How can researchers monitor health care workers’ mental health during a crisis, when they have the least time to spare?
A one-time survey captures how people feel at a particular moment. Repeated assessments can reveal how distress changes over several weeks, while feedback based on participants’ answers can also connect data collection with timely support.
During the first two waves of COVID-19, a research team in Quebec asked health care workers to check in on their own well-being once a week through Avicenna. Each weekly check-in took about five minutes. It covered anxiety, depression, and posttraumatic stress symptoms, along with exposure to COVID-19, social support, and quality of life. When a participant’s answers crossed a clinical threshold, the app provided immediate feedback and showed them where to find help.
The program was led by researchers at the Centre de recherche de l’Institut universitaire en santé mentale de Montréal and the Université de Montréal, with the Centre hospitalier de l’Université de Montréal (CHUM), across eight health and social services centers in Quebec. Between May 2020 and February 2021, 831 health care workers took part.
A weekly check-in can collect research data and support the people answering it at the same time.
Study at a Glance
| Study feature | Detail |
|---|---|
| Population | Health care workers in 8 integrated health and social services centers in Quebec |
| Took part | 831 health care workers |
| Data collection | May 2020 to February 2021, during the first two waves of COVID-19 |
| Monitoring period | 12 weeks per participant |
| Check-ins | 1 per week, about 5 minutes each |
| Reminders | Every 12 hours until the check-in was completed |
| Validated measures | GAD-7 (anxiety), PHQ-9 (depression), and an 8-item PCL-5 (posttraumatic stress), in French |
| Other questions | COVID-19 exposure, perceived social support, and quality of life |
| Feedback | A distress message and a list of resources when a score crossed its clinical threshold |
| Follow-up | Questionnaire completed by 424 participants and 30 telephone interviews |
How the Study Worked
Health care workers in the eight participating centers were invited to join. Those who participated installed Avicenna on their own smartphones. Participation was voluntary, and participants could enter a draw for one of forty CA$50 prepaid cards.
One Check-In a Week
Once a week for 12 weeks, Avicenna sent participants a notification asking them to complete their check-in. If they had not completed it, a reminder followed every 12 hours.
Each check-in combined three validated questionnaires with questions about the participant’s week:
- Anxiety: the Generalized Anxiety Disorder-7 (GAD-7), with a clinical cutoff of 10
- Depression: the Patient Health Questionnaire-9 (PHQ-9), with a clinical cutoff of 10
- Posttraumatic stress: an abbreviated 8-item French version of the PTSD Checklist for DSM-5 (PCL-5), with a cutoff of 13
- Context: exposure to COVID-19, perceived availability of social support, and perceived quality of life
The repeated assessments gave researchers a week-by-week record of participants’ symptoms and reported experiences.
Feedback Built Into the Check-In
The team did more than collect answers. They also used participants’ responses to provide feedback at the end of each check-in:
- Below every threshold: the participant saw a list of available support resources.
- At or above a threshold on any questionnaire: the participant first saw a message indicating elevated symptoms, followed by the list of resources.
- Suicidal ideation: the next page showed the contact details of the regional helpline, and an automatic email went to the project coordinator, who followed up with the participant by phone.
These pathways connected self-monitoring with support resources. The questionnaire thresholds were screening indicators, not clinical diagnoses.
After the 12 Weeks
Between February and April 2021, participants were invited to complete a follow-up questionnaire about their experience. Thirty participants were randomly selected for individual telephone interviews lasting about 15 minutes.
Where Avicenna Fits
Avicenna provided the infrastructure for the weekly self-monitoring program. It was used to:
- Deliver the weekly check-in on participants’ own smartphones
- Send the weekly notification and 12-hour reminders
- Present the validated questionnaires and context questions in French
- Show messages and support resources based on each participant’s answers
- Collect and store weekly responses for longitudinal analysis
By combining recurring questionnaires, reminders, conditional feedback, and data collection, the platform supported a single workflow with two purposes. For the research team, it produced repeated measures of distress across two pandemic waves. For participants, it provided a short, regular opportunity to reflect on their well-being, with support resources presented when their answers indicated elevated symptoms.
What Participants Took From It
Among the 424 participants who completed the follow-up questionnaire, mean adherence over the 12 weeks was 74.5%, and mean satisfaction was 8.0 out of 10. Of the 418 respondents who answered the self-awareness question, 305 (72.8%) said the app contributed moderately or a lot to their awareness of their own well-being.
Satisfaction and perceived improvements in self-awareness were associated with higher adherence, although these factors explained only a modest share of the differences in participants’ adherence.
The interviews helped explain how participants experienced the program. Most interviewees described the weekly check-in as a moment to pause and reflect on their own state, something they rarely made time for during the pandemic:
“I found that [using the app] had benefits, in the sense that it helped us to make certain realizations, that it helped us to take a moment to stop when it’s not always something we think about doing.”
