Objectives: This study will assess the feasibility, acceptability, adoption, and other implementation parameters of the e-mhGAP-IG for diagnosis and management of depression in two low- and middle-income countries (Nepal and Nigeria), as well as conduct a feasibility cluster randomised control trial (cRCT) to evaluate trial procedures for a subsequent fully-powered trial comparing the clinical and cost-effectiveness of e-mhGAP-IG and remote supervision with standard mhGAP implementation.
Methods: A feasibility cRCT will be conducted in Nepal and Nigeria to evaluate the feasibility of the e-mhGAP-IG for use in depression diagnosis and treatment. In each country, an estimated 20 primary health clinics (PHCs) in Nepal and 6 PHCs in Nigeria will be randomized to have their staff trained in e-mhGAP-IG or the paper version of mhGAP-IG v2.0. The PHC will be the unit of clustering. All primary care workers (PCWs) within a facility will receive the same training (e-mhGAP-IG vs. paper mhGAP-IG). Approximately 2-5 PCWs, depending on staffing, will be recruited per clinic (estimated n=20 health workers per arm in Nepal and 15 per arm in Nigeria). The primary outcomes of interest will be the feasibility and acceptability of training, supervision, and care delivery using e-mhGAP-IG. Secondary implementation outcomes include adoption of the e-mhGAP-IG and feasibility of trial procedures. The secondary intervention outcome—and primary outcome for a subsequent fully-powered trial—will be the accurate identification of depression by PCWs. Detection rates before and after training will be compared in each arm.
Results: To date, qualitative formative work has been conducted in both sites to prepare for the pilot cRCT, and the e-mhGAP-IG and remote supervision guidance have been developed.
Conclusions: Incorporation of mobile digital technology has the potential to improve the scalability of mental health services in primary care and enhance the quality and accuracy of care.
|Journal||JMIR research protocols|
|Publication status||Published - 1 Jun 2021|
- Mental health
- community mental health
- Digital technology
- Primary health care
- Remote supervision