Recruitment, training and supervision of nurses and nurse assistants for a task-shifting depression intervention in two RCTs in Brazil and Peru

TY - JOUR

T1 - Recruitment, training and supervision of nurses and nurse assistants for a task-shifting depression intervention in two RCTs in Brazil and Peru

AU - Rocha, Thais Izabel Ugeda

AU - Aschar, Suzana Crismanis de Almeida Lopes

AU - Hidalgo-Padilla, Liliana

AU - Daley, Kate

AU - Claro, Heloísa Garcia

AU - Martins Castro, Hellen Carolina

AU - dos Santos, Daniela Vera Cruz

AU - Miranda, J. Jaime

AU - Araya, Ricardo

AU - Menezes, Paulo Rossi

N1 - Funding Information: This study was funded by the NIMH—National Institute of Mental Health US (Grant Number: 1U19MH098780). Funding Information: The Latin America Treatment Innovation Network in Mental Health (LATIN-MH) is one of five hubs funded by the US-National Institute of Mental Health (NIMH) to research the use of task-shifting in LMICs to address mental health problems. LATIN-MH conducted two Randomized Controlled Trials (RCTs) to evaluate a task-shifting intervention, one in Brazil, one in Peru. Participants were being treated for diabetes and/or hypertension in the public health system and were experiencing depressive symptoms. The intervention (CONEMO) aims to reduce depressive symptoms that often coexist with chronic health conditions. CONEMO consists of 18 sessions, delivered three times a week, over a course of 6 weeks. It is based on Behavior Activation, delivered by smartphones and supported by nurses or nurse assistants (NA). Nurses/NA trained participants to use CONEMO, monitored app usage and adherence, called participants to follow-up on progress or encourage adherence; and gave technical support when necessary. The CONEMO platform has two interfaces: a participant-facing smartphone application and a professional-facing dashboard used to monitor participant progress. The platform assists in the supervision and enables data gathering. Given the known challenges in implementing task-shifting, nurses/NA were given training and supervision throughout. Publisher Copyright: © 2021, The Author(s). Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

PY - 2021/12

Y1 - 2021/12

N2 - Background: Task-shifting and technology in psychological interventions are two solutions to increasing access to mental health intervention and overcoming the treatment gap in low and middle-income countries. The CONEMO intervention combines a smartphone app with support from non-specialized professionals, aiming to treat depression in patients with diabetes and/or hypertension. The aim of this paper is to describe the process of recruitment, training and supervision of the non-specialized professionals who participated in the CONEMO task-shifting intervention in Brazil and Peru. Methods: We described and analyzed data related to the recruitment, training and supervision of 62 nurse assistants from the health system in Sao Paulo, Brazil, and three hired nurses in Lima, Peru. The data were collected from information provided by nurses and nurse assistants, supervisor records from supervision meetings and the CONEMO platform database. Results: We found that task-shifting was feasible using existing resources in Sao Paulo and additional human resources in Lima. Training and supervision were found to be crucial and well received by the staff; however, time was a limitation when using existing human resources. Ensuring technological competence prior to the start of the intervention was essential. Group supervision meetings allowed non-specialized professionals to learn from each other’s experiences. Conclusion: Carefully considering recruitment, training and supervision of non-specialized professionals is important for effective task-shifting when delivering an mHealth intervention for depression. Opportunities and challenges of working in different health systems are described, which should be considered in future implementation, either for research or real settings. Trial registration NCT028406662 (Sao Paulo), NCT03026426 (Peru).

AB - Background: Task-shifting and technology in psychological interventions are two solutions to increasing access to mental health intervention and overcoming the treatment gap in low and middle-income countries. The CONEMO intervention combines a smartphone app with support from non-specialized professionals, aiming to treat depression in patients with diabetes and/or hypertension. The aim of this paper is to describe the process of recruitment, training and supervision of the non-specialized professionals who participated in the CONEMO task-shifting intervention in Brazil and Peru. Methods: We described and analyzed data related to the recruitment, training and supervision of 62 nurse assistants from the health system in Sao Paulo, Brazil, and three hired nurses in Lima, Peru. The data were collected from information provided by nurses and nurse assistants, supervisor records from supervision meetings and the CONEMO platform database. Results: We found that task-shifting was feasible using existing resources in Sao Paulo and additional human resources in Lima. Training and supervision were found to be crucial and well received by the staff; however, time was a limitation when using existing human resources. Ensuring technological competence prior to the start of the intervention was essential. Group supervision meetings allowed non-specialized professionals to learn from each other’s experiences. Conclusion: Carefully considering recruitment, training and supervision of non-specialized professionals is important for effective task-shifting when delivering an mHealth intervention for depression. Opportunities and challenges of working in different health systems are described, which should be considered in future implementation, either for research or real settings. Trial registration NCT028406662 (Sao Paulo), NCT03026426 (Peru).

KW - Depression

KW - Diabetes

KW - Hypertension

KW - Mental health

KW - mhealth

KW - Recruitment

KW - Supervision

KW - Task-shifting

KW - Training

UR - http://www.scopus.com/inward/record.url?scp=85100570120&partnerID=8YFLogxK

U2 - 10.1186/s12960-021-00556-5

DO - 10.1186/s12960-021-00556-5

M3 - Article

AN - SCOPUS:85100570120

SN - 1478-4491

VL - 19

JO - Human Resources For Health

JF - Human Resources For Health

IS - 1

M1 - 16

ER -