Peer mentor training and supervision for a digital adolescent depression treatment in South Africa and Uganda: a mixed-methods evaluation

Background: Blended digital mental health interventions that combine technology with human support are more effective than standalone treatments. However, limited research has focused on how to train and supervise the personnel delivering human support components. The Kuamsha app, a gamified digital intervention based on Behavioral Activation for adolescent depression, was designed to be paired with low-intensity telephone-based peer support. A structured training and supervision program for peer supporters was co-developed through a series of workshops with mental health professionals and youth with lived experience of mental health challenges in South Africa and Uganda. To the best of our knowledge, this is the first study to evaluate a structured peer mentor model within a digital mental health intervention in any LMIC and one of only a few worldwide.

Objective: This study assessed the feasibility, acceptability, and fidelity of a training and supervision program for peer supporters of a digital mental health intervention in South Africa and Uganda.

Methods: We conducted a mixed-methods evaluation of the peer mentor program. Quantitative metrics assessed the feasibility of recruitment, retention, and attendance among peer mentors (N=13 in South Africa; N=4 in Uganda) as well as the acceptability of training. Fidelity, adherence, and competence were scored at the session level and converted to percentages of the maximum possible score to facilitate comparison across outcomes. Linear mixed-effects regression models with a random intercept for provider and site were used to estimate adjusted marginal means (95% CI). In-depth interviews and focus group discussions with peer mentors broadened our understanding of program acceptability and explored implementation barriers and facilitators.

Results: The peer mentor training and supervision program was feasible and acceptable in both settings, as demonstrated by high recruitment (South Africa: 13/19, 68%; Uganda: 4/4, 100%), retention (South Africa: 9/13, 69%; Uganda: 4/4, 100%), and training attendance rates (89–92% in South Africa, and 100% in Uganda) along with qualitative reports of high satisfaction. All peer mentors met a minimum competency threshold after training (≥50%) with median competency scores of 70.7% (45.8-78.2) in South Africa and 75.4% (73.8-77.3) in Uganda. Independent ratings of call recordings during program implementation indicated high overall fidelity in South Africa (84.7%, 95% CI 80.3–89.0) and Uganda (87.7%, 95% CI 83.4–92.1). Adherence was higher in Uganda than South Africa (adjusted mean difference 13.30 percentage points, 95% CI 8.99–17.61; P<.001), as was competence (adjusted mean difference 4.88 percentage points, 95% CI 1.23–8.53; P=.009). The adjusted mean difference in overall fidelity (3.06 percentage points, 95% CI −0.98–7.10) was not statistically significant (P=.138). Qualitative findings emphasized the value of ongoing supervision and capacity development, as well as interactive training approaches and blended models of training and supervision.

Conclusions: Locally adapted training and supervision models can strengthen peer mentor capabilities to support digital interventions. Adequate supervisory capacity and incentive structures are critical to ensure ongoing engagement, retention, and fidelity of peer mentors. In environments with frequent network disruptions, periodic in-person contact between peer mentors and supervisors may enhance fidelity. Future research should explore how peer mentor fidelity (adherence and competence) contributes to user engagement and mental health outcomes.

Trial Registration: Pan African Clinical Trials Registry (PACTR202206574814636).