The research was carried out according to the guidelines of the Ethics Committee of the Ramón de la Fuente National Institute of Psychiatry, which approved the research protocol (approval number CEI/C/023/2021) [11]. Participation was free and voluntary. Pseudonyms chosen by the participants were used to maintain confidentiality. Those who experienced more complex mental health conditions and needed more intensive help could send the word “support” to the platform administration to be referred to a psychiatrist who would respond within 24 hours.

To ensure that the program was sensitive to the needs of migrants returning to Mexico, this phase explored the difficulties they faced with respect to mental health care and substance use, as well as their perception of the usefulness of a message-based psychoeducational program.

The purpose of the third phase was to evaluate the usefulness of the information in achieving the objectives of the project.

The program “Here Again: Coping With Return” included 80 messages that responded to the needs identified in the situational diagnosis for coping with the emotional problems associated with return. A pilot study was conducted with the objective of evaluating whether the messages conveyed the expected information and adjusting the functioning of the platform and the general characteristics of sending and receiving messages.

A total of 80 messages were created, of which 65% (n=52) focused on mental health (management of emotions and self-care), 25% (n=20) on alcohol use, and 10% (n=8) on the experience of migration. The latter were included at the beginning and the end of the intervention, and before each topic, to motivate participants to stay in the program. Figure 3 shows the sequence of the topics and the number of messages in each section.

Each topic was addressed with an average of 4 messages (motivation, ability, and triggers). The first message of the sequence offered information about the activity, highlighting the benefits of adopting the behavior; the second provided guidelines for carrying out the task; the third offered alternatives for facilitating involvement in the activity; and the fourth reinforced the success and the benefits of maintaining the change. Figure 4 shows an example of the sequence of messages.

The messages were created considering participants’ preferences for their characteristics and format. These coincide with recommendations in the literature [18] for increasing the effectiveness of SMS text messaging, including expression in positive terms, providing direction, and facilitating access to resources. The messages were brief and direct, using colloquial language, and with an emphasis on practical content. The information was presented in various formats: text, images, video, audio, and questionnaire (Figure 5).

The highest levels of agreement were observed regarding the appropriateness of the messages for the goals of the project, the number of messages in the program, the relevance of the messages to the topic, and their contribution to the section. Table 3 shows the average level of agreement in the evaluation criteria by question. Table 4 shows the averages by topic.

The lowest scores were for the understandability of the language for some of the messages on the topics of experience of migration and alcohol use. The evaluators gave recommendations related to the precision of the information: for example, on the topic of alcohol use, to use the phrase “use that doesn’t put you at risk” instead of “to have lower risk with use.” Some evaluators identified the use of technical language and suggested more colloquial language, such as “headache” instead of “migraine” and “increased heartbeat” instead of “tachycardia.” They also suggested changes to enhance the motivational effect of the messages, such as using the phrase “when we allow ourselves to feel sadness” instead of “it is necessary to allow ourselves to feel sadness.”

The most common commentaries referred to the clarity, precision, conciseness, coherence, and practicality of the messages. Evaluators expressed their satisfaction with the psychoeducational strategy as a valuable option for creating change: “Concise, practical messages, with simple language. They generate interest, with tools that are easy to apply. They help each person to be responsible for their own changes; they succeed in providing accompaniment without being intrusive...”

Changes were made to some messages in response to the evaluators’ observations. No changes were made to the number of messages or their sequence. These changes resulted in a significant improvement in the content of the messages and the psychoeducational strategy.

The platform used to implement the program was BroadcasterBot, a messaging service that enables the scheduling and delivery of standardized message templates to predefined groups, in accordance with the Mexican Federal Law on the Protection of Personal Data Held by Private Parties [30], which regulates how companies handle personal data, guaranteeing privacy, and ARCO (Rights of Access, Rectification, Cancellation, as Well as Opposition to the Processing of Personal Data Held by Private Parties) rights. Communication was primarily unidirectional; however, participants were able to respond by selecting predefined response options. User inputs were monitored through the platform for research and statistical purposes. Tests were carried out among the research team, and once the proper functioning of the platform was confirmed, the pilot study was carried out.

A total of 14 migrants participated (9 women and 5 men; Table 5), aged 19 to 50 years (mean 30). The time since their return to Mexico ranged from a few days to 12 months (mean 5). Of the total, 11 completed the program.

Messages were programmed and sent to various groups, and no problems were encountered with the platform. The functions for personalization and monitoring participant interactions performed well.

Six participants were contacted for follow-up 3 months after the intervention. The results are summarized in Table 6.

