World Health Organization Evidence-Based Self-Help Plus Intervention for Stress Management via Chatbot: Protocol for Adaptation to a Tech-Enabled Model

Abstract

Background: This paper describes the adaptation of an evidence-based intervention for mental health, Self-Help Plus (SH+), to a digital platform, aiming to expand mental health support through innovative technological solutions. The SH+ intervention, designed by the World Health Organization (WHO), is a low-intensity, self-guided program aimed at improving mental well-being. The intervention has been integrated into a chatbot-driven mobile app called "ALBA" (Automated Well-Being Assistant).

Objective: This protocol describes the stages of transition (porting) from a traditional face-to-face, group-based approach to a tech-enabled model, tailored specifically for women with breast cancer and pregnant women. The adaptation of this approach is described, focusing on 2 key aspects: (1) the shift from in-person delivery to a tech-enabled intervention and (2) the customization of the intervention to address the unique needs of the selected target groups.

Methods: The development of the ALBA app involved a collaborative, multidisciplinary approach combining expertise in psychology, eHealth IT, interaction design, and specific domain knowledge related to pregnancy and oncology. The development process followed 2 primary methodologies: user-centered design and service design. These approaches emphasize understanding user needs, promoting iterative improvements, and continuously incorporating user feedback. The development followed the Obesity-Related Behavioral Intervention Trials (ORBIT) model, which involves a cycle of literature review, stakeholder consultation, content development, software development, and evaluation. At the same time, specific attention was dedicated to (1) adapting the SH+ protocol to suit the chatbot-driven ALBA platform, (2) tailoring content to the target population, and (3) incorporating interactive features to improve engagement and potential efficacy.

Results: The manuscript outlines the key steps and processes involved in adapting the SH+ intervention into the ALBA digital platform. This includes an overview of the challenges and opportunities of translating a face-to-face, group-based intervention into a tech-enabled model and provides insight into how customization for specific populations, such as women with breast cancer and pregnant women, was integrated into the design of the platform. This is in view of informing future studies on the development and adaptation of already validated protocols into mobile health (mHealth) interventions in the field of mental health and mental well-being.

Conclusions: The digital adaptation of the SH+ intervention into the ALBA platform could represent a significant step forward in expanding the accessibility and personalization of mental health interventions in potentially different settings and target groups. The use of virtual coaching applications can play a central role in improving the availability and ease of access of psychological support, even in different and mHealth formats. Future developments could include further testing in real-world settings to expand (1) adaptations for various target groups and (2) the purpose of use to range from primary prevention to more clinically focused interventions.

International registered report identifier (irrid): DERR1-10.2196/69644.

Keywords: breast cancer; digital health; mobile application; pregnancy; stress management; virtual coach.

Figure 1

The Obesity-Related Behavioral Intervention Trials (ORBIT) model [41].

Figure 2

Automated Well-Being Assistant (ALBA) chatbot and its functionalities as a virtual coach (VC). AI: artificial intelligence.

Figure 3

Representation of the intervention’s structure in an exemplary week (Week 2: Session Unhooking). DWM: Doing What Matters in times of stress; SH+: Self-Help Plus; VC: virtual coach.

Figure 4

Automated Well-Being Assistant (ALBA) app mock-ups of different sections (Exercises, Diary, Principal Menu, Galley, and Progress). DWM: Doing What Matters in times of stress; SH+: Self-Help Plus; VC: virtual coach.

Figure 5

Automated Well-Being Assistant (ALBA)’s dialogue section with open-ended questions and button-based responses (guided answers).