Community-Engaged Peer Support for Spanish-Language Digital Mental Health

Background and Purpose:
Latine communities in the United States face persistent barriers to mental health care, including limited English proficiency, cost, stigma, transportation, and a shortage of Spanish-speaking clinicians. Digital mental health interventions can expand access, but engagement remains limited without culturally responsive support. Peer supporters may help bridge this gap by offering shared lived experience, language concordance, and community trust. This study examined the training process for peer supporters in SUPERA, a Spanish-language digital cognitive behavioral therapy (dCBT) intervention delivered in primary care, and identified lessons learned to improve peer-supported digital mental health implementation. We also examined a participatory action research (PAR) process in which community members who chose not to continue as peer supporters generated feedback on the intervention and its fit with community needs.

Methods:
We used a qualitative, community-engaged design embedded in the SUPERA hybrid effectiveness-implementation trial. A purposive sample of 12 Spanish-speaking Latinx adults from Somos Esenciales, a San Francisco-based community organization, participated in eight audio-recorded training sessions over five months. Training covered psychoeducation, CBT principles, digital literacy, and use of the SilverCloud platform. Six participants completed additional training to become peer supporters; others participated in a PAR process to reflect on barriers, facilitators, and recommendations for improving the intervention. Transcripts were analyzed using iterative inductive and deductive thematic content analysis in Dedoose. The codebook was developed collaboratively and refined through team consensus.

Results:
Four major themes emerged. First, peer supporters identified important design barriers, including text-heavy content, unfamiliar clinical terminology, limited digital literacy, and usability challenges. Second, training was strengthened by relational supports such as mutual encouragement, storytelling, humor, and culturally familiar communication practices, including WhatsApp-based support. Third, the training process itself increased mental health literacy, self-awareness, and confidence in using CBT skills in daily life. Fourth, peer supporters emphasized that the intervention was most relevant when it reflected community stressors such as job loss, family strain, and pandemic-related hardship. Across the PAR process, community members highlighted the need for simpler language, more accessible formats, and clearer role expectations for peer supporters.

Conclusions and Implications:
Peer support can help expand access to digital mental health care for Spanish-speaking Latinx communities, but implementation depends on training that is accessible, culturally grounded, and responsive to the realities of participants’ lives. Findings suggest that peer-supported digital interventions should be designed with community members rather than for them, with attention to literacy, digital access, emotional burden, and flexible participation. These lessons have implications for improving workforce development, civic engagement, and the equitable scale-up of community-based digital mental health services. These lessons are particularly relevant during times of difficulty accessing in-person services and when immigration and economic stressors in the community are high.