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Abstract
BackgroundSmartphone apps could constitute a cost-effective strategy to overcome health care system access barriers to mental health services for people in low- and middle-income countries.ObjectiveThe aim of this paper was to explore the patients’ perspectives of CONEMO (Emotional Control, in Spanish: Control Emocional), a technology-driven, psychoeducational, and nurse-supported intervention delivered via a smartphone app aimed at reducing depressive symptoms in people with diabetes, hypertension or both who attend public health care centers, as well as the nurses’ feedback about their role and its feasibility to be scaled up.MethodsThis study combines data from 2 pilot studies performed in Lima, Peru, between 2015 and 2016, to test the feasibility of CONEMO. Interviews were conducted with 29 patients with diabetes, hypertension or both with comorbid depressive symptoms who used CONEMO and 6 staff nurses who accompanied the intervention. Using a content analysis approach, interview notes from patient interviews were transferred to a digital format, coded, and categorized into 6 main domains: the perceived health benefit, usability, adherence, user satisfaction with the app, nurse’s support, and suggestions to improve the intervention. Interviews with nurses were analyzed by the same approach and categorized into 4 domains: general feedback, evaluation of training, evaluation of study activities, and feasibility of implementing this intervention within the existing structures of health system.ResultsPatients perceived improvement in their emotional health because of CONEMO, whereas some also reported better physical health. Many encountered some difficulties with using CONEMO, but resolved them with time and practice. However, the interactive elements of the app, such as short message service, android notifications, and pop-up messages were mostly perceived as challenging. Satisfaction with CONEMO was high, as was the self-reported adherence. Overall, patients evaluated the nurse accompaniment positively, but they suggested improvements in the technological training and an increase in the amount of contact. Nurses reported some difficulties in completing their tasks and explained that the CONEMO intervention activities competed with their everyday work routine.ConclusionsUsing a nurse-supported smartphone app to reduce depressive symptoms among people with chronic diseases is possible and mostly perceived beneficial by the patients, but it requires context-specific adaptations regarding the implementation of a task shifting approach within the public health care system. These results provide valuable information about user feedback for those building mobile health interventions for depression.
Highlights
Mental health disorders are one of the main health burdens worldwide
Of the 20 leading causes of years lived with disability in the world, 9 of them are mental, neurological or substance use disorders [1]; neuropsychiatric disorders make a contribution of 13% to 14% to the global burden of disease, measured by the disability-adjusted life years (DALYs), because of the mortality and years of life lost derived from the time lived with compromised health [2,3,4]
Considering this high comorbidity, the great incidence of noncommunicable diseases (NCDs) in low- and middle-income countries (LMICs) [13,14], as well as the important possible negative consequences of this relationship on health outcomes [6,11,12,14,15,16,17,18] and adherence to treatment [8,16], interventions designed for individuals with depression and comorbid diabetes, hypertension or both are needed
Summary
Mental health disorders are one of the main health burdens worldwide. Of the 20 leading causes of years lived with disability in the world, 9 of them are mental, neurological or substance use disorders [1]; neuropsychiatric disorders make a contribution of 13% to 14% to the global burden of disease, measured by the disability-adjusted life years (DALYs), because of the mortality and years of life lost derived from the time lived with compromised health [2,3,4]. Shifting tasks within health care from a specialized professional to a person not specialized in the same field, for example, from a psychiatrist to a comprehensively trained nurse or other health worker not specialized in mental health, is a cost-effective [25,26] and cost-saving approach [27,28,29,30,31] It has shown promising results for a wide variety of health outcomes, including mental health conditions [32,33] such as depression [29,33], and could be an ideal option for LMIC settings to amplify the access to health care [34] where human resources are scarce. Smartphone apps could constitute a cost-effective strategy to overcome health care system access barriers to mental health services for people in low- and middle-income countries
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