@article{f402d48d753f4edfadec76097f2d11ba,
title = "Adaptation of the World Health Organization Electronic Mental Health Gap action programme intervention guide app for mobile devices in Nepal and Nigeria: Protocol for a feasibility cluster randomized controlled trial",
abstract = "Background: There is a growing global need for scalable approaches to training and supervising primary care workers (PCWs) to deliver mental health services. Over the past decade, the World Health Organization Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) and associated training and implementation guidance have been disseminated to more than 100 countries. On the basis of the opportunities provided by mobile technology, an updated electronic Mental Health Gap Action Programme Intervention Guide (e-mhGAP-IG) is now being developed along with a clinical dashboard and guidance for the use of mobile technology in supervision. Objective: This study aims to assess the feasibility, acceptability, adoption, and other implementation parameters of the e-mhGAP-IG for diagnosis and management of depression in 2 lower-middle-income countries (Nepal and Nigeria) and to conduct a feasibility cluster randomized controlled trial (cRCT) to evaluate trial procedures for a subsequent fully powered trial comparing the clinical effectiveness and cost-effectiveness of the e-mhGAP-IG and remote supervision with standard mhGAP-IG 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 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 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 the e-mhGAP-IG. Secondary implementation outcomes include the adoption of the e-mhGAP-IG and feasibility of trial procedures. The secondary intervention outcome—and the 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 at both sites to prepare for the pilot feasibility cRCT, and the e-mhGAP-IG and remote supervision guidelines have been developed. Conclusions: The 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.",
keywords = "Community mental health, Digital technology, EHealth, Intervention, LMIC, Mental health, MHealth, Mobile phone, Primary health care, Remote supervision, Training",
author = "Salisbury, {Tatiana Taylor} and Kohrt, {Brandon A.} and Ioannis Bakolis and Jordans, {Mark J.D.} and Louise Hull and Luitel, {Nagendra P.} and Paul McCrone and Nick Sevdalis and Pooja Pokhrel and Kenneth Carswell and Akin Ojagbemi and Green, {Eric P.} and Neerja Chowdhary and Lola Kola and Heidi Lempp and Tarun Dua and Maria Milenova and Oye Gureje and Graham Thornicroft",
note = "Funding Information: The Emilia program is a collaboration of research colleagues in 5 countries committed to improving the identification and treatment of mental health problems in LMICs. It is coordinated by the Centre for Global Mental Health, Institute of Psychiatry, Psychology, and Neuroscience at King?s College London. This work was supported by the Medical Research Council (grant MR/S001255/1). NS, GT, and LH?s research is supported by the National Institute for Health Research (NIHR) Applied Research Collaboration South London at King?s College Hospital National Health Service (NHS) Foundation Trust. NS, GT, and LH are members of King?s Improvement Science, which offers cofunding to the NIHR Applied Research Collaboration South London and comprises a specialist team of improvement scientists and senior researchers based at King?s College London. GT?s and HL?s work was also supported by the Guy?s and St Thomas? Charity for the On Trac project (EFT151101), and by the UK Medical Research Council (UKRI) in relation the Indigo Partnership (MR/R023697/1). HL is additionally supported by a grant by the National Axial Spondyloarthritis Society and the NIHR (RP-PG-0610-10066). NS and GT are further funded by the NIHR Global Health Research Unit on Health System Strengthening in sub-Saharan Africa, King?s College London (GHRU 16/136/54), using aid from the UK government to support global health research. NS?s research is further supported by the ASPIRES (Antibiotic Use Across Surgical Pathways-Investigating, Redesigning, and Evaluating Systems) research program, funded by the Economic and Social Research Council. TTS?s research is supported by a UK Research and Innovation Future Leaders Fellowship (MR/T019662/1). The authors alone are responsible for the views expressed in this study, and they do not necessarily represent the views, decisions, or policies of the institutions with which they are affiliated or the funders. Funding Information: The Emilia program is a collaboration of research colleagues in 5 countries committed to improving the identification and treatment of mental health problems in LMICs. It is coordinated by the Centre for Global Mental Health, Institute of Psychiatry, Psychology, and Neuroscience at King{\textquoteright}s College London. This work was supported by the Medical Research Council (grant MR/S001255/1). NS, GT, and LH{\textquoteright}s research is supported by the National Institute for Health Research (NIHR) Applied Research Collaboration South London at King{\textquoteright}s College Hospital National Health Service (NHS) Foundation Trust. NS, GT, and LH are members of King{\textquoteright}s Improvement Science, which offers cofunding to the NIHR Applied Research Collaboration South London and comprises a specialist team of improvement scientists and senior researchers based at King{\textquoteright}s College London. GT{\textquoteright}s and HL{\textquoteright}s work was also supported by the Guy{\textquoteright}s and St Thomas{\textquoteright} Charity for the On Trac project (EFT151101), and by the UK Medical Research Council (UKRI) in relation the Indigo Partnership (MR/R023697/1). HL is additionally supported by a grant by the National Axial Spondyloarthritis Society and the NIHR (RP-PG-0610-10066). NS and GT are further funded by the NIHR Global Health Research Unit on Health System Strengthening in sub-Saharan Africa, King{\textquoteright}s College London (GHRU 16/136/54), using aid from the UK government to support global health research. NS{\textquoteright}s research is further supported by the ASPIRES (Antibiotic Use Across Surgical Pathways-Investigating, Redesigning, and Evaluating Systems) research program, funded by the Economic and Social Research Council. TTS{\textquoteright}s research is supported by a UK Research and Innovation Future Leaders Fellowship (MR/T019662/1). The authors alone are responsible for the views expressed in this study, and they do not necessarily represent the views, decisions, or policies of the institutions with which they are affiliated or the funders. Publisher Copyright: {\textcopyright} Tatiana Taylor Salisbury, Brandon A Kohrt, Ioannis Bakolis, Mark JD Jordans, Louise Hull, Nagendra P Luitel, Paul McCrone, Nick Sevdalis, Pooja Pokhrel, Kenneth Carswell, Akin Ojagbemi, Eric P Green, Neerja Chowdhary, Lola Kola, Heidi Lempp, Tarun Dua, Maria Milenova, Oye Gureje, Graham Thornicroft. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.",
year = "2021",
month = jun,
doi = "10.2196/24115",
language = "English",
volume = "10",
journal = "JMIR research protocols",
issn = "1929-0748",
publisher = "JMIR Publications Inc.",
number = "6",
}
