JMIR Publications

ABSTRACT

Background:

Mental health conditions are a significant public health problem globally, responsible for over 8 million deaths per year. They also lead to lost productivity, exacerbate physical illness, and people with mental health problems suffer stigma and human rights violations. Uganda, like many low- and middle-income countries (LMICs), faces a massive treatment gap for mental health conditions, and numerous sociocultural challenges exacerbate the burden of mental health conditions.

Objective:

To describe the development and formative evaluation of a digital health intervention for improving access to mental healthcare in Uganda.

Methods:

This was a qualitative study employing principles of user-centered design and design science research. Stakeholders, including patients, caregivers, mental healthcare providers, and implementation experts (N=65), participated in focus group discussions in which we explored participants’ experience of mental illness and mental healthcare, experience with digital interventions, and opinions about a proposed digital mental health service. Data was analyzed using the consolidated framework for implementation research to derive requirements for the digital solution, which was iteratively co-created with users.

Results:

Several challenges were identified, including a severe shortage of mental health facilities, unmet mental health information needs, heavy burden of caregiving, financial challenges, stigma, and negative beliefs related to mental health. Participants’ enthusiasm about digital solutions as feasible, acceptable and convenient for accessing mental health services was also revealed, along with recommendations to make the service user-friendly, affordable, available 24/7, and to ensure anonymity. A hospital call center service was developed to provide mental health information and advice in two languages through interactive voice response and live calls with healthcare professionals and peer support workers (recovering patients). Early implementation results indicate positive user feedback, with callers appreciating the inclusion of peer support workers who share their personal recovery journeys. However, some recommendations from participants (e.g., adding video calls options) could not be accommodated due to resource limitations or technical feasibility, and it is not possible to address individualized clinical questions such as prescriptions.

Conclusions:

This study demonstrates a systematic and theory-driven approach for developing contextually appropriate digital solutions for improving mental healthcare in Uganda and similar contexts. The positive reception of the implemented service underscores its potential impact. Future research should address the identified limitations, and evaluate clinical outcomes of long-term adoption.