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Accepted for/Published in: JMIR Mental Health

Date Submitted: Mar 5, 2021
Date Accepted: May 6, 2021

The final, peer-reviewed published version of this preprint can be found here:

A Digital Toolkit (M-Healer) to Improve Care and Reduce Human Rights Abuses Against People With Mental Illness in West Africa: User-Centered Design, Development, and Usability Study

Ben-Zeev D, Meller S, Snyder J, Attah DA, Albright L, Le H, Asafo SM, Collins PY, Ofori-Atta A

A Digital Toolkit (M-Healer) to Improve Care and Reduce Human Rights Abuses Against People With Mental Illness in West Africa: User-Centered Design, Development, and Usability Study

JMIR Ment Health 2021;8(7):e28526

DOI: 10.2196/28526

PMID: 34255712

PMCID: 8285751

Development of M-Healer: A Digital Toolkit to Improve Care and Reduce Human Rights Abuses Against People with Mental Illness in West Africa

  • Dror Ben-Zeev; 
  • Suzanne Meller; 
  • Jaime Snyder; 
  • Dzifa A. Attah; 
  • Liam Albright; 
  • Hoa Le; 
  • Seth M. Asafo; 
  • Pamela Y. Collins; 
  • Angela Ofori-Atta

ABSTRACT

Background:

West African mental healthcare systems have severely constrained resources that contribute to significant unmet mental health needs. Consequently, people with psychiatric conditions often receive care from traditional and faith healers. Healers may use practices that constitute human rights violations, such as flogging, caging, forced fasting, and chaining.

Objective:

Our multinational team partnered with healers in Ghana in order develop a smartphone toolkit designed to support dissemination of evidence-based psychosocial interventions and strengthening of human rights awareness in the healer community.

Methods:

We conducted on-site observations and qualitative interviews with healers, a group co-design session, content development and prototype system build out, and usability testing.

Results:

Qualitative Interviews: Eighteen healers completed individual interviews. Participants reported on their understanding of the causes and treatments of mental illnesses. They identified situations in which they elect to use mechanical restraints and other coercive practices. Participants described an openness to using a smartphone-based application to help introduce them to alternative practices. Co-Design Session: Twelve healers participated. Eight participants (67%) reported owning a smartphone. Participants reported that they prefer spiritual guidance but that it was acceptable that M-Healer would provide mostly non-spiritual content. They provided suggestions for who should be depicted as the toolkit protagonist and ranked their preferred content delivery modality in the following order: live-action video, animated video, comic strip, and still images with text. Participants viewed “mood board” prototypes and rated their preferred visual design in the following order: religious theme, nature motif, community/ medical, and Ghanaian culture. Content Development and Prototype Build Out: Content was organized into modules including an introduction to the system, brief mental health interventions, verbal de-escalation strategies, guided relaxation techniques, and human rights training. Each module contains several scripted digital animation videos with accompanying audio narration in English or Twi. The module menu is represented by touchscreen icons and a single word or phrase to maximize accessibility to users with limited literacy. Usability Testing: Twelve participants completed M-Healer usability testing. Participants commented that they liked the look and functionality of the application, and understood the content. Participants reported the information and displays were clear. They navigated the application successfully but identified several areas where usability can be enhanced. Post-testing usability measures indicated participants found M-Healer to be feasible, acceptable, and usable.

Conclusions:

This study is the first to develop a digital mental health toolkit for healers in West Africa. Engaging healers in user-centered development produced an accessible and acceptable resource. Future field-testing will determine whether M-Healer can improve healer practices and reduce human rights abuses.


 Citation

Please cite as:

Ben-Zeev D, Meller S, Snyder J, Attah DA, Albright L, Le H, Asafo SM, Collins PY, Ofori-Atta A

A Digital Toolkit (M-Healer) to Improve Care and Reduce Human Rights Abuses Against People With Mental Illness in West Africa: User-Centered Design, Development, and Usability Study

JMIR Ment Health 2021;8(7):e28526

DOI: 10.2196/28526

PMID: 34255712

PMCID: 8285751

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