Effectiveness and cost-effectiveness of guided e-mental health care for Syrian refugees in urban Lebanon

Grant awarded: £499, 294

Lead organisation: World Health Organisation

Partnering organisations: International Medical Corps (IMC); VU University Amsterdam; United Nations High Commissioner for Refugees (UNHCR); AFMM & St Joseph University, Lebanon; University of Zurich

Project length: 2017 - 2019

Study locations: Lebanon

Principal Investigator: Mark van Ommeren


The long-term objective of this proposal is to reduce mental suffering and improve the mental health and functioning of people affected by humanitarian crises. Adequate ability to function is important for survival and for re-building communities. WHO’s aim is to contribute to this objective by developing a suite of evidence based interventions that are scalable in humanitarian settings.

We will evaluate the effectiveness and cost-effectiveness of Step-by-Step (SbS) with Syrian refugees in Lebanon. SbS is an innovative 5-session guided WHO intervention designed to improve mental health care coverage, with scalability as central design feature. It is delivered through (a) users’ own smartphones or desktop computers or (b) tablets placed in health/community facilities to enable access to those without devices or internet access. The intervention content involves a narrative with simple language, illustrations and interactive exercises. Step-by-Step centers on behavioural activation, an empirically-supported therapeutic strategy, with additional elements of cognitive coping, stress management and social support. Users receive weekly phone guidance from a helper to maintain motivation, ensure understanding of the intervention content and to prevent drop out.

Expected outcomes:

This research would provide a proof of concept for the use of SbS and other e-mental health intervention in humanitarian settings where (a) a meaningful proportion of the population has access to smartphones or other internet devices or (b) health and other facilities can provide access to devices and the internet. It will provide insight into the feasibility, effectiveness and cost-effectiveness of a locally adapted e-mental health intervention in a humanitarian setting. Evaluating SbS will (a) generate adequate evidence for the decision whether or not to release this guided e-mental health intervention as a public good and (b) improve the scant evidence-base for such interventions in humanitarian settings. The results of this research have the potential to inform scale up of Step-by-Step or similar interventions in humanitarian settings.



Elrha is a registered charity in England and Wales (1177110).

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