Text Messaging Versus Email Messaging to Support Patients With Major Depressive Disorder: Protocol for a Randomized Hybrid Type II Effectiveness-Implementation Trial.

Medard Kofi Adu,Adegboyega Sapara,Andrew J Greenshaw,Ejemai Eboreime,Michael Achor,Rajan Chawla,Felix Osiogo,Pierre Chue,Reham Shalaby,Nnamdi Nkire,Chidi Chima,Vincent Israel Agyapong

doi:10.2196/29495

Abstract

BackgroundMajor depressive disorder (MDD) accounts for 40.5% of disability-adjusted life years caused by mental and substance use disorders. Barriers such as stigma and financial and physical access to care have been reported, highlighting the need for innovative, accessible, and cost-effective psychological interventions. The effectiveness of supportive SMS text messaging in alleviating depression symptoms has been proven in clinical trials, but this approach can only help those with mobile phones.ObjectiveThis paper presents the protocol for a study that will aim to evaluate the feasibility, comparative effectiveness, and user satisfaction of daily supportive email messaging as an effective strategy compared to daily supportive text messaging as part of the treatment of patients with MDD.MethodsThis trial will be carried out using a hybrid type II implementation-effectiveness design. This design evaluates the effectiveness of an implementation strategy or intervention, while also evaluating the implementation context associated with the intervention. Patients with MDD receiving usual care will be randomized to receive either daily supportive email messaging or daily supportive text messaging of the same content for 6 months. The Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, and the 5-item World Health Organization Well-Being Index will be used to evaluate the effectiveness of both strategies. The implementation evaluation will be guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework, as well as the Consolidated Framework for Implementation Research. All outcome measures will be analyzed using descriptive and inferential statistics. Qualitative data will be analyzed using thematic analysis.ResultsData collection for this trial began in April 2021. We expect the study results to be available within 18 months of study commencement. The results will shed light on the feasibility, acceptability, and effectiveness of using automated emails as a strategy for delivering supportive messages to patients with MDD in comparison to text messaging.ConclusionsThe outcome of this trial will have translational impact on routine patient care and access to mental health, as well as potentially support mental health policy decision-making for health care resource allocation.Trial RegistrationClinicalTrials.gov NCT04638231; https://clinicaltrials.gov/ct2/show/NCT04638231International Registered Report Identifier (IRRID)DERR1-10.2196/29495

Highlights

BackgroundDepression is a debilitating condition characterized by changes in mood, self-attitude, cognitive functioning, sleep, appetite, and energy levels [1,2]
The Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, and the 5-item World Health Organization Well-Being Index will be used to evaluate the effectiveness of both strategies
The results will shed light on the feasibility, acceptability, and effectiveness of using automated emails as a strategy for delivering supportive messages to patients with Major depressive disorder (MDD) in comparison to text messaging. The outcome of this trial will have translational impact on routine patient care and access to mental health, as well as potentially support mental health policy decision-making for health care resource allocation

Summary

Introduction

BackgroundDepression is a debilitating condition characterized by changes in mood, self-attitude, cognitive functioning, sleep, appetite, and energy levels [1,2]. Psychosocial interventions and pharmacotherapy are among preferred first-line treatments for severe mental health problems including major depression [9] Psychotherapies, such as cognitive behavior therapy, interpersonal psychotherapy, problem-solving, and behavioral activation are common and effective forms of treatment for depression [9]. Major depressive disorder (MDD) accounts for 40.5% of disability-adjusted life years caused by mental and substance use disorders. Barriers such as stigma and financial and physical access to care have been reported, highlighting the need for innovative, accessible, and cost-effective psychological interventions. The effectiveness of supportive SMS text messaging in alleviating depression symptoms has been proven in clinical trials, but this approach can only help those with mobile phones

Methods

Results

Conclusion