Concept and Design Validation of a Trauma-Informed Digital Mental Health App for Frontline Workers: A Large-Scale Mixed-Methods Study (Preprint)

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BACKGROUND Background: Frontline professionals are routinely exposed to trauma and occupational stress yet face persistent barriers to help-seeking, including stigma, confidentiality concerns, and limited access to timely support. Despite these challenges, frontline professionals consistently demonstrate resilience and sustained functioning under pressure, highlighting the need for interventions that protect psychological wellbeing within demanding systems rather than locating distress solely at the individual level. Digital mental health interventions offer scalable and potentially discreet solutions; however, few undergo structured concept and design evaluation prior to feasibility testing. OBJECTIVE Objective: Guided by the UK Medical Research Council (MRC) framework for complex interventions, this study aimed to evaluate the concept and design of a trauma-informed digital mental health app for frontline professionals. Specifically, we examined perceived acceptability, visual appeal, content appropriateness, credibility, perceived usefulness, and preferred design features, alongside identifying barriers and facilitators to adoption. METHODS Methods: A cross-sectional mixed-methods survey was conducted with 1,125 frontline professionals across healthcare, emergency services, transportation, social care, military, and related high-risk sectors. Participants completed a structured prototype walkthrough followed by quantitative ratings of visual appeal, content appropriateness, content relevance, credibility, perceived usefulness, and current digital mental health behaviours. Open-text responses were analysed using the Framework Method to identify themes related to implementation, trust, and occupational fit. Quantitative data were summarised descriptively, and internal consistency of the prototype evaluation scale was assessed. RESULTS Results: Participants reported relatively low routine use of mobile apps for their own mental health but strong endorsement of the potential usefulness of a frontline-specific digital intervention. The prototype received favourable ratings across domains of visual appeal (M=3.82, SD=0.67), appropriateness for the target audience (M=4.34, SD=0.84), content relevance (M=4.15, SD=0.79), and credibility (M=4.29, SD=1.03), with appropriateness and credibility receiving the highest endorsement. The four-item evaluation scale demonstrated acceptable internal consistency (Cronbach’s α=.75). Preferred features prioritised personalised guidance and rapid-access support over AI-mediated or socially interactive functions. Framework analysis of free-text responses from 484 participants generated seven themes relating to human support, trust and confidentiality, occupational tailoring, in-the-moment coping tools, peer-informed elements, usability requirements, and organisational culture. CONCLUSIONS Conclusions: This large-scale formative evaluation provides strong early support for the acceptability, perceived relevance, and context fit of a trauma-informed digital mental health intervention tailored to frontline professionals. Findings identify clear user-informed priorities for refinement, particularly regarding privacy safeguards, occupational tailoring, integration with human support pathways, and low cognitive burden. Progression through the MRC development phase provides a strong foundation for feasibility testing and implementation research within frontline occupational settings.

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