JMIR Publications

ABSTRACT

Background:

Blended digital mental health interventions that combine technology with human support are more effective than standalone treatments. However, limited research has focused on how to train and supervise the personnel delivering human support components. The Kuamsha app, a gamified digital intervention based on Behavioral Activation for adolescent depression, was designed to be paired with low-intensity telephone-based peer support. A structured training and supervision program for peer supporters was co-developed through a series of workshops with mental health professionals and youth with lived experience of mental health challenges in South Africa and Uganda. To the best of our knowledge, this is the first study to evaluate a structured peer mentor model within a digital mental health intervention in any LMIC and one of only a few worldwide.

Objective:

This study assessed the feasibility, acceptability, and fidelity of a training and supervision program for peer supporters of a digital mental health intervention in South Africa and Uganda.

Methods:

We conducted a mixed-methods evaluation of the peer mentor program. Quantitative metrics assessed the feasibility of recruitment, retention, and attendance among peer mentors (N=13 in South Africa; N=4 in Uganda) as well as the acceptability of training. Independent raters assessed fidelity through ratings of competence and adherence to the intervention protocol. In-depth interviews and focus group discussions with peer mentors broadened our understanding of program acceptability and explored implementation barriers and facilitators.

Results:

The peer mentor training and supervision program was feasible and acceptable in both settings, as demonstrated by high recruitment (South Africa 68%; Uganda 100%), retention (70%; 100%), and training attendance rates (approximately 90%; 100%), along with qualitative reports of high satisfaction. All peer mentors met a minimum competency threshold (50%) after training, and independent ratings of call recordings indicated moderate overall adherence during treatment delivery. A smaller sample size and shorter follow-up period in Uganda limit direct quantitative comparisons between sites. Still, higher peer mentor retention and fidelity in Uganda are likely due to differences in program implementation. Qualitative findings emphasized the value of ongoing supervision and capacity development, as well as interactive training approaches and blended models of training and supervision.

Conclusions:

Locally adapted training and supervision models can strengthen peer mentor capabilities to support digital interventions. Future research should explore how peer mentor fidelity (adherence and competence) contributes to user engagement and mental health outcomes. Clinical Trial: South African National Clinical Trials Registry (DOH-27-112020-5741) and the Pan African Clinical Trials Registry (PACTR202206574814636).