This implementation study evaluates an integrated digital e-clinic designed to provide mental health, psychosocial, and reproductive health support to women and adolescent girls in Jordan, including Jordanian and Syrian refugee participants and other vulnerable groups. The e-clinic provides individualized psychosocial support, evidence-based educational content, self-help resources, scheduled interactions with trained healthcare providers, and referral pathways for participants requiring additional or specialized services. Participants complete baseline assessments before using the e-clinic and follow-up assessments approximately three months after baseline or following completion of the intervention. The study evaluates changes in mental health and well-being outcomes as well as acceptability, appropriateness, feasibility, accessibility, digital health literacy, reproductive health knowledge and attitudes, service utilization, participant satisfaction, privacy, and engagement with the e-clinic.
Female participants aged 14 to 65 years.
Jordanian women and adolescent girls and Syrian refugee women and adolescent girls residing in Jordan.
Eligible to receive psychosocial, mental-health and/or reproductive-health support through the e-clinic.
Able to access the e-clinic using an internet-connected device or another approved method of access.
Acute psychiatric or psychological condition requiring immediate specialist or emergency intervention beyond the scope of the e-clinic.
Imminent risk of suicide or serious self-harm requiring emergency assessment or intervention.
Acute medical or reproductive-health emergency requiring urgent face-to-face care.
Inability to provide informed consent/assent or participate meaningfully in the intervention and assessments.
Single group
Integrated Digital MHPSS-Reproductive Health E-Clinic
BehavioralA culturally tailored digital intervention providing integrated mental health and psychosocial support and reproductive health information to women and adolescent girls in Jordan. The intervention includes individualized psychosocial support, scheduled provider interactions, evidence-based educational content, self-help resources, peer/group support where applicable, and referral pathways to appropriate health, mental health and psychosocial services. Participants with urgent or specialized needs are referred according to the study safety and referral protocol.
Primary Outcome 1 -Change From Baseline in Depressive Symptoms Measured Using the Patient Health Questionnaire-9 (PHQ-9) or Patient Health Questionnaire-Adolescent Version (PHQ-A)
Depressive symptoms will be assessed using the Patient Health Questionnaire-9 (PHQ-9) for adult women and the Patient Health Questionnaire-Adolescent version (PHQ-A) for adolescent girls. Each participant will complete only the age-appropriate 9-item instrument. Each item is scored from 0 to 3, and the 9 item scores are summed to produce a total score ranging from 0 to 27. Higher scores indicate greater depressive symptom severity and lower scores indicate fewer depressive symptoms. Change from baseline will be calculated as the follow-up total score minus the baseline total score; negative change scores indicate improvement.
Primary Outcome 2 - Change From Baseline in Anxiety Symptoms Measured Using the Generalized Anxiety Disorder-7 (GAD-7)
Anxiety symptoms will be assessed using the Generalized Anxiety Disorder-7 (GAD-7), a 7-item self-report measure. Each item is scored from 0 to 3. Item scores are summed to produce a total score ranging from 0 to 21. Higher scores indicate greater anxiety symptom severity and lower scores indicate fewer anxiety symptoms. Change from baseline will be calculated as the follow-up total score minus the baseline total score; negative change scores indicate improvement.
Change From Baseline in Psychological Well-Being Measured Using the World Health Organization-Five Well-Being Index (WHO-5)
Psychological well-being will be assessed using the World Health Organization-Five Well-Being Index (WHO-5), a 5-item measure of subjective psychological well-being. Each item is scored from 0 to 5. The 5 item scores are summed to produce a raw total score ranging from 0 to 25. The raw total is multiplied by 4 to produce the reported WHO-5 score ranging from 0 to 100. Higher scores indicate better psychological well-being. Change from baseline will be calculated as the follow-up score minus the baseline score; positive change scores indicate improvement.
Change From Baseline in Post-Traumatic Stress Symptoms Measured Using the Posttraumatic Stress Disorder Checklist for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (PCL-5)
Post-traumatic stress symptoms will be assessed using the Posttraumatic Stress Disorder Checklist for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (PCL-5), a 20-item self-report measure. Each item is scored from 0 (not at all) to 4 (extremely). The 20 item scores are summed to produce a total score ranging from 0 to 80. Higher scores indicate greater post-traumatic stress symptom severity and lower scores indicate fewer symptoms. Change from baseline will be calculated as the follow-up total score minus the baseline total score; negative change scores indicate improvement.
Change From Baseline in Electronic Health Literacy Measured Using the eHealth Literacy Scale (eHEALS)
Electronic health literacy will be assessed using the eHealth Literacy Scale (eHEALS), an 8-item self-report measure. Each item is rated on a 5-point scale from 1 (strongly disagree) to 5 (strongly agree). The 8 item scores are summed to produce a total score ranging from 8 to 40. Higher scores indicate greater perceived electronic health literacy. Change from baseline will be calculated as the follow-up total score minus the baseline total score; positive change scores indicate improvement.
Change From Baseline in Reproductive-Health Knowledge Measured Using the 12-Item Reproductive-Health Literacy/Knowledge Module
Reproductive-health knowledge will be assessed using the study-specific 12-item Reproductive-Health Literacy/Knowledge Module. Each item has True, False, and Don't know response options. A correct response is scored 1, while an incorrect or Don't know response is scored 0. The 12 item scores are summed to produce a total score ranging from 0 to 12. Higher scores indicate greater reproductive-health knowledge. Change from baseline will be calculated as the follow-up total score minus the baseline total score; positive change scores indicate improvement.
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Jordan University of Science and Technology
Lead sponsor
International Development Research Centre, Canada
Collaborator
