WellMe: The Resilience Application for Frontline Workers

Post 2: Q3 Update from the WellMe Team

Introduction

Earlier this year, Dimagi released WellMe– a resilience-building application for Frontline Workers– with the vision of improving wellbeing for the world’s frontline workforce. In our previous post, we outlined two key hypotheses that we intend to test this year: First, that substantial use of WellMe will increase Frontline Worker resilience and wellbeing, and second, that we can foster use of WellMe by Frontline Workers. In this post, the WellMe team reflects on the progress made towards these hypotheses so far, the key feedback we’ve received from Frontline Workers, and the questions we seek to answer going forward. 

A Quick Refresher: Why are We Focused on Resilience?

WellMe is designed to help Frontline Workers learn, practice, and ultimately adopt evidence-based behaviors that improve resilience. We believe that building resilience is important for three reasons: First, resilience is shown to guard against burnout, which is critical given the chronic stress that many FLWs experience at their jobs; second, resilience prevents the development of mental disorders, which is key given the significant mental health treatment gaps particularly in LMICs, and third, resilience can be improved by practicing simple and accessible behaviors, which mobile applications are well-placed to teach and encourage at scale. 

Our Progress 

This section outlines the progress we’ve made since releasing WellMe in April of this year (demo video of WellMe here). As of today, WellMe is available in Hindi and English and is being used by 300+ Frontline Workers across India, Nigeria, Uganda, and Malawi. While WellMe is designed with the vision of improving wellbeing for all Frontline Workers, our work to date has been in collaboration with Frontline Health Workers in particular. Our initial focus on health workers is due to Dimagi’s previous experience working with health workers and associated partners. 

Launch of Pilot Projects in India and Nigeria

In May, our partner Sangath began testing WellMe with 50 Community Health Workers in the state of Madhya Pradesh, India. This formative work allowed us to collect feedback on the Hindi version of WellMe and resolve technical issues before a larger rollout of the application. In August, Sangath launched a pilot with 150 new Community Health Workers in the same area. The 150-user pilot will conclude in November of this year, after which Sangath plans to analyze the results and publish findings about the feasibility and acceptability of WellMe in a peer-reviewed journal. 

In June, our partner Centre for Well-being and Integrated Nutrition Solutions (C-WINS) launched a 100-user pilot of WellMe with Community Health Workers in the state of Katsina, Nigeria. This pilot uses the English version of WellMe and will conclude in October of this year.

Introduction of the WellMe Beta Testing Program 

In May, Dimagi launched the WellMe Beta Testing Program in an effort to gather additional user feedback and test the uptake of WellMe in less structured deployments (unlike our pilot projects, which receive significant organizational support). Beta testing partners receive free access to WellMe in exchange for feedback on the application. 

In June, our Uganda-based partners Nama Wellness Community Centre (NAWEC) and Komo Learning Centres began beta testing WellMe in English with 18 Frontline Workers. In July, Dimagi team members assisted 11 Community Health Workers in Malawi with onboarding onto the application. This month, we expect additional partners to begin beta testing with new cohorts of Frontline Workers.

Key Feedback from Frontline Workers

This section outlines the key feedback we have received from Frontline Workers through our pilot projects and beta testing program. 

• Customized videos are preferable to content available in the public domain. WellMe includes a combination of publicly-available YouTube videos and animated videos that were custom-created by Dimagi. FLWs across settings have expressed a preference for the animated videos, signaling to us that it is important to create content that is specifically designed with Frontline Workers in mind. 
• Mobile data is a barrier to accessing content online. WellMe users in Nigeria and Uganda expressed concern about the cost of mobile data and reported that they did not watch any of the YouTube videos due to the data required for streaming. However, since the custom animated videos were available offline due to the capabilities of CommCare (Dimagi’s platform that powers WellMe), they were able to consume these videos. This feedback further solidified our belief that content and digital solutions must be available offline to ensure affordability and accessibility for FLWs. 
• There is a desire for two-way communication. FLWs expressed that while they found the WellMe solution to be helpful, it was limited in its ability to “listen” and provide feedback when a FLW was experiencing a specific challenge or stressor. This feedback has prompted us to start exploring ways to leverage large language model (LLM)-powered chatbots in order to provide this two-way communication channel at scale.

Where do we stand on our hypotheses? 

While we have made progress towards testing our hypotheses, there are still many unknowns as we await the conclusion of our pilot projects and beta testing program. The insights below are based on our current understanding through conversations with Frontline Workers and our partners.

Hypothesis 1: Substantial use of WellMe will increase Frontline Worker resilience and wellbeing

WellMe collects self-assessments of resilience (using the Brief Resilience Scale) and wellbeing (using the WHO-5 Well-being Index) on a monthly basis in the “Monthly Survey” menu of the application. Assessments are conducted once at the time of registration and are repeated every 25 days after the previous survey. In total, FLWs participating in the pilot projects and beta testing program are eligible to complete four surveys (one at baseline and three subsequent surveys). While we don’t have results from these surveys yet, we should have good visibility into this hypothesis by the end of the year. 

Hypothesis 2: We can foster use of WellMe by Frontline Workers

Industry-wide data shows that user retention for mental health applications is a challenge, with retention rates at the end of 30 days as low as <5%. Therefore, fostering user engagement and retention is a critical design challenge for us to address. Given the low levels of user retention in real-world settings, our initial goal is to utilize extrinsic motivators to increase application usage to ensure that we receive high-quality feedback on the solution.

In our initial testing stage, our approach to fostering use of WellMe has been driven by two factors: financial incentives and organizational support. In the pilot projects, FLWs receive a conditional incentive of USD $12 for participating in the pilot, and in the beta testing program FLWs receive organizational support for installation of the application and follow up sessions to discuss app feedback. Both of these approaches have led to user retention rates that are much higher than industry standards. We will share insights about user retention in a subsequent post once the pilot projects and beta testing program have concluded. Of course, an important test of usage will be when WellMe is scaled up without the guarantee that these extrinsic motivators will be in place.

Closing

We are encouraged by the amount and quality of feedback we have received from FLWs so far, which enabled us to release multiple WellMe product improvements to our current users. As we wait for our pilot projects and beta testing program to conclude, we are eager to answer our hypotheses: Will WellMe have the impact on resilience and wellbeing that we hope it will? And will we be able to retain users in the absence of financial incentives and organizational support? 

Beyond these hypotheses, there are new questions that have emerged that we are committed to exploring, specifically: Can WellMe add value to Frontline Workers outside of the health sector? How much content will be required and how will we create new content that is appropriately adapted at scale? Can emerging technology such as LLM-powered chatbots improve the user experience and impact of the solution? 

Stay tuned to learn more about our journey towards realizing a vision of wellbeing for the world’s frontline workforce. You can contact the WellMe team at wellme@dimagi.com.