The development of a World Health Organization transdiagnostic chatbot intervention for distressed adolescents and young adults

2025 · doi:10.1101/2025.02.19.25322432
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This study details the human-centered development of a transdiagnostic WHO chatbot intervention for distressed adolescents and young adults in LMICs, designed for acceptability and adaptability.

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⚙ AI-generated deep summary by claude@2026-07, 2026-07-14 · read from full text ⓘ

This paper describes the development of the WHO STARS chatbot, a transdiagnostic digitally delivered psychological intervention for adolescents and young adults experiencing impairing psychological distress in low- and middle-income countries. Using a limited user-centred design process based on Human Centred Design principles, the authors refined a chatbot originally built for ages 15–18 through focus groups and key informant interviews with end-users, community members, and psychology intervention experts in Jordan, targeting adaptation for ages 18–21. The resulting chatbot content used interactions with fictional characters and followed a non-AI decision-tree structure across multiple sessions, addressing low mood, stress, and anger in relation to vocational, familial, and interpersonal stressors, with prototypes well-received by adolescents and young adults; the main limitation acknowledged is that efficacy is not established here, with randomized controlled trials underway in Jordan and Lithuania. This paper does not explicitly discuss endometriosis or adenomyosis; it was included in the corpus via a keyword match in the upstream search index.

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Abstract

Background Common mental disorders are prevalent in young people in low- and middle-income countries (LMICs). Digitally delivered interventions have the potential to overcome many structural and psychosocial barriers to mental health care. Chatbots have been proposed as one potentially acceptable and feasible method that may increase engagement. Yet, there is currently limited evidence for their efficacy in reducing psychological distress. This paper summarises the development of a World Health Organization digital psychological intervention for young people experiencing impairing psychological distress, developed in line with Human Centred Design (HCD) principles. Objective This study refined and adapted a chatbot intervention initially developed for adolescents aged 15-18 years that was completed in consultation with end-users in this age group (N =236), community members (N =73), and psychology intervention experts (N =9) across varied settings. The purpose was to create an adaptation fit for use by young adults aged 18-21 years experiencing psychological distress in Jordan. Methods The current study followed a limited user-centred design process involving focus groups and key informant interviews with stakeholders including young adults aged 18-21 years (N =33), community members (N= 13), and psychology intervention experts (N= 11). Iterative design development occurred throughout the cultural adaptation and refinement process. Results There was a clear preference for a chatbot based intervention that included interactions with fictional characters with relatable problems. The chatbot content followed a transdiagnostic model that addressed common problems including low mood, stress and anger with reference to vocational, familial and interpersonal stressors that the target population commonly faced. It followed a non-AI decision tree format with multiple sessions and was designed to be adaptable for use in different countries with different populations and software systems. Prototype versions of the chatbot were well-received by adolescents (15– 18-year-old) and young adults (18–21-year-old). Conclusions This is the first report of the development of a chatbot intervention for adolescents and young adults in LMICs that was designed using a HCD framework. Systematic end-user engagement through all phases of the research aimed to make this intervention acceptable and useable for adolescents and young adults in a wide variety of settings. The chatbot is currently being tested in randomised controlled trials in Jordan and Lithuania.
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Abstract

Background Common mental disorders are prevalent in young people in low- and middle-income countries (LMICs). Digitally delivered interventions have the potential to overcome many structural and psychosocial barriers to mental health care. Chatbots have been proposed as one potentially acceptable and feasible method that may increase engagement. Yet, there is currently limited evidence for their efficacy in reducing psychological distress. This paper summarises the development of a World Health Organization digital psychological intervention for young people experiencing impairing psychological distress, developed in line with Human Centred Design (HCD) principles.

Objective

This study refined and adapted a chatbot intervention initially developed for adolescents aged 15-18 years that was completed in consultation with end-users in this age group (N =236), community members (N =73), and psychology intervention experts (N =9) across varied settings. The purpose was to create an adaptation fit for use by young adults aged 18-21 years experiencing psychological distress in Jordan.

Methods

The current study followed a limited user-centred design process involving focus groups and key informant interviews with stakeholders including young adults aged 18-21 years (N =33), community members (N= 13), and psychology intervention experts (N= 11). Iterative design development occurred throughout the cultural adaptation and refinement process.

Results

There was a clear preference for a chatbot based intervention that included interactions with fictional characters with relatable problems. The chatbot content followed a transdiagnostic model that addressed common problems including low mood, stress and anger with reference to vocational, familial and interpersonal stressors that the target population commonly faced. It followed a non-AI decision tree format with multiple sessions and was designed to be adaptable for use in different countries with different populations and software systems. Prototype versions of the chatbot were well-received by adolescents (15– 18-year-old) and young adults (18–21-year-old).

Conclusions

This is the first report of the development of a chatbot intervention for adolescents and young adults in LMICs that was designed using a HCD framework. Systematic end-user engagement through all phases of the research aimed to make this intervention acceptable and useable for adolescents and young adults in a wide variety of settings. The chatbot is currently being tested in randomised controlled trials in Jordan and Lithuania. Competing Interest Statement The authors have declared no competing interest. Funding Statement Development of the STARS chatbot was funded by Foundation Botnar. The RCT mentioned in this paper was funded by the Research for Health in Humanitarian Crises (R2HC, managed by Elrha; https://www.elrha.org) (resources mobilized by KC). Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The current study received ethical approval from the School of Nursing, University of Jordan (PF.22.9 on March 23, 2022). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability N/A

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