JMIR Publications

ABSTRACT

Background:

Recent research indicates that mental health remains among the top ten leading causes of disease burden globally and with a significant treatment gap due to lack of human resources for mental health, stigma, accessibility, uneven mental health services distribution, and lack of perceived need for treatment. Problem Management Plus, a World Health Organization endorsed brief psychological intervention for mental health disorders, has been tested for effectiveness and cost-effectiveness in various countries globally and has been recommended for scale up due to challenges in implementation like issues of quality-control in training, supervision and delivery. While digital technologies to foster mental healthcare worldwide hold the potential to close treatment gap and address issues of quality-control, there is a need to develop them in consideration of context and infrastructure with an interdisciplinary and participatory approach to increase impact and acceptance.

Objective:

To co-produce a Technology Assisted Problem Management Plus (TA-PM+) for lay (Lady) health worker (LHWs) to use in efficiently delivering sessions to women with symptoms of common mental health disorders within community settings of Pakistan.

Methods:

Three-stage framework of coproducing and prototyping public health interventions was used. Stage one, evidence-review and stakeholder consultation included three focus group discussions with 32 LHWs and seven in-depth interviews with key stakeholders from health system and health policy level. Deductive analyses using the Capability Opportunity, Motivation-Behavior (COM-B) model was conducted. In stage two, over eight online workshops, a multidisciplinary intervention development group co-produced the TA-PM+. Stage three, prototyping, included two rounds of usability testing with six LHWS and six participants, screened for depression and anxiety, using a 15-item usability scale for mHealth Apps used by healthcare providers (possible range 0-7) and Patient Satisfaction Questionnaire with mHealth intervention.

Results:

Qualitative analysis indicated lack of digital skills of LHWs, high workload of LHWs, resources scarcity for digitization specifically internet bandwidth in community, and need for comprehensive training were perceived barriers to implement TA-PM+ in the community through LHWs. Training, professional support, user guidance, easy and automated interface, offline functionalities, incentives, and deepening credibility among communities were perceived to enhance capability, opportunity and motivation of LHWs to implement TA-PM+. Informed by stage one, the TA-PM+ was coproduced with features like automated interface, personal dashboard, guidance videos, and connected supervisory panel. The Usability score in round one was X=5.62 and improved after incorporating feedback from LHWs to X=5.96 in round two.

Conclusions:

Co-production of TA-PM+ for lay health workers balanced context and evidence. Three-stage iterative development resulted in high usability and acceptability by lay health workers and the participants.