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 implementation challenges like quality control issues in training, supervision, and delivery. While digital technologies to foster mental healthcare worldwide hold the potential to close the treatment gap and address quality control issues, there is a need to develop them considering 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 workers (LHWs) to use in efficiently delivering sessions to women with symptoms of common mental health disorders within community settings of Pakistan.

Methods:

A three-stage framework of coproducing and prototyping public health interventions was used. Stage one, stakeholder consultation, included three focus group discussions with 32 LHWs and seven in-depth interviews with key health system and health policy stakeholders. Deductive analyses using the Capability Opportunity, Motivation-Behaviour (COM-B) model was conducted. In stage two, a multidisciplinary intervention development group co-produced the TA-PM+ over eight online workshops. 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 that the lack of digital skills of LHWs, workload of LHWs, resource scarcity for digitization specifically internet bandwidth in the community, and the need for comprehensive training were perceived barriers to implementing 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 the capability, opportunity, and motivation of LHWs to implement TA-PM+. Informed by stage one, the TA-PM+ was coproduced with features like an automated interface, personal dashboard, guidance videos, and a 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.