Obsessive-compulsive disorder (OCD) is a mental disorder characterized by the presence of obsessions (i.e., distressing, intrusive, and recurring thoughts) and compulsions (i.e., repetitive behaviors or mental acts), which are heterogeneous in their content and cause significant distress and impairment [1].

Individuals with OCD, both adults and minors, experience a reduced quality of life, as well as lower social, occupational, and academic performance [2–4]. Regarding academic settings, OCD negatively impacts learning, as symptoms may interfere with productivity and concentration [5, 6]. Students may struggle to pay attention in class because they are preoccupied with their obsessions or may fail to complete assignments due to performing mental rituals [7]. Furthermore, compulsive behaviors are often a reason for becoming victims of bullying. People with OCD struggle to hide these behaviors, which can increase social isolation. To this effort, one may add the mental exhaustion inherent in compulsions and obsessions, leaving students with little energy to socialize [5].

OCD has a lifetime prevalence of 2.3% [8]. It affects between 1–3% of the youth population [2], with many experiencing subclinical symptoms [8]. The first symptoms often occur between childhood and adolescence, a period of considerable vulnerability [9, 10]. A substantial delay often exists between symptom onset and formal diagnosis of OCD [11], as well as in seeking formal treatment [12], despite the availability of empirically validated interventions [13]. In this sense, Hezel et al. [11] reported an average 11.4-year delay between the onset of obsessive-compulsive symptoms and their diagnosis, a phenomenon observed across different demographic groups. Furthermore, the age at onset has been identified as a significant predictor of diagnostic delay [14]. Specifically, patients with an early onset (prior to age 17) were diagnosed after an average of 11.7 years, compared to a delay of 5.6 years for those with later onset [10]. This delay is associated with poorer clinical response, worse prognosis, chronicity of OCD, and symptom severity [10–12, 14, 15]. Therefore, early detection during the initial stages of the disorder is crucial for providing adequate treatment [10, 11].

Limited help-seeking among individuals with OCD may be due, among other factors, to stigma associated with mental disorders and poor mental health literacy, that is, a poor understanding of mental disorders and their treatment, stigma, help-seeking efficacy and how to optimize and maintain good mental health [16].

Stigma and mental health literacy are critical factors that can be addressed to reduce delays in help-seeking behaviors. Educational settings represent ideal contexts for addressing these variables. First, education occurs during a critical developmental period in these settings [16, 17]. Second, students spend most of their time in classrooms, engaging in social interaction with peers [18]. Therefore, teachers occupy a privileged position for primary prevention of OCD, as they are constantly in contact with vulnerable individuals and can serve as sources of support both inside and outside of the school environment [6, 19, 20]. However, previous studies have found that teachers possess limited mental health literacy [19]. Educational programmes aimed at improving teachers’ ability to detect early symptoms of OCD could facilitate timely interventions for at-risk students [21]. Without proper training, teachers may misinterpret OCD symptoms as merely disruptive behavior [6] or disorders such as attention-deficit/hyperactivity disorder (ADHD) or oppositional defiant disorder [5]. Nonetheless, certain limitations hinder teachers’ capacity to act effectively, including insufficient knowledge about symptom manifestation in the classroom, high student-to-teacher ratios, and limited time for individual interactions [22].

For all these reasons, the development of educational programs for teachers is urgently needed. Thus far, some programs have been developed to address these variables in relation to mental health problems in general, such as The Mental Health and High School Curriculum Guide (the Guide) [16] or the Youth Mental Health First Aid course [22]. In the case of OCD, it is difficult to find specific interventions or educational programs in the literature [18]. White et al. [23] evaluated the knowledge of primary school teachers of Tourette syndrome, OCD, and ADHD before and after a training workshop. However, there was an unexpected decrease in OCD knowledge afterward. Jassi et al. [24] studied the effect of information packs and webinars on OCD knowledge among teachers and school staff. They concluded that reading the material increased participants’ general knowledge of symptoms and treatments; however, the effectiveness of the interventions was not assessed. Chaves et al. [19] published the first article evaluating the effectiveness of a brief educational intervention on teachers’ knowledge and stigmatizing attitudes about OCD. The program was effective in improving knowledge of OCD symptoms and increasing response strategies for students with OCD, although it was less effective at reducing stigma.

To address this gap, esTOCma, an educational program on OCD aimed at the general population, which uses new technologies and serious games, was developed [25]. This app-based intervention has been proven effective in increasing knowledge about OCD and help-seeking intentions, as well as reducing stigmatizing attitudes and social distance in general [25, 26] and clinical [27] populations.

