Feasibility of group versus individual self-management of depression using a mobile app, to increase treatment adherence among Dominican primary care patients.

使用移动应用程序对抑郁症进行团体与个人自我管理的可行性，以提高多米尼加初级保健患者的治疗依从性。

• 批准号: 10005476
• 负责人: SUSAN CAPLAN
• 金额: $ 17.58万
• 依托单位: NORTHERN ILLINOIS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-01 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10005476
• 关键词: Activities of Daily Living; Address; Adherence; Adult; Android; Antidepressive Agents; Cellular Phone; Clinic; Cognitive Therapy; Communication; Community Health Aides; Computers; Country; Dominican; Dominican Republic; Effectiveness; Emotional; Ensure; Evaluation; Exercise; Exposure to; Frequencies; Funding; Group Therapy; Health; Health Services Accessibility; Healthcare; Hispanics; Income; Individual; Institution; Internet; Intervention; Intervention Studies; Knowledge; Language; Logistics; Low income; Major Depressive Disorder; Measures; Mediating; Medical; Mental Depression; Mental Health; Mental Health Services; Mobile Health Application; Modality; Modeling; Monitor; Online Systems; Outcome; Outcome Measure; Participant; Patient Care; Patients; Perception; Persons; Population; Primary Health Care; Privacy; Process; Program Evaluation; Provider; Psychotherapy; Questionnaires; Randomized; Randomized Controlled Trials; Research; Self Management; Social Interaction; Social Perception; Social support; System; Telephone; Testing; Text; Time; Training; Travel; United States; Voice; Work; base; behavioral health; care seeking; community setting; cost; depressed patient; depression prevention; depressive symptoms; design; digital; disability; evidence base; experience; handheld mobile device; health care availability; health care delivery; health care settings; health literacy; improved; low and middle-income countries; mHealth; medical specialties; mobile application; multidisciplinary; peer; peer support; portability; preference; primary care setting; primary outcome; programs; prototype; recruit; research study; response; secondary outcome; self help; smartphone Application; social; social stigma; therapy design; treatment adherence; treatment as usual

In the Dominican Republic, depression is rarely treated until a person is severely ill and unable to perform activities of daily living. This is due to the unavailability of antidepressants, the cost of and logistical barriers to obtaining psychotherapy, stigma, and low mental health literacy which preclude recognition of depression. Health care delivered through mobile devices (known as mHealth) could surmount many of these barriers due to its ease of access and privacy. Guided mHealth to deliver mental health interventions (MHapps) have been shown to be effective in High Income Countries, (HICs). However, in Low and Middle-Income Countries (LMICs), where access to health care is limited, there have been few interventional research studies conducted using MHapps. The purpose of this project is to develop processes to ensure feasible dissemination of the app within an integrated primary care - behavioral health care setting and to evaluate its implementation. The app, El Buen Consejo Móvil (EBCM) has the functionality to connect individuals to one another via a CHW-guided chat room (ECBM-G) or to receive the same contents as an individualized program without the group functionality. The app allows users to communicate with others or their CHW guide using voice and text. This research builds upon several recently funded studies in the DR which: explored stigma and mental health service delivery; modified the contents of an evidenced-based CBT depression prevention course for Dominicans; and further modified this course for use in an MHapp. In the proposed study, we will refine the app and increase capacity for integrated primary care- behavioral health care for depression. We will conduct a randomized controlled trial in a primary care clinic in Santo Domingo among 120 patients who screen positive for mild to moderate depression on the Patient Health Questionnaire (PHQ-9). The MHapp will be downloaded to the participant’s own Android phone. We will evaluate process outcomes for CHWs and primary care staff, including 1) feasibility, 2) fidelity, 3) acceptability, and 4) perceived confidence in identifying and managing patients’ symptoms of depression. The primary outcomes for app users will be acceptability of the app and perceptions of social interactivity for those randomized to the group condition. We will assess the acceptability of EBCM, and, for users randomized to the group condition, perceptions of social interactivity using the Computer-Mediated Communication Questionnaire rating scale and open-ended questions. The Online Social Support Scale will be administered to measure perceptions of peer social support in the domains of Emotional Support, Social Companionship, Informational and Instrumental Support. Level of adherence and effectiveness, the secondary outcomes, will be assessed by frequency of interaction with the MHapp, completion of treatment for either treatment modality, and change in depressive symptoms. We hypothesize that the use of MHapps for guided self-help can be enhanced through group interaction. EBCM potentially will expand mental health service delivery in LMICs, for primary care patients who rarely seek care for depression.

在多米尼加共和国，抑郁症很少受到治疗，直到一个人严重生病并且无法执行 日常生活的活动。这是由于抗抑郁药的不可用，其成本和后勤障碍的 获得心理疗法，污名和心理健康素养低，从而排除了对抑郁症的认识。 通过移动设备（称为MHealth）提供的医疗保健可以克服许多此类障碍 为了易于访问和隐私。指导MHealth提供心理健康干预措施（MHAPPS） 被证明在高收入国家有效，（HIC）。但是，在低收入和中等收入国家 （LMIC），如果获得医疗保健的机会有限，则进行介入的研究很少 使用MHAPP。该项目的目的是开发流程以确保应用程序的可行传播 在综合的初级保健 - 行为医疗保健环境中并评估其实施。应用程序， El BuenConsejoMóvil（EBCM）具有通过CHW引导的个人连接个人的功能 聊天室（ECBM-G）或接收与没有组的个性化程序相同的内容 功能。该应用程序允许用户使用语音和文字与他人或其CHW指南进行通信。 这项研究基于博士最近资助的几项研究：探索污名和心理健康 服务交付；修改了基于证据的CBT抑郁预防课程的内容 多米尼加人；并进一步修改了本课程以用于MHAPP。在拟议的研究中，我们将完善 应用程序并增加了对抑郁症综合行为保健综合的能力。我们将进行 120名筛查阳性的患者的初级保健诊所的随机对照试验 对于患者健康问卷（PHQ-9）的轻度至中度抑郁症。 MHAPP将下载 参与者自己的Android手机。我们将评估CHW和初级保健人员的过程成果， 包括1）可行性，2）保真度，3）可接受性和4）识别和管理的信心 患者的抑郁症状。应用程序用户的主要结果将是应用程序的可接受性和 对随机到群体状况的人的社会互动感的看法。我们将评估可接受性 EBCM的，对于随机分配到组条件的用户，使用 计算机介导的通信问卷评级量表和开放式问题。在线社交 支持量表将进行管理，以衡量情感领域中对同伴社会支持的看法 支持，社会陪伴，信息和工具支持。依从性和 有效性，次要结果，将通过与MHAPP相互作用的频率来评估， 完成治疗方式的治疗方法，并改变抑郁症状。我们假设 可以通过小组互动来增强MHAPP进行指导自助的。 EBCM可能会 扩大LMIC的心理健康服务提供，对于很少寻求抑郁症护理的初级保健患者。