Creative facilitation methods to support responsible innovation in digital mental health research: a case study involving contextual adaptation of AVATAR therapy in India and Ethiopia

Abstract

Background A Responsible Research and Innovation (RRI) approach engages diverse stakeholders throughout the research process and holds researchers accountable for both benefits and harms. Practical examples of its application remain limited, particularly in global mental health research. We present an in-depth case study of creative facilitation as a participatory method for embedding RRI within a research study. We describe a two-day RRI stakeholder engagement workshop held in the UK at the outset of the AVATAR3 study, which focuses on the contextual adaptation of AVATAR therapy - an innovative UK-developed digital therapy for distressing voices - for implementation in Ethiopia and India. Methods 27 participants attended the workshop including: i) representatives from study sites in the UK, Ethiopia and India; ii) individuals with lived experience of voice hearing; and iii) independent interdisciplinary experts. A range of creative facilitation tools were employed, including Clean Set-up, Focused Conversations, Open Space, and Consensus Workshop. Results We present key outputs from the workshop, including physical and visual materials that captured rich and deliberative discussions around ethical issues associated with the project. Conclusion Creative facilitation has the potential to embolden diverse perspectives and flatten hierarchies which often dominate research environments. This RRI-focused workshop, conducted at the intersection of digital innovation and global mental health, brought together diverse stakeholders in open and respectful dialogue around the adaptation of AVATAR therapy for Ethiopia and India. Insights from the workshop continue to shape the adaptation and testing of the intervention in these contexts.