Piloting a Digital App Based on the Friendship Bench for Depression and Anxiety in Palestine: Mixed Methods Study

Area of Science:

• Global Mental Health
• Digital Health Interventions
• Conflict Psychology

Background:

• Conflict-affected populations experience a high burden of mental disorders.
• Inuka Coaching, a digital intervention adapted from the Friendship Bench, was piloted in Palestine.
• Implementation occurred in a highly volatile context following October 7, 2023.

Purpose of the Study:

• To describe the implementation of Inuka Coaching, a digital mental health tool using task-shifting, in Palestine.
• To examine contextual challenges, fidelity to the coaching model, and lessons learned.
• To understand recruitment, retention, and delivery during escalating ethnic cleansing.

Main Methods:

• Two head coaches trained 5 lay coaches in the Inuka method.
• Palestinian adults were recruited via social media for up to 4 text-based coaching sessions.
• Standardized mental health questionnaires (SRQ-20, PCL-5) and transcript reviews were used.

Main Results:

• 70 participants enrolled; 95.7% showed likely PTSD symptoms and 69.4% were at risk for distress.
• Participant retention was low (7.1% completion); effectiveness could not be determined.
• Coach fidelity was high (94.6%), but challenges included recruitment and session continuity.

Conclusions:

• Digital, task-shifted mental health interventions can be delivered with fidelity in conflict zones.
• Sustaining engagement during escalating violence remains a significant challenge.
• Future implementations require flexible, context-sensitive strategies and strong lay coach support.