Some participants were surprised by a distress message. Several described it as a “wake-up call” that prompted them to take action, such as consulting their physician, talking with family or colleagues, setting limits at work, or reducing their exposure to pandemic news. Others incorporated the check-in into a weekly routine:
“I always did it at the same time, after reading the newspaper on Saturday, and it was a bit of a retrospective of my week, part of my little ritual of taking care of myself.”
These accounts reflect participants’ reported experiences. They do not establish that the app itself caused improvements in mental health.
Quotes are from interview participants, as published in Khaldoun et al. (2025).
One Program, Several Analyses
The weekly data supported several analyses of how psychological distress developed over time.
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Assessment of psychological distress in health care workers during and after the first wave of COVID-19 (2021): How did distress evolve during and after the first wave? Using data from 373 health care workers collected between May and September 2020, the study identified four trajectories. About two-thirds of participants followed a resilient trajectory.
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Assessment of psychological distress in health care workers during the first two waves of COVID-19 (2022): Did the same patterns hold through the second wave? With 787 participants and data collected through January 2021, about two-thirds again followed a resilient trajectory. Among participants who experienced distress, symptoms were transient in many cases. However, the study could not establish whether distress would resolve for participants whose symptoms remained elevated at the end of monitoring.
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Longitudinal assessment and determinants of short-term and longer-term psychological distress (2023): What distinguishes short-term from longer-term distress? Analyzing 382 participants, the study examined distress lasting less than four weeks versus four weeks or more, along with the personal and work-related factors associated with each.
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Health care workers’ experience with a psychological self-monitoring app (2025): How did participants experience weekly self-monitoring, and what was associated with continued participation? This mixed-methods study examined app data from 424 participants and interviews with 30 participants. It found that satisfaction and perceived contributions to self-awareness were associated with adherence, while interviews highlighted reflection and self-care as themes in participants’ experiences.
Together, these publications show how a recurring data collection program can support several research questions, from symptom trajectories to participants’ experiences of self-monitoring.
Research Team
Steve Geoffrion, Ph.D.
Senior author of all four papers
Centre de recherche de l’Institut universitaire en santé mentale de Montréal
École de psychoéducation, Université de Montréal
Nicolas Bergeron, M.D.
Co-author of all four papers
Centre de recherche du Centre hospitalier de l’Université de Montréal
Département de psychiatrie et d’addictologie, Université de Montréal
Marie-Michèle Dufour
First author of the 2021 and 2022 distress trajectory analyses
École de psychoéducation, Université de Montréal
Filippo Rapisarda
First author of the 2023 analysis of short-term and longer-term distress
Research Centre, Institut universitaire en santé mentale de Montréal
Lydia Khaldoun, B.Sc.
First author of the 2025 user experience study
Centre de recherche de l’Institut universitaire en santé mentale de Montréal
École de psychoéducation, Université de Montréal
Publications
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Assessment of Psychological Distress in Health-care Workers during and after the First Wave of COVID-19: A Canadian Longitudinal Study. Dufour, M.-M., Bergeron, N., Rabasa, A., Guay, S., & Geoffrion, S. (2021). The Canadian Journal of Psychiatry, 66(9), 807–814.
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Assessment of Psychological Distress in Health Care Workers During the First Two Waves of COVID-19: A Follow-up of a Canadian Longitudinal Study. Dufour, M.-M., Bergeron, N., Guay, S., & Geoffrion, S. (2022). Chronic Stress, 6.
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Longitudinal assessment and determinants of short-term and longer-term psychological distress in a sample of healthcare workers during the COVID-19 pandemic in Quebec, Canada. Rapisarda, F., Bergeron, N., Dufour, M.-M., Guay, S., & Geoffrion, S. (2023). Frontiers in Psychiatry, 14, 1112184.
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Health Care Workers’ Experience With a Psychological Self-Monitoring App During the COVID-19 Pandemic: Mixed Methods Study. Khaldoun, L., Bellemare, F., Genest, C., Bergeron, N., & Geoffrion, S. (2025). JMIR mHealth and uHealth, 13, e70412.
Planning a Similar Study?
Weekly self-monitoring like this program relies on a few building blocks. Surveys hold the validated questionnaires, and a Time Triggering Logic repeats the check-in every week for each participant’s Participation Period. Notifications send the weekly prompt and reminders. They can also email a member of the research team when a participant’s answers meet conditions defined with Criteria. Flow Control determines which questions and messages each participant sees based on their answers.
For studies involving several institutions or languages, Multi-Site Studies and Localization provide options for coordinating study setups across sites and languages. Responses can be exported as Raw Data for longitudinal analysis.
Explore Avicenna’s features and integrations or talk to our team to see how you can build your study protocol.