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

在多米尼加共和国，抑郁症很少得到治疗，直到一个人病得很重，无法执行任务 日常生活活动。这是由于无法获得抗抑郁药、成本和后勤障碍。 获得心理治疗、耻辱和心理健康素养低，这排除了对抑郁症的认识。 通过移动设备(称为移动健康)提供的医疗保健可以克服其中许多障碍 其访问和隐私的简便性。引导移动健康提供心理健康干预(MHapp) 在高收入国家(高收入国家)被证明有效。然而，在低收入和中等收入国家 (LMICs)，在获得医疗保健的机会有限的情况下，很少进行干预性研究 使用MHapp。该项目的目的是制定流程，以确保应用程序的可行传播 在综合初级保健--行为保健的背景下，并评估其实施情况。这款应用， El Buen Consejo Móvil(EBCM)具有通过CHW引导的个人相互联系的功能 聊天室(ECBM-G)或在没有群的情况下接收与个性化节目相同的内容 功能性。这款应用程序允许用户使用语音和文本与其他人或他们的CHW指南进行交流。 这项研究建立在最近发表在《美国医学会杂志》上的几项研究的基础上，这些研究探讨了耻辱和心理健康 服务提供；修改了基于证据的CBT抑郁症预防课程的内容 多米尼加人；并进一步修改了该课程，以便在MHapp中使用。在拟议的研究中，我们将完善 APP和提高抑郁症初级保健-行为保健一体化的能力。我们将进行一项 在圣多明各一家初级保健诊所对120名筛查阳性的患者进行的随机对照试验 轻至中度抑郁症患者健康问卷(PHQ-9)。将下载MHapp 到参与者自己的Android手机上。我们将评估CHW和初级保健人员的流程结果， 包括1)可行性，2)保真度，3)可接受性，4)识别和管理的信心 病人的抑郁症状。应用程序用户的主要结果将是应用程序的接受度和 对那些随机进入群体的人的社交互动的看法。我们将评估其可接受性。 对于随机进入组状态的用户，使用 网络沟通问卷评定量表和开放式问题。网络社交 采用支持评定量表在情绪领域测量同伴社会支持知觉 支持、社会陪伴、信息和工具支持。遵守程度和 有效性，即次要结果，将通过与MHapp互动的频率进行评估， 完成任何一种治疗方式的治疗，以及抑郁症状的变化。我们假设 MHapp在引导自助方面的使用可以通过小组互动得到加强。EBCM可能会 扩大LMIC中的精神卫生服务，为很少寻求抑郁症治疗的初级保健患者提供服务。

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.