“It’s the modern way of doing things”: a qualitative study of user-experience, acceptability, and content validity of a digital mental health screener for refugees
TL;DR
The user experience with the i-TAP among individuals with a refugee background in Sweden is explored, with a particular focus on acceptability and content validity, and developments to increase usability and comprehensiveness are suggested.
Abstract
Background Digital mental health tools hold potential to bridge barriers to services, and efficient screening could facilitate access and assessment. An internet-based tiered assessment procedure (i-TAP) screening for common psychiatric symptoms among refugees has been developed and validated in previous work. Further validation requires investigation of acceptability and content validity, which in turn can inform potential implementation. Aim This study aimed to explore the user experience with the i-TAP among individuals with a refugee background in Sweden, with a particular focus on acceptability and content validity. Methods In conjunction with a psychometric validation study of the i-TAP, semi-structured interviews were conducted with 71 adult participants with a refugee background living in Sweden. Interviews were conducted in Arabic, Dari, Farsi and Swedish, and analysed using reflexive thematic analysis. Results Four themes were generated. Two themes addressed the content and usability of the i-TAP: Capturing what matters – but not everything that matters and A user-friendly and accessible tool - provided sufficient (health) literacy. A third theme: Digital mental health screening could facilitate care, but can not replace a care visit, highlighted perspectives on prospective implementation. The fourth theme, Sharing can be difficult, but opens the door to support, reflected emotional and cultural aspects of addressing mental health issues. Conclusion Participants mainly found the i-TAP to be relevant and easy to use, and the digital format familiar. Items were comprehensible and relevant topics were covered, supporting content validity. Concurrent and prospective acceptability was high; however, with the prerequisite that screening must lead to action. The results highlighted the importance of trust and language when addressing mental health. We suggest developments to increase usability and comprehensiveness, and discuss considerations important for implementation.