Promoting Mental Health of Teachers and Caregivers using a Personalized mHealth Toolkit in Uganda

摘要 儿童照料者的焦虑和抑郁是人群中最常见的心理健康问题 在撒哈拉以南非洲(SSA)国家，这是一个重大的公共卫生挑战，对其进行广泛的管理 战略目前还不存在。SSA的照顾者心理健康研究主要集中在父母身上 而不是教师，尽管据报道，教师中焦虑/抑郁的发生率很高。在乌干达(地点 在我们建议的研究中)，估计有28%的父母有心理健康问题，25%的教师有 焦虑/抑郁。解决照料者和教师心理健康需求的干预措施仍然有限， 部分原因是缺乏资源和具有成本效益的人口战略。因此，迫切需要发展 心理健康干预：1)改善教师和家长的压力管理，减少 精神健康问题的流行率；和2)采用低成本人口战略，以改善获得 对更广泛的学校系统的干预。该提案旨在测试可行性(R21阶段)和 新的移动健康应用干预的有效性(R33阶段)--健康和赋权的移动健康工具包 乌干达学校社区生活(MWEL)。MWEL-App是一款交互式预防干预工具 教师和家长作为一种自助支持方式。MWEL整合了三项关键的精神健康服务 功能：i)全面筛查以评估精神健康(焦虑、抑郁)、压力和相关 背景风险；ii)量身定制的优势和劣势简介/报告，并提出建议，以促进自我 提高认识和心理健康知识；三)有针对性的循证战略和额外支助 和临床资源，以提高压力管理、情绪调节和保持心理健康的技能 身体健康。为了促进可访问性和扩大人口覆盖面，mWEL将嵌入 我们将制定一种符合当地能力和能力的可持续的实施办法 政策。具体地说，我们将应用社区和同行授权的任务转移方法来开发 用于实施的劳动力。具体目标是：(1)建设数字化和信息化的研究和服务能力 公共卫生方法，以改善学校照顾者的心理健康；(2)测试和提高 MWEL-T和P，并测试两种工具包在小学的可行性和有效性；(3)测试 使用整群随机对照试验(CRCT)的mWEL优化版本的有效性；以及(4) 确定大数据分析策略，以改善Digital-Toolkit决策支持和精准心理健康 关心。

ABSTRACT Anxiety and depression in caregivers of children are the most prevalent mental health problems in populations in Sub-Saharan African (SSA) countries and are a major public health challenge for which broad management strategies currently do not exist. Caregiver mental health research in SSA has primarily focused on parents and not teachers despite high prevalence of anxiety/depression reported in teachers. In Uganda (the location of our proposed study), an estimated 28% of parents have mental health problems, and 25% of teachers have anxiety/depression. Intervention to address caregivers’ and teachers’ mental health needs remains limited, in part due to lack of resources and cost-effective population strategies. Thus, there is an urgent need to develop mental health interventions that: 1) improve both teachers and parents stress management and reduce prevalence of mental health problems; and 2) apply low-cost population strategies to improve accessibility of the interventions in the broader school system. This proposal seeks to test the feasibility (R21 phase) and effectiveness (R33 phase) of a new mHealth-App intervention, the mHealth Toolkit for Wellness & Empowering Lives of School Community (mWEL) in Uganda. mWEL-App is an interactive preventive intervention tool for teachers and parents as a self-help support modality. mWEL integrates three key mental health service functions: i) comprehensive screen to assess mental health (anxiety, depression), stress, and related contextual risks; ii) a tailored strength and weakness profile/report with recommendations to promote self- awareness and mental health knowledge; and iii) tailored evidence-based strategies and additional support and clinical resources to improve skills in stress management, emotion regulation, and maintain mental wellness. To promote accessibility and to have broader population reach, mWEL will be embedded in the education system and we will develop a sustainable approach to its implementation suited to local capacity and policy. Specifically, we will apply a community and peer-empowered task-shifting approach to develop a workforce for implementation. The Specific Aims are: (1) to build research and service capacity for digital and public health approaches to improve caregivers’ mental health in schools; (2) to test and enhance usability of the mWEL-T and P and to test feasibility and efficacy of both Toolkits in primary schools; (3) to test the effectiveness of the optimized versions of mWEL using a cluster-randomized control trial (cRCT); and (4) to identify big data analytic strategies for improving Digital-Toolkit decision support and precision mental health care.