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.

项目摘要 对治疗的依从性不佳是抑郁症护理中的全球问题，其中三分之一的患者中断 治疗的第一个月抗抑郁药。社区医疗保健工人（CHW）已成功使用 动机访谈（MI）以提高美国和全球各种疾病的治疗依从性。 但是，持续的挑战包括：1）缺乏对沟通技巧的实时支持（例如MI） CHW正在与患者交谈。 2）在没有时间的情况下，CHW之间的MI技能衰减 持续的监督是因为CHW远离设施，从一个患者的家到另一个患者的家。 移动健康（MHealth）工具有可能通过以下方式解决这些挑战：1）提供MI决策 - 在社区中的支持； 2）创建患者-CHW录音，然后可以由 主管帮助CHW保持MI技能，以防止技巧衰减。在过去的十个工作中建立我们的工作 在尼泊尔农村地区，我们将开发一个用于CHW的MHealth应用程序 - 基于社区的MHealth激励性 抑郁症的采访工具（提交D） - 将为MI提供决策支持和捕获 基于设施的MI专家的审查和反馈的患者互动的同意录音。 科学前提是基于三个公认的行为原则：五步设计思维 （迭代利益相关者的投入增强可接受性和可行性），社会心理学（内在，而不是 外部动机与积极行为相关）和MI因果链模型 （CHW的MI一致陈述改善了患者的预后）。我们已经开发了设施 - 以及基于移动的数字决策支持尼泊尔抑郁症和其他慢性病的工具。 尽管我们现有的工具专注于基于知识的技能，但拟议的干预将重点放在 沟通技巧（例如，评估患者的变化阶段，并在MI一致的情况下做出反应 方式）。使用五步以人为本的设计思维，我们将迭代开发和测试commit-d 经常有来自利益相关者的结构化输入。然后，我们将进行6个月的试点试验，以研究其 患者，CHW及其主管之间的可接受性和可行性。我们将评估影响途径 通过测量对MI原理的CHW保真度（使用标准工具MITI），治疗依从性 （抗抑郁药和诊所任命）以及对抑郁症结果的总体影响（患者健康 问卷-9分数）。我们的团队构成了研究团队之间为期十年的合作 尼泊尔非营利性医疗保健提供者和尼泊尔政府。这项研究将发展并维持 通过面对面的研讨会，在线讲座和 在MHealth，MI，抑郁，手稿写作和研究道德行为的研究中进行了研究。 成功，这项研究的结果将为一项有力的试验提供信息，以评估有效性和相关性 服务不足的全球人口，包括美国的人口。