Human Development Research Foundation, Rawalpindi, Pakistan.
Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK.
BMC Health Serv Res. 2022 Jun 30;22(1):842. doi: 10.1186/s12913-022-08233-6.
In low-income settings, ninety percent of individuals with clinical depression have no access to evidence-based psychological interventions. Reasons include lack of funds for specialist services, scarcity of trained mental health professionals, and the stigma attached to mental illness. In recent years there have been many studies demonstrating effective delivery of psychological interventions through a variety of non-specialists. While these interventions are cost-effective and less stigmatising, efforts to scale-up are hampered by issues of quality-control, and what has been described by implementation scientists as 'voltage-drop' and 'programme-drift.' Using principles of Human Centred Design in a rural setting in Pakistan, we worked with potential users to co-design a Tablet or Smartphone-based App that can assist a lay-person deliver the Thinking Healthy Programme, a World Health Organization-endorsed evidence-based intervention for perinatal depression. The active ingredients of this cognitive-therapy based intervention are delivered by a virtual 'avatar' therapist incorporated into the App which is operated by a 'peer' (a woman from the neighbourhood with no prior experience of healthcare delivery). Using automated cues from the App, the peer reinforces key therapeutic messages, helps with problem-solving and provides the non-specific but essential therapeutic elements of empathy and support. The peer and App therefore act as co-therapists in delivery of the intervention. The peer can deliver the intervention with good fidelity after brief automated in-built training. This approach has the potential to be applied to other areas of mental health and help bridge the treatment gap, especially in resource-poor settings. This paper describes the process of co-development with end-users and key features of the App.
在低收入环境中，90%的临床抑郁症患者无法获得基于证据的心理干预措施。原因包括缺乏专业服务资金、缺乏训练有素的心理健康专业人员以及精神疾病的污名化。近年来，有许多研究表明，通过各种非专业人员可以有效地提供心理干预措施。虽然这些干预措施具有成本效益且污名化程度较低，但扩大规模的努力受到质量控制问题以及实施科学家所谓的“电压降”和“项目漂移”的阻碍。我们在巴基斯坦的农村地区使用以人为本的设计原则，与潜在用户合作设计了一款基于平板电脑或智能手机的应用程序，可以帮助非专业人员提供 Thinking Healthy Programme，这是世界卫生组织认可的针对围产期抑郁症的基于证据的干预措施。这种基于认知疗法的干预措施的有效成分由虚拟“化身”治疗师通过应用程序提供，该应用程序由“同行”（来自社区的没有医疗保健提供经验的女性）操作。应用程序使用自动提示，同行可以加强关键治疗信息，帮助解决问题并提供同理心和支持等非特定但必要的治疗元素。因此，同行和应用程序可以共同作为干预措施的治疗师。经过简短的自动化内置培训，同行可以很好地忠实地提供干预措施。这种方法有可能应用于其他心理健康领域，并有助于缩小治疗差距，特别是在资源匮乏的环境中。本文介绍了与最终用户共同开发的过程和应用程序的主要特点。
