Peer Perspectives on Challenges Encountered During a Multi-Site Digital Mental Health Intervention Project

Peers are individuals with lived experience of mental health challenges trained to provide support to others with similar challenges. Help@Hand was a multi-site project that integrated peers into digital mental health intervention (DMHI) implementation. This study uses the Consolidated Framework for Implementation Research (CFIR) to frame challenges reported by peers when implementing DMHIs. Individuals leading the local peer workforce completed quarterly online surveys about perceived challenges to DMHI implementation. Biannual interviews probed for details on survey-reported challenges. 103 quarterly surveys and 39 bi-annual interviews were collected from key informants at 11 Help@Hand sites between Summer 2020 and Fall 2022. One challenge was tied directly to DMHIs; namely, device distribution. Several related to the Implementation Process, including challenges with recruiting qualified peers and integrating peers into DMHI implementations; communication and collaboration; and translation. Challenges in the Individual domain included unclear peer roles and multi-tasking across various projects. Inner Setting challenges included structural barriers to hiring peers, issues with communication and project management, and workforce turnover. Outer Setting challenges related to environmental technology readiness, COVID-19, unclear decision-making processes across the collaborative, and uneven communication between sites' peers. Funding uncertainty bridged the Inner and Outer Settings. Using the CFIR model to frame challenges to DMHI implementation yielded useful lessons, especially when peers are engaged as partners in planning and implementation process. Successful implementation will be enhanced by ensuring adequate environmental readiness for tech-based interventions, clear role definition, streamlined peer hiring processes, and well-delineated lines of communication locally and across sites.