AniMovil mHealth Support for Depression Management in a Low-Income Country

 描述（由申请人提供）：由于资源有限，低收入和中等收入国家（LMIC）无法实施世界卫生组织（WHO）改善抑郁症结局的模式，其中社区卫生工作者（CHW）提供认知行为疗法（CBT）和其他心理治疗。我们将开发和评估一种移动健康干预措施，以增加中低收入国家精神卫生保健的覆盖面和有效性。基于我们在玻利维亚建立的移动健康合作研究基础，我们将开发和测试AniMóvil，这是一种可扩展的移动健康服务，旨在监测患者的抑郁症状，并提供基于CBT原则的定制行为激活信息。在目标1中，我们将与玻利维亚的精神卫生专业人员、潜在的社区卫生工作者和抑郁症患者合作，开发AniMóvil的移动健康组件，包括基于自动电话（IVR）和短信（SMS）的患者监测和心理教育，以及智能手机资源，使社区卫生工作者能够通过电话提供简短、结构化的CBT。患者的抑郁症状和CBT技能实践将每周通过IVR报告，患者将在这些电话中收到量身定制的行为激活消息。患者将每天通过短信报告他们的情绪，并根据这些报告接受强化和随访。患有严重抑郁症的患者将“加强”接受至少3次CHW提供的电话CBT会话。CHW将使用智能手机工具：访问有关CBT培训的信息，管理预约和临床记录，与彼此及其主管共享有关挑战性病例的信息，并请求监督咨询。在目标2中，我们将在114名抑郁症患者中进行随机试验，以确定AniMóvil对抑郁症相关结局的影响。患者将被随机分配到干预或增强的对照条件下，他们收到书面材料，并通过自动短信报告每日情绪信息。主要结局是3个月时抑郁缓解的患者比例。两组的SMS每日情绪报告将是一个关键的次要结局。该试验包括对干预过程的评估，例如患者和CHW使用mHealth工具以及计划成本。通过强调与玻利维亚共同研究者的合作，我们将提高他们独立进行移动健康科学发现的能力。如果有效，AniMóvil可以改善中低收入国家以人口为基础的精神卫生保健，以及CHW培训和监督的效率和质量，以提供世卫组织推荐的治疗。这项研究的证据将直接为玻利维亚精神卫生部关于国家扩大和财政可持续性的决策提供信息。研究结果还将指导更大规模的有效性试验和国际传播工作的设计。通过将SMS/IVR监控和患者激活与CHW和主管的智能手机支持相结合，Animóvil可以作为移动医疗服务的原型，增加患有其他高优先级非传染性疾病的LMIC患者获得护理管理的机会。

 DESCRIPTION (provided by applicant): Due to limited resources, low and middle-income countries (LMICs) have been unable to implement World Health Organization (WHO) models for improving depression outcomes, in which community health workers (CHWs) deliver cognitive behavioral therapy (CBT) and other psychological treatments. We will develop and evaluate an mHealth intervention that can increase the reach and effectiveness of mental health care in LMICs. Building on our established foundation of collaborative mHealth research in Bolivia, we will develop and test AniMóvil, a scalable mHealth service designed to monitor patients' depressive symptoms and deliver tailored behavioral activation messages derived from CBT principles. In Aim 1, we will collaborate with Bolivian mental health professionals, potential CHWs, and people with depression to develop AniMóvil's mHealth components, including automated phone (IVR)- and text message (SMS)-based patient monitoring and psychoeducation, plus smartphone resources that will enable CHWs to deliver brief, structured CBT by telephone. Patients' depressive symptoms and CBT skill-practice will be reported weekly via IVR, and patients will receive tailored behavioral activation messages during those calls. Patients will report their mood daily via SMS and receive reinforcement and follow-up based on those reports. Patients with severe depression will be "stepped up" to receive a minimum of 3 CHW-delivered telephone CBT sessions. CHWs will use smartphone tools to: access information about CBT training, manage appointments and clinical records, share information with one another and their supervisor regarding challenging cases, and request supervisory consults. In Aim 2, we will conduct a randomized trial among 114 depressed patients to determine the impact of AniMóvil on depression-related outcomes. Patients will be randomized to the intervention or an enhanced control condition in which they receive written materials and report daily mood information via automated SMS. The primary outcome will be the proportion of patients with remitted depression at 3 months. SMS daily mood reports in both arms will be a key secondary outcome. The trial includes an evaluation of intervention processes such as use of mHealth tools by patients and CHWs, and program costs. By emphasizing collaborative engagement with Bolivian co-investigators, we will increase their capacity for independent mHealth scientific discovery. If effective, AniMóvil could improve population-based mental health care in LMICs, as well as the efficiency and quality of CHW training and supervision for delivering WHO-recommended treatments. Evidence from this study will directly inform decision-making by the Bolivian Ministry of Mental Health regarding national scale-up and financial sustainability. Results also will guide the design of larger effectiveness trials and international dissemination efforts. By combining SMS/IVR monitoring and patient activation with smartphone support for CHWs and supervisors, Animóvil can serve as a prototype for mHealth services that increase access to care management for LMIC patients with other high priority non-communicable diseases.