Acceptability and feasibility of Community-based mHealth Motivational Interviewing Tool for Depression (COMMIT-D) to improve adherence to treatment

基于社区的 mHealth 抑郁症动机访谈工具 (COMMIT-D) 提高治疗依从性的可接受性和可行性

• 批准号: 10407416
• 负责人: Bibhav Acharya
• 金额: $ 11.04万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-01 至 2022-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10407416
• 关键词: Address; Adherence; Antidepressive Agents; Appointment; Behavior; Behavioral; Caring; Chronic; Clinic; Collaborations; Communication; Communities; Community Healthcare; Community Workers; Consent; Educational workshop; Ethics; Feedback; Government; Health; Health Personnel; Home; Human; Intervention; Manuscripts; Measures; Mental Depression; Mentors; Mobile Health Application; Modeling; Nepal; Outcome; Pathway interactions; Patient-Focused Outcomes; Patients; Persons; Population; Questionnaires; Research; Research Personnel; Rural; Social Psychology; Specialist; Structure; Supervision; Testing; Thinking; Time; Travel; United States; Work; Writing; acceptability and feasibility; base; design; digital; effectiveness evaluation; extrinsic motivation; improved; knowledge base; lectures; mHealth; motivational enhancement therapy; pilot trial; prevent; skills; support tools; tool; treatment adherence

Project Summary Poor adherence to treatment is a global problem in depression care, with one-third of patients discontinuing antidepressants in the first month of treatment. Community healthcare workers (CHWs) have successfully used Motivational Interviewing (MI) to improve treatment adherence for various illnesses in the US and globally. However, persistent challenges include: 1) lack of real-time support for communication skills (such as MI) as the CHWs are talking to the patients; and 2) decay of MI skills among CHWs through time in the absence of ongoing supervision because CHWs work away from facilities, traveling from one patient's home to another. Mobile health (mHealth) tools have the potential to address these challenges by: 1) providing MI decision- support in the community; and 2) creating patient-CHW audio recordings, which can then be used by supervisors to help CHWs maintain MI skills, preventing skill decay. Building on our work over the last ten years in rural Nepal, we will develop an mHealth app for CHWs—Community-based mHealth Motivational Interviewing Tool for Depression (COMMIT-D)—that will provide decision-support for MI and capture consented audio recordings of patient interactions for review and feedback by facility-based MI specialists. The scientific premise is based on three well-established behavioral principles: five-step design thinking (iterative stakeholder inputs enhance acceptability and feasibility), social psychology (intrinsic, rather than extrinsic, motivation correlate with positive behaviors), and the MI causal chain model (MI-consistent statements made by CHWs improve patient outcomes). We have already developed facility- and mobile-based digital decision-support tools for depression and other chronic conditions in Nepali. Whereas our existing tools focus on knowledge-based skills, the proposed intervention will focus on communication skills (e.g., assessing the patient’s stage of change and responding in an MI-consistent manner). Using the five-step human-centered design thinking, we will iteratively develop and test COMMIT-D with frequent, structured input from stakeholders. We will then conduct a 6-month pilot trial to study its acceptability and feasibility among patients, CHWs, and their supervisors. We will assess pathways to impact by measuring CHW fidelity to MI principles (using the standard tool MITI), treatment adherence (antidepressants and clinic appointments), and the overall impact on depression outcomes (Patient Health Questionnaire-9 scores). Our team constitutes a ten-year-long collaboration between the research team, the Nepali non-profit healthcare provider Possible, and the Nepal Government. This study will develop and sustain research capacity-building in Nepal by supporting researchers via in-person workshops, online lectures, and mentored research in mHealth, MI, depression, manuscript writing, and ethical conduct of research. If successful, the results from this study will inform a well-powered trial to assess effectiveness and relevance to underserved global populations, including those in the United States.

项目概要 治疗依从性差是抑郁症治疗中的一个全球性问题，三分之一的患者停止治疗 社区医护人员 (CHW) 在治疗的第一个月就成功使用了抗抑郁药物。 动机访谈 (MI) 旨在提高美国和全球各种疾病的治疗依从性。 然而，持续存在的挑战包括：1）缺乏对沟通技能（例如 MI）的实时支持 社区卫生工作者正在与患者交谈；2) 在缺乏指导的情况下，社区卫生工作者的 MI 技能随着时间的推移而下降。 由于社区卫生工作者的工作地点远离医疗机构，需要从一个患者的家到另一个患者的家，因此需要进行持续的监督。 移动医疗 (mHealth) 工具有潜力通过以下方式应对这些挑战：1) 提供 MI 决策- 社区支持；2) 创建患者 CHW 录音，供社区卫生工作者使用 督导人员帮助社区卫生工作者保持 MI 技能，防止技能衰退。 在尼泊尔农村，我们将为社区卫生工作者开发一款移动医疗应用程序——基于社区的移动医疗励志 抑郁症访谈工具 (COMMIT-D)——将为 MI 和捕获提供决策支持 同意患者互动的录音，供设施内的 MI 专家审查和反馈。 科学前提基于三个行之有效的行为原则：五步设计思维 （迭代利益相关者的投入增强了可接受性和可行性），社会心理学（内在的，而不是 外在动机与积极行为相关）以及 MI 因果链模型 （CHW 做出的与 MI 一致的声明可改善患者的治疗效果）。 以及针对尼泊尔语抑郁症和其他慢性病的基于移动设备的数字决策支持工具。 除了我们现有的工具侧重于基于知识的技能之外，拟议的干预措施还将侧重于 沟通技巧（例如，评估患者的变化阶段并以与 MI 一致的方式做出反应） 采用以人为本的五步设计思维，迭代开发和测试COMMIT-D 然后，我们将根据利益相关者频繁、结构化的意见进行为期 6 个月的试点研究。 我们将评估影响途径。 通过测量 CHW 对 MI 原则的忠诚度（使用标准工具 MITI）、治疗依从性 （抗抑郁药和诊所预约），以及对抑郁结果的总体影响（患者健康 问卷9分数）。我们的团队是研究团队、研究团队之间长达十年的合作。 尼泊尔非营利医疗保健提供者可能，尼泊尔政府将开展和维持这项研究。 通过现场研讨会、在线讲座和支持研究人员来建设尼泊尔的研究能力 指导了移动医疗、MI、抑郁症、手稿写作和研究道德行为方面的研究。 如果成功的话，这项研究的结果将为一项强有力的试验提供信息，以评估其有效性和相关性 全球人口服务不足，包括美国人口。