JMIR Publications

ABSTRACT

Background:

The unmet need for mental health care impacts millions of Americans. A growing body of evidence in implementation science supports the effectiveness of task-sharing in the delivery of brief psychosocial interventions. The digitization of training and processes supporting supervision can rapidly scale up task-shared interventions and enable frontline health workers (FLWs) to learn, master, and deliver interventions with quality and support.

Objective:

To assess the perceived feasibility and acceptability of a novel web/mobile application (“app”) designed and adapted to support supervision, training, and quality assurance of FLWs delivering brief psychosocial interventions.

Methods:

We followed human-centered design principles to adapt a prototype app for FLWs delivering brief psychosocial interventions for depression, drawing from an app previously designed for use in rural India. We used a mixed methods approach to assess perceived feasibility and acceptability. Usability testing sessions and focus group discussions were conducted with FLWs recruited from a large health system in Texas. The positive System Usability Scale (SUS) was used to assess the app’s overall usability. We also calculated the participants’ likelihood of recommending the app to others using ratings of 0 to 10 from least to most likely (Net Promoter Score, NPS). Focus group transcripts were coded and analyzed thematically, and recommendations were summarized across four key domains.

Results:

A total of 18 FLWs varying in role and experience with client care participated in the study. Participants found the app to be usable with an average SUS of 72.5 (SD=18.1), consistent with the industry benchmark of 68. Participants’ likelihood of recommending the app ranged from 5 to 10, yielding an NPS of 0, indicating medium acceptability. Overall impressions of the app from participants were positive. Most participants found the app easy to access and navigate. The app was considered important to support FLWs in delivering high-quality mental healthcare services. Participants felt the app could provide more structure to FLW training and supervision processes through systematic collection and facilitation of performance-related feedback. Key concerns included privacy-related and time constraints in implementing a separate peer supervision mechanism that may add to FLWs’ workloads.

Conclusions:

We designed, built, and tested a usable, functional web/mobile app prototype that supports FLW-delivered psychosocial interventions in the US through a structured supervision mechanism and systematic collection and review of performance measures. The app has the potential to scale the work of FLWs tasked to deliver these interventions to the hardest-to-reach communities they serve. The results of this project inform future work to evaluate the app’s use and efficacy in real-world settings to support task-shared mental health programs across the United States.