Early Deployment of an Integrated Digital Platform (shamiriOS) for Scalable Youth Mental Health Service Delivery in Kenya: Development and Usability Study.

BACKGROUND: Scaling youth mental health services in low-resource settings requires digital infrastructure that supports not just clinical delivery but the full operational, supervisory, and engagement demands of community-based, task-shifted models. Existing platforms-whether commercial health systems, open-source medical records, or consumer-facing wellness apps-address fragments of this need, but none provide the integrated, offline-capable, and affordable architecture required for lay-provider delivery at scale. OBJECTIVE: We introduce shamiriOS, an open-source, modular digital platform comprising 3 interlinked suites-the Shamiri Digital Hub (SDH) for operational management, Rafi for youth engagement, and the Shamiri Provider Platform (SPP) for clinical workflows-designed for scalable, stepped-care youth mental health delivery in Kenya. Our objectives were (1) to conduct an environmental scan of existing platforms and characterize their limitations, (2) to describe the user-centered design and development of shamiriOS, and (3) to report early deployment outcomes across centralized and decentralized settings between 2023 and 2024. METHODS: We conducted a structured environmental scan of 6 case management platforms and 28 youth-facing mental health apps, assessing cost, usability, open-source availability, customizability, offline capability, and suitability for task-shifted delivery. Based on identified gaps, SDH was built as a browser-based operation platform, and Rafi was developed as a native mobile app (Android or iOS) with an offline-first architecture. The SPP was adapted from an existing electronic medical record system. Development followed a user-centered design process with community consultation, including cocreation workshops with 77 university-aged youths. Deployment was evaluated using use analytics, usability ratings, and Net Promoter Scores. RESULTS: No reviewed platform met the combined requirements for stepped-care delivery. SDH was deployed across 11 sites serving 76,344 youths via 1195 lay providers and 111 clinical supervisors by Q1 2024. Staff reported high satisfaction (usability: mean 8.36/10, SD 1.49; Net Promoter Score: mean 8.63/10, SD 1.46). Rafi achieved 74.7% (n=3737) registration at Mount Kenya University, with 50.4% (508/1008) booking therapy sessions, but sustained engagement with self-guided features declined to near 0 by 9 months. CONCLUSIONS: shamiriOS demonstrates the feasibility of building modular, open-source digital infrastructure for scalable, task-shifted youth mental health delivery. Its component-based architecture is designed for adaptation to other contexts, though extension would require participatory redesign. The most significant obstacles to impact lie not in platform design but in implementation readiness, incentive alignment, and institutional integration. Future priorities include SPP deployment, artificial intelligence-assisted supervision features (shamiriAI), and strengthening sustained engagement.