The aim of this study is to assess the feasibility, acceptability, and preliminary effectiveness of the mobile app esTOCma from a quantitative and qualitative perspective among teachers. Additionally, the study explores areas for improvement to optimize the app for the educational context. We hypothesize that participants will consider esTOCma a feasible and acceptable tool for educational settings. Regarding preliminary efficacy, we hypothesize that the intervention will: (1) increase OCD knowledge, (2) reduce stigmatizing attitudes and desire for social distance associated with OCD, (3) increase OCD help-seeking intention in case of experiencing OCD symptoms, and (4) decrease the disturbance of their own OCD symptoms. Even though the main objective of the app is not to reduce OCD symptomatology, psychoeducation on the disorder and normalizing intrusions could act as primary prevention [28].

The aim of the present study was to assess whether esTOCma, a serious game designed to improve understanding of OCD, is feasible and acceptable, as well as to offer preliminary data about its effectiveness within the teaching field. Results indicate that esTOCma demonstrates feasibility and acceptability, and that completion of the game seems to be associated with positive changes in the variables of interest.

Of the total participants assigned to the intervention, 63.6% (21/33) completed the application, and of these, 90.5% (19/21) responded to the subsequent individual survey. Therefore, 36.4% (12/33) discontinued the application before completion. Even though this dropout rate is higher than the one in the study with the general population [26], it is lower than in the study with the clinical population [27] and lower than the common average attrition rate (57%) reported in online health interventions for depression [44]. Dropout before completion or sudden cessation of use represents a significant challenge in this type of intervention [45, 46]. Participants who completed the app were older than those who did not; in fact, older age has been associated with higher adherence in previous studies [47]. Other causes of attrition, as noted by participants, could be the duration of the app, the desire for more interactive elements or perceiving the app as not personally relevant [48]. Mitigation strategies for future versions of esTOCma could include shortening the app, including more gamified elements, incorporating enhanced push notifications, or progress tracking [49]. Enhancing usability features, as advised by participants, could help improve user engagement and completion rates [50]. Additionally, attrition-specific measures could be included in future studies [49].

Regarding usage patterns, the app recommended completing one mission per day, although adherence to this guideline was not mandatory. The most frequent pattern, observed in 26.3% (5/19) of participants, was completing esTOCma in one day or less, consistent with findings from studies in the general population [26]. On the contrary, participants in clinical population studies dedicated up to nine days to completion [27]. In the present study, most participants completed several missions on the same day following periods of inactivity, either continuously or at different times throughout the day. Interruptions may have resulted from participants forgetting or disregarding app notifications. Although all missions were brief (< 10 minutes), dropout during missions was concentrated in specific ones (missions 1, 6, and 7). This pattern was also observed in the study with the general population (missions 3, 4, 5, 7, 8) [26], although only the dropout trend in mission 7 was replicated here. These pauses may be attributable to the length or format of the missions. Mission 1 introduces OCD symptoms and typically follows completion of the pre-intervention assessment and introductory video, which may cause fatigue when receiving new information. Missions in module 2 (missions 6 and 7) are the longest (7–8 minutes) and include videos of patients describing OCD symptoms and interference. Shorter, more dynamic missions (i.e., missions 2, 3, 4, 5, 8, and 9) appeared more engaging.

The results suggest that esTOCma serves as a viable and applicable tool across diverse educational settings. Despite the limited number of participants, the heterogeneous characteristics of the sample help support this claim. The study includes teachers with a high educational level, a wide age range (28–62 years), and considerable variability in the educational levels (pre-school, primary and secondary education, vocational training, language school, and others) and types of institutions in which they teach, both public and private.

esTOCma demonstrated excellent acceptability, as measured by usability (SUS) and perceived usefulness (USE), with teachers reporting satisfaction with the application. These findings are consistent with those found in clinical populations [27]. Therefore, we have a tool that is easy to use and perceived as useful by teachers. Most participants would recommend the app to other colleagues, especially those interested in mental health. Moreover, they reported learning a lot about OCD: They formed a general idea of the disorder, its symptoms, and treatment. esTOCma illustrates the wide range of OCD content with effective mechanisms such as vignettes, practical examples/case studies, and personal experiences [51]. The need for this type of training is reflected in the literature [9].

Most teachers believe that esTOCma would be a useful tool for identifying students with OCD, although they expressed the need for additional information on how OCD symptoms manifest in the classroom, as they often appear covertly [6]. One teacher specified that receiving training on action protocols would increase their confidence in providing help. Understanding how confidence translates into helping behaviors constitutes a valuable future research direction. This would improve mental health literacy among teachers and, consequently, the mental health of students [18].