Although the interviewees did not suggest changes to the content or format of the messages, some changes were made to make them visually more attractive, and texts were synthesized to aid in their comprehension. The interviewers made suggestions for improving the evaluation questionnaire.

This study describes the process of creating a psychoeducational program to reduce the risk of mental health problems related to the experience of voluntary or involuntary return of a group of migrants. The development of the intervention includes various notable characteristics. First, both the identification of the most important topics and the development of content and the design of the distribution strategy were based on the needs expressed by a group of returning migrants. In this first stage, the major challenges identified by returning migrants included (1) the identification of emotional problems associated with the experience of migration, (2) the management of emotions and self-care, and (3) the use of psychoactive substances. These findings are consistent with those of other studies [4,31], which identify a variety of effects on mental health associated with the experience of migration.

A second important feature is the active collaboration of representatives of the target group and other actors in different stages of the process. This participatory methodology, also called coproduction, is an innovative way of finding responses or solutions to complex situations [32]. In this case, coproduction enriched the general aim of the project by incorporating the needs expressed by the migrants, the perspective of key informants, the production of videos, and the validation of experts on themes related to migration, mental health, and substance use. This process led to an appropriate psychoeducation program, based on research data and committed to the primary goal of improving the management of emotions and encouraging the development of habits of self-care, even in conditions of psychosocial vulnerability.

Coproduction also allowed for the identification of features of content and design that were or were not acceptable. The review by the target population at an early stage contributed to the development of relevant content, presented in comprehensible language that described situations consistent with the experiences of returning migrations, facilitating acceptance of the intervention [10]. The same was true for the technical aspects of the program: it was designed specifically for distribution using WhatsApp, the platform most used by the target population. It is easily accessible and, for many people, has no cost, which favors its adoption. The frequency and scheduling of messages were also determined by the coproducers. In future studies, it will be necessary to determine whether this characteristic contributed to adherence.

The use of coproduction allowed for the development of a culturally sensitive intervention for returning migrants, using a language and examples related to the needs of this population. In a study carried out with Syrian refugees, it was observed that this adaptation to the language, culture, and context of refugees improved the relevance, acceptability, and ease of use of the app [33].

A third important feature of this project is that, in addition to incorporating the points of view of different actors, the psychoeducational program included recommendations from international literature regarding the management of emotions and the modification of behavior using effective techniques that can be easily applied. This was corroborated in the pilot phase, where participants reported that it was easy to put the recommendations into practice and that they succeeded in recalling some of the messages. The pilot study found that 80% of the participants continued through the last of the 16 weeks of the program; this is an encouraging sign for the feasibility of the intervention, but a specific study will be required to assess adherence.

The intervention was found to be useful for helping participants to deal with daily emotional problems, with minimal synchronic intervention by a mental health specialist. Requests for support during the intervention consisted of a few interactions, one of which involved referral to a community service, which was also one of the messages of the program.

This study shows the different stages in the design of a psychoeducational program directed at returning migrants. Given that it is a study of process, the participants were not chosen to be statistically representative. However, this could constitute a limitation in generalizing the information about the experience of migration. Another limitation of the study is that the intervention can only be used by people who have a smartphone; it fails to reach those who are in even more vulnerable conditions.

This study outlines the different stages of designing a psychoeducational program for returning migrants. Participant selection focused on the depth and relevance of their migration experiences, rather than statistical representativeness. This selection procedure could limit the generalizability of the findings to other migration profiles. Another limitation is that the intervention is only accessible to individuals with smartphones, thus excluding those in even more vulnerable situations.

Furthermore, while the expert content evaluation phase followed a specialized design to ensure the content validity of the messages, a comprehensive psychometric evaluation of each message was not conducted. This analysis is a recommended step in developing digital interventions to strengthen their reliability. Although the 80% retention rate suggests the intervention’s viability, further research into the reasons for dropout among the remaining 20% was needed. Future research should incorporate a qualitative analysis to identify internal and external factors associated with dropout, thereby improving the intervention’s design and relevance.

Future studies should evaluate, in the short and medium term, the effect of the psychoeducational program on emotional problems and the adoption of self-care habits. They should also identify the participant characteristics associated with greater adherence, the characteristics that predict attrition, and the best conditions for the implementation of the strategy.

This study describes the different stages in the development of the psychoeducational program “Here Again: Coping With Return,” whose objective was to reduce the risks to mental health associated with a return to Mexico. The determination of topics to address, the language to be used, and the technological tools to distribute the content were the result of a process of coproduction, which is indispensable to the design of culturally relevant interventions. The use of coproduction allowed for an interchange of ideas, enabled diverse voices to be heard throughout the development of the intervention, and helped migrants to feel that they were part of the team and not just passive recipients.