A personalized mHealth lifestyle intervention for depression in primary care: a qualitative study

Background Depression is highly prevalent in primary care and frequently co-occurs with unhealthy lifestyle patterns. Although lifestyle interventions have shown beneficial effects for depression, their structured implementation in primary care is limited. Digital health tools may support the integration of such interventions into routine primary care. Aim To iteratively develop a personalized app-based mobile Health (mHealth) lifestyle intervention as an adjunct to routine primary care for depression, by exploring the needs and requirements of individuals with (past) depression (IDs) and primary care providers (PCPs). Design & setting A qualitative study using semi-structured interviews and focus groups in the Netherlands. Method We conducted 26 semi-structured interviews and three heterogeneous focus groups, involving a total of 34 participants, including 14 IDs and 20 PCPs. Data were analyzed using inductive thematic analysis. Insights from the qualitative findings were used to iteratively co-develop the intervention. Results Analysis revealed two main themes: (1) the intervention should reflect core elements of depression recovery, including self-management, a positive and person-centered approach, making lifestyle changes in small steps, and social connection; and (2) prerequisites for effective use, including integration within blended care, support for lifestyle goal setting, an accessible design, and attention for concerns such as data security. Conclusion Co-development of an app-based mHealth lifestyle intervention with IDs and PCPs proved feasible in primary depression care. Through an iterative, practice-based approach, key intervention elements were identified, integrated, and tested, resulting in a blended-care intervention tailored to the needs of both patients and providers.