Doukani Asmae, van Dalen Robin, Valev Hristo, Njenga Annie, Sera Francesco, Chibanda Dixon
Department of Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
Inuka Foundation, Rapsodieplantsoen 11, 1312EJ Almere, Netherlands.
Glob Ment Health (Camb). 2021 Mar 10;8:e9. doi: 10.1017/gmh.2021.3. eCollection 2021.
Sub-Saharan Africa (SSA) has the largest care gap for common mental disorders (CMDs) globally, heralding the use of cost-cutting approaches such as task-shifting and digital technologies as viable approaches for expanding the mental health workforce. This study aims to evaluate the effectiveness of a problem-solving therapy (PST) intervention that is delivered by community health volunteers (CHVs) through a mobile application called 'Inuka coaching' in Kenya.
A pilot prospective cohort study recruited participants from 18 health centres in Kenya. People who self-screened were eligible if they scored 8 or higher on the Self-Reporting Questionnaire-20 (SRQ-20), were aged 18 years or older, conversant in written and spoken English, and familiar with the use of smart mobile devices. The intervention consisted of four PST mobile application chat-sessions delivered by CHVs. CMD measures were administered at baseline, 4-weeks (post-treatment), and at 3-months follow-up assessment.
In all, 80 participants consented to the study, of which 60 participants (female, = 38; male, = 22) completed their 4-week assessments, and 52 participants completed their 3-month follow-up assessment. The results showed a significant improvement over time on the Self-Reporting Questionnaire-20 (SRQ-20). Higher-range income, not reporting suicidal ideation, being aged over 30 years, and being male were associated with higher CMD symptom reduction.
To our knowledge, this report is the first to pilot a PST intervention that is delivered by CHVs through a locally developed mobile application in Kenya, to which clinically meaningful improvements were found. However, a randomised-controlled trial is required to robustly evaluate this intervention.
撒哈拉以南非洲地区（SSA）在全球常见精神障碍（CMD）的治疗缺口最大，这预示着采用诸如任务转移和数字技术等成本削减方法是扩大精神卫生劳动力的可行途径。本研究旨在评估由社区卫生志愿者（CHV）通过肯尼亚一款名为“Inuka辅导”的移动应用程序提供的问题解决疗法（PST）干预措施的有效性。
一项前瞻性队列试点研究从肯尼亚的18个健康中心招募参与者。自我筛查的人若在20项自评问卷（SRQ - 20）中得分8分或更高、年龄在18岁及以上、精通英语读写且熟悉智能移动设备的使用，则符合条件。干预措施包括由社区卫生志愿者提供的4次问题解决疗法移动应用聊天课程。在基线、4周（治疗后）和3个月随访评估时进行常见精神障碍测量。
共有80名参与者同意参与研究，其中60名参与者（女性 = 38；男性 = 22）完成了4周评估，52名参与者完成了3个月随访评估。结果显示，20项自评问卷（SRQ - 20）随时间有显著改善。较高收入、未报告有自杀意念、年龄超过30岁以及男性与常见精神障碍症状减轻程度较高相关。
据我们所知，本报告首次试点了由社区卫生志愿者通过肯尼亚当地开发的移动应用程序提供的问题解决疗法干预措施，并发现了具有临床意义的改善。然而，需要进行随机对照试验来有力评估这一干预措施。