Several participants reported not having learned a resource directly applicable to the classroom, possibly because this version of esTOCma is not adapted to school contexts, as it is designed for the general population. The ultimate goal of this work is to explore the app in the teaching context to create a specific module for teachers as part of the application, providing an effective tool for identifying and managing students with OCD within the classroom. Hence, in this study, we aimed to assess which aspects teachers would consider relevant to include in a new version. The recommendations can be summarized as follows: (1) understanding possible manifestations of OCD symptoms in the classroom (e.g., include a list of OCD symptomatology in students, etc.); (2) establishing an action protocol (e.g., how to act when a student presents OCD symptoms, which school professional to approach, etc.); and (3) shortening the app’s duration. Following participants’ recommendations and literature [51], the next iteration of esTOCma for teachers should include a teacher-specific module featuring case studies of OCD symptoms in students, practical classroom action protocols, and interactive exercises. These adaptations would contribute to increased individualization and user-centered design [45]. In this way, adherence would be enhanced and the app would be more appealing and useful for teachers.

Regarding preliminary effectiveness, the current version of esTOCma improves mental health and OCD literacy. These results are consistent with traditional psychoeducational programs for teachers in the mental health field [16, 22] and for OCD [19, 23, 24]. These findings also align with studies of the app conducted in the general [25, 26] and clinical population [27]. App usage has also significantly decreased the levels of stigma associated with OCD. The same result has been observed with the extended version of the app in the general population [25, 26] and in interventions targeting stigma related to other mental disorders in educational contexts [52]. The results are also consistent with other training programs in mental health for teachers [16, 22]. esTOCma has proven more effective as an anti-stigma program than other educational interventions that use information sheets (e.g., [19]). Additionally, completing the application increases help-seeking intention among teachers, a result also observed after using esTOCma in the general population [25]. With this type of intervention, teachers can learn about how to early detect OCD symptoms and where to seek evidence-based help [25]. esTOCma could empower teachers to seek help for themselves and help their students to ask for formal help and have fewer stigmatizing attitudes towards it.

Although a reduction in social distance desire towards a person with OCD symptoms was observed, it did not reach statistical significance. This reduction was significant in studies conducted with the general population [25] and another serious game about stigma in mental disorders for students [52]. Likewise, distress scores related to OCD symptoms did not change. High levels were not expected in this variable, as it assesses personal OCD symptoms, which participants may not have. Studies with general [25] and clinical [27] populations did find a significant reduction in these symptoms. The non-significant reductions in social distance (SDS) and OCD symptom distress (OCI-4) may be due to the small sample size, low baseline scores, or the use of abbreviated instruments. Future studies should employ full versions of these scales to enhance sensitivity. Normalizing intrusions and increasing knowledge about OCD may function as protective factors for vulnerable groups [28, 30]. Learning about the OCD cognitive model (mission 3), the universality of the intrusions (mission 2), and the role played by dysfunctional appraisals (mission 3) could help participants not to worry or focus on their own normal intrusive thoughts. This would avoid appraising these thoughts dysfunctionally, therefore not facilitating that intrusive thoughts escalate into obsessions.

Some limitations must be considered. This is a pilot study, with a small sample size and no control group. While the sample size of 19 is consistent with other pilot studies (n = 10–14) evaluating user experiences in digital interventions [53–55], a power analysis suggests that a larger sample (n = 34) would be needed for more robust statistical conclusions in future trials for detecting medium effect size changes. However, due to the sample size, we advise caution in the generalizability of our findings to broader teacher populations. Also, the absence of a control group poses a limitation on the interpretation of causal claims made; a randomized controlled trial should be conducted for future validation. It must be considered that around 70% of the sample were women. The predominance of female participants may have influenced outcomes, as women have been found to be more prone to seeking professional help [56, 57]. Future studies should aim for balanced gender representation to explore potential gender-specific effects. Also, there is a considerable dropout rate (i.e., not completing the 10 missions), probably due to participants forgetting to continue. Another point is the narrative analysis of the open-ended questions, as there was only a single coder. Future studies should employ at least two independent coders and calculate inter-rater reliability (e.g., Cohen’s kappa) to enhance the robustness of thematic analyses.

Despite these limitations, this is the first study to evaluate the feasibility and acceptability of a psychoeducational intervention for OCD using indirect contact and cognitive restructuring for teachers with a mental health app. Moreover, preliminary data on its effectiveness are provided. Considering the aforementioned results, esTOCma has proven to be an effective tool for reducing stigma, increasing help-seeking intentions and knowledge about OCD, and is a feasible and acceptable tool to implement in educational settings.

Mental health literacy programs for teachers appear as a response to current social needs, given the increasing impact of mental disorders [58]. These consequences are also present in educational contexts, where school psychologists and teachers play a key role as they work with vulnerable populations daily. esTOCma provides a platform to make the reality of OCD visible in classrooms, offering a tool that allows for a better-informed and less biased teaching staff in mental health. When teachers are more knowledgeable about OCD symptoms and treatment, they can detect possible cases, encourage earlier help-seeking, and guide students towards professional help.