching session, and three months later. To evaluate coaches’ adherence to the protocol, session transcripts were screened, and a focus group discussion was conducted to gather coaches’ insights on the programme and identify areas for adaptation.
Results:
Recruitment commenced in August 2023, enrolling 70 participants over three months. Baseline data revealed a high prevalence of mental health issues, including Post-Traumatic Stress Disorder (PTSD)symptoms. Effectiveness of the method could not be determined since retention was low, with only 7% (n=5) of clients completing all four sessions due to the impact of war. Coach fidelity to the protocol was 92% and they expressed positive sentiments towards the method, but noted areas for improvement that could enhance support for both themselves and their clients.
Conclusions:
Digital mental health solutions delivered by trained lay workers in volatile humanitarian settings, such as Palestine, require agile intervention designs that incorporate flexible recruitment strategies and contextually adapted content to address the challenges posed by escalating violence. Further research is needed to improve retention and minimize attrition for sustained impact. Clinical Trial: NA
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