JMIR Publications

ABSTRACT

Background:

Mobile phone apps could constitute a cost-effective strategy to overcome healthcare system access barriers to mental health services for people in low and middle income countries.

Objective:

The aim of this paper is to explore the patients’ perspectives of CONEMO (Emotional Control, in Spanish: Control Emocional), a technology-driven, psycho-educational and nurse-supported intervention delivered via a smartphone application aimed at reducing depressive symptoms in people with diabetes and/or hypertension, who attend to public health care centers, as well as the nurses’ feedback about their role and its feasibility to be scaled up.

Methods:

This manuscript combines data from two pilot studies performed in Lima, Peru, between 2015 and 2016, to test the feasibility of CONEMO. Interviews were conducted with 29 patients with diabetes and / or hypertension with comorbid depressive symptoms, who used CONEMO, and six 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 to six main domains: the perceived health benefit, usability, adherence, user satisfaction with the app, the nurse’s support, and suggestions to improve the intervention. Interviews with nurses were analyzed by the same approach and categorized into four domains: general feedback, evaluation of training, evaluation of study activities and feasibility of implementing this intervention within existing structures of health system.

Results:

Patients perceived improvement of their emotional health due to CONEMO, while 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 SMS, 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 suggested improvements in the technological training and an increase in the amount of contact. Nurses reported some difficulties completing their tasks and explained that CONEMO intervention activities competed with their everyday work-routine.

Conclusions:

Using a nurse-supported smartphone application to reduce depressive symptoms among people with chronic diseases is possible and mostly perceived beneficial by the patients, but requires context-specific adaptations regarding the implementation of a task-shifting approach within the public healthcare system. These results provide valuable information about user feedback for those building mHealth interventions for depression.