Mobile Mental Health in Community-Based Organizations: A Stepped Care Approach to Women's Mental Health

社区组织中的移动心理健康：女性心理健康的阶梯式护理方法

• 批准号: 10052781
• 负责人: Amritha Subray Bhat
• 金额: $ 16.87万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-06-07 至 2023-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10052781
• 关键词: Address; Administrator; Adopted; Adoption; Algorithms; Applications Grants; Auditory; Behavioral; Benchmarking; Car Phone; Caring; Clinical Research; Communities; Community Health Aides; Community Medicine; Data Analyses; Depression and Suicide; Depression screen; Development; Diagnosis; Dropout; Education; Enrollment; Evaluation; Evidence based intervention; Family; Feedback; First Aid; Focus Groups; Friends; Funding; Future; Goals; Grant; Group Meetings; Health; Health Professional; Health care facility; Healthcare; Healthcare Systems; High Risk Woman; Human; Improve Access; India; Intervention; Interview; Language; Logic; Low income; Major Depressive Disorder; Manuscripts; Measures; Mediating; Mental Depression; Mental Health; Mental Health Services; Mentors; Mind; Mobile Health Application; Modeling; Morbidity - disease rate; Patients; Phase; Physicians; Pilot Projects; Play; Population; Primary Health Care; Process; Psychiatry; Psychotherapy; Questionnaires; Randomized; Research; Research Activity; Research Methodology; Research Project Grants; Resources; Role; Rural; Severities; Site; Standardization; Supervision; Symptoms; System; Testing; Therapeutic; Training; Translations; Transportation; Triage; Underserved Population; Voice; Woman; Writing; acceptability and feasibility; adherence rate; base; care providers; chronic depression; control trial; cost; depressive symptoms; design; disability; efficacy evaluation; feasibility testing; follow-up; health application; health care availability; health care model; health related quality of life; health service use; illiteracy; illiterate; innovation; low and middle-income countries; medical schools; meetings; mental training; mobile application; mobile computing; mortality; prenatal; programs; prototype; psychologic; public health intervention; response; screening; social stigma; suicide rate; symptom treatment; touchscreen; treatment as usual; treatment program; usability

PROJECT SUMMARY Background: Undiagnosed and untreated depression is a significant cause of morbidity and mortality in low-, middle-income countries (LMIC) such as India. The rates of diagnosis and treatment of depression among women in rural India are disproportionately low despite a primary care based task-sharing model of mental- health treatment. Stepped care approaches support appropriate treatment of symptoms while reducing the burden on healthcare systems and mobile technology can reduce the mental health treatment gap given its reach and easy access. However, our preliminary study at a task-sharing care model in rural south India revealed that illiteracy and the practice of sharing mobile phones as a family resource present hurdles to the adoption of mobile mental health (mHealth) based interventions. To date, the feasibility of a community based multiple user mHealth application to screen depression, track symptom severity and support the delivery of stepped care treatment has not been tested in LMIC. Specific Aim 1: In phase I of this exploratory study, we will adopt a user centered participatory approach to design and develop a multiple-user, voice-response, mobile application (“MITHRA”), to be used in community- based organizations for screening, tracking and supporting stepped care treatment for depression, including select modules of the Healthy Activity Program, a brief psychological intervention based on behavioral activation. The application will include audio, video and enhanced touchscreen capabilities, to overcome the barrier of illiteracy and lack of access. Specific Aim 2: In phase II, using a randomized-control design, we will examine feasibility and utility of “MITHRA” deployed at community-based organizations (n=3) vs enhanced usual care (n=3) in community- based organizations (enrolling approximately 60 women). Specific aim 3: Throughout the duration of the funding period we will arrange for mentored participation of Psychiatry and Community Medicine residents from India in the research project with involvement in the entire spectrum of research activities from interview development and conduct to qualitative and quantitative data analysis and manuscript writing and dissemination. This mentored participation will be supported by regular videoconferenced didactic and case presentation sessions on research methodology. The grant will accomplish the goals of developing a unique mobile application that is scalable, examining its feasibility and building research capacity at the research site in India.

项目概要 背景：未经诊断和治疗的抑郁症是低收入人群发病率和死亡率的一个重要原因。 印度等中等收入国家（LMIC）。抑郁症诊断率和治疗率 尽管存在基于初级保健的精神任务分担模式，但印度农村地区的妇女的生育率仍然偏低。 健康治疗。阶梯式护理方法支持对症状进行适当的治疗，同时减少 医疗保健系统的负担和移动技术可以缩小心理健康治疗差距 到达并轻松访问。然而，我们对印度南部农村地区任务分担护理模式的初步研究 据透露，文盲以及将手机作为家庭资源共享的做法给人们的生活带来了障碍。 采用基于移动心理健康（mHealth）的干预措施。迄今为止，基于社区的可行性 多用户 mHealth 应用程序可筛查抑郁症、跟踪症状严重程度并支持提供治疗 阶梯式护理治疗尚未在中低收入国家进行过测试。 具体目标 1：在本次探索性研究的第一阶段，我们将采用以用户为中心的参与式方法 设计和开发多用户语音响应移动应用程序（“MITHRA”），用于社区 - 筛查、跟踪和支持抑郁症分级护理治疗的组织，包括 健康活动计划的选择模块，这是基于行为的简短心理干预 激活。该应用程序将包括音频、视频和增强的触摸屏功能，以克服 文盲和缺乏机会的障碍。 具体目标 2：在第二阶段，我们将使用随机对照设计来检验以下方法的可行性和实用性： 部署在社区组织中的“MITHRA”（n=3）与社区中加强的常规护理（n=3） 基础组织（招募了大约 60 名女性）。 具体目标 3：在整个资助期间，我们将安排以下人员参与指导： 来自印度的精神病学和社区医学居民参与了整个研究项目 研究活动的范围从访谈的开展和实施到定性和定量数据 分析以及手稿撰写和传播。这种指导性的参与将得到定期的支持 关于研究方法的视频教学和案例演示会议。 这笔赠款将实现开发可扩展的独特移动应用程序的目标，并检查其 印度研究基地的可行性和研究能力建设。