Abstract
BackgroundTask-shifting and technology in psychological interventions are two solutions to increasing access to mental health intervention and overcoming the treatment gap in low and middle-income countries. The CONEMO intervention combines a smartphone app with support from non-specialized professionals, aiming to treat depression in patients with diabetes and/or hypertension. The aim of this paper is to describe the process of recruitment, training and supervision of the non-specialized professionals who participated in the CONEMO task-shifting intervention in Brazil and Peru.MethodsWe described and analyzed data related to the recruitment, training and supervision of 62 nurse assistants from the health system in Sao Paulo, Brazil, and three hired nurses in Lima, Peru. The data were collected from information provided by nurses and nurse assistants, supervisor records from supervision meetings and the CONEMO platform database.ResultsWe found that task-shifting was feasible using existing resources in Sao Paulo and additional human resources in Lima. Training and supervision were found to be crucial and well received by the staff; however, time was a limitation when using existing human resources. Ensuring technological competence prior to the start of the intervention was essential. Group supervision meetings allowed non-specialized professionals to learn from each other’s experiences.ConclusionCarefully considering recruitment, training and supervision of non-specialized professionals is important for effective task-shifting when delivering an mHealth intervention for depression. Opportunities and challenges of working in different health systems are described, which should be considered in future implementation, either for research or real settings.Trial registration NCT028406662 (Sao Paulo), NCT03026426 (Peru).
Highlights
Task-shifting and technology in psychological interventions are two solutions to increasing access to mental health intervention and overcoming the treatment gap in low and middle-income countries
Aim The aim of this paper is to provide a description of the process of recruitment, training and supervision of nonspecialized workers who participated in a task-shifting intervention in two Rand‐ omized control trial (RCT) in Sao Paulo and Lima
Recruitment and sample characteristics In Sao Paulo, Family health unit (FHU) Managers were requested to conduct the recruitment; in reality, this was mostly completed by the head nurse since they had more knowledge about nurse assistants1 (NA)’ competences
Summary
Task-shifting and technology in psychological interventions are two solutions to increasing access to mental health intervention and overcoming the treatment gap in low and middle-income countries. The aim of this paper is to describe the process of recruitment, training and supervision of the non-specialized professionals who participated in the CONEMO task-shifting intervention in Brazil and Peru. In low and middle-income countries (LMICs), mental disorders account for 11.1% of the total burden of disease [1–3], yet only 10–25% of people with mental health conditions receive treatment [3–5]. One contributory factor to this treatment gap is the low number of mental health workers in LMICs: it is estimated an additional 1.18 million mental health professionals are required to attend basic needs [6]. In Brazil and Peru, there have been efforts to implement mental health reforms to increase access; the lack of financial and human resources are significant barriers [9]
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