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，抑郁症很少得到治疗，直到一个人病情严重，无法履行 日常生活活动。这是由于抗抑郁药的不可用，成本和后勤障碍， 获得心理治疗，耻辱和心理健康素养低，这妨碍了对抑郁症的认识。 通过移动的设备（称为mHealth）提供的医疗保健可以克服许多这些障碍， 它的便捷性和隐私性。引导mHealth提供心理健康干预（MHapps）已经 在高收入国家（HIC）中有效。在低收入和中等收入国家， （中低收入国家），在那里获得保健的机会有限，很少进行干预性研究 使用MHapps。该项目的目的是制定程序，以确保应用程序的可行传播 在一个综合的初级保健-行为卫生保健设置，并评估其实施。这个应用程序 El Buen Consejo Móvil（EBCM）具有通过CHW引导的个人相互连接的功能 聊天室（ECBM-G）或接收与没有群组的个性化节目相同的内容 功能.该应用程序允许用户使用语音和文本与他人或他们的CHW指南进行交流。 这项研究建立在DR最近资助的几项研究的基础上，这些研究： 服务提供;修改了循证CBT抑郁症预防课程的内容， 多米尼加人;并进一步修改了这门课程，用于MHapp。在建议的研究中，我们会改善 应用程序，并增加综合初级保健的能力-抑郁症的行为卫生保健。我们将进行 在圣多明各初级保健诊所进行的一项随机对照试验，纳入了120名筛查阳性的患者 患者健康问卷（PHQ-9）中的轻度至中度抑郁症。MHapp将被下载 到参与者自己的Android手机上。我们将评估CHW和初级保健人员的过程结果， 包括1）可行性，2）保真度，3）可接受性，4）识别和管理的感知信心 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， 社会互动的看法为那些随机分组条件。我们将评估 的EBCM，并为用户随机分组的条件下，社会互动的看法，使用 计算机介导的沟通问卷评分量表和开放式问题。在线社交 支持量表将被用来测量同伴社会支持在情感领域的感知 支持，社会友谊，信息和工具支持。遵守程度和 有效性，次要结局，将通过与MHapp的交互频率进行评估， 完成任一治疗方式的治疗，以及抑郁症状的变化。我们假设 使用MHapps进行引导自助可以通过小组互动来增强。EBCM可能会 扩大中低收入国家的精神卫生服务，为很少寻求抑郁症治疗的初级保健患者提供服务。