Dambi Jermaine, Norman Clara, Doukani Asmae, Potgieter Stephan, Turner Jean, Musesengwa Rosemary, Verhey Ruth, Chibanda Dixon
Rehabilitation Sciences Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe.
Friendship Bench, Harare, Zimbabwe.
JMIR Ment Health. 2022 Oct 7;9(10):e37968. doi: 10.2196/37968.
Common mental health disorders (CMDs) are leading causes of disability globally. The ongoing COVID-19 pandemic has further exacerbated the burden of CMDs. COVID-19 containment measures, including lockdowns, have disrupted access to in-person mental health care. It is therefore imperative to explore the utility of digital mental health interventions to bridge the treatment gap. Mobile health technologies are effective tools for increasing access to treatment at a lower cost. This study explores the utility of Inuka, a chat-based app hinged on the Friendship Bench problem-solving therapy intervention. The Inuka app offers double anonymity, and clients can book or cancel a session at their convenience. Inuka services can be accessed either through a mobile app or the web.
We aimed to explore the feasibility of conducting a future clinical trial. Additionally, we evaluated the feasibility, acceptability, appropriateness, scalability, and preliminary effectiveness of Inuka.
Data were collected using concurrent mixed methods. We used a pragmatic quasiexperimental design to compare the feasibility, acceptability, and preliminary clinical effectiveness of Inuka (experimental group) and WhatsApp chat-based counseling (control). Participants received 6 problem-solving therapy sessions delivered by lay counselors. A reduction in CMDs was the primary clinical outcome. The secondary outcomes were health-related quality of life (HRQoL), disability and functioning, and social support. Quantitative outcomes were analyzed using descriptive and bivariate statistics. Finally, we used administrative data and semistructured interviews to gather data on acceptability and feasibility; this was analyzed using thematic analysis.
Altogether, 258 participants were screened over 6 months, with 202 assessed for eligibility, and 176 participants were included in the study (recruitment ratio of 29 participants/month). The participants' mean age was 24.4 (SD 5.3) years, and most participants were female and had tertiary education. The mean daily smartphone usage was 8 (SD 3.5) hours. Eighty-three users signed up and completed at least one session. The average completion rate was 3 out of 4 sessions. Inuka was deemed feasible and acceptable in the local context, with connectivity challenges, app instability, expensive mobile data, and power outages cited as potential barriers to scale up. Generally, there was a decline in CMDs (F=2.63; P=.08), depression (F=7.67; P<.001), and anxiety (F=2.95; P=.06) and a corresponding increase in HRQoL (F=7.287; P<.001) in both groups.
Study outcomes showed that it is feasible to run a future large-scale randomized clinical trial (RCT) and lend support to the feasibility and acceptability of Inuka, including evidence of preliminary effectiveness. The app's double anonymity and structured support were the most salient features. There is a great need for iterative app updates before scaling up. Finally, a large-scale hybrid RCT with a longer follow-up to evaluate the clinical implementation and cost-effectiveness of the app is needed.
常见精神障碍（CMDs）是全球致残的主要原因。持续的新冠疫情进一步加剧了CMDs的负担。包括封锁在内的新冠疫情防控措施扰乱了面对面心理健康护理的获取途径。因此，探索数字心理健康干预措施以弥合治疗差距势在必行。移动健康技术是降低成本增加治疗可及性的有效工具。本研究探讨了基于友谊长椅问题解决疗法干预的聊天应用程序Inuka的效用。Inuka应用程序提供双重匿名性，客户可以在方便时预订或取消会话。可通过移动应用程序或网络访问Inuka服务。
我们旨在探讨开展未来临床试验的可行性。此外，我们评估了Inuka的可行性、可接受性、适用性、可扩展性和初步有效性。
使用并行混合方法收集数据。我们采用实用的准实验设计来比较Inuka（实验组）和基于WhatsApp聊天的咨询（对照组）的可行性、可接受性和初步临床有效性。参与者接受了由非专业咨询师提供的6次问题解决疗法会话。CMDs的减少是主要临床结果。次要结果是健康相关生活质量（HRQoL）、残疾和功能以及社会支持。使用描述性和双变量统计分析定量结果。最后，我们使用行政数据和半结构化访谈收集关于可接受性和可行性的数据；使用主题分析对其进行分析。
在6个月内共筛选了258名参与者，其中202名被评估是否符合资格，176名参与者被纳入研究（每月招募29名参与者的招募率）。参与者的平均年龄为24.4（标准差5.3）岁，大多数参与者为女性且拥有高等教育学历。平均每日智能手机使用时间为8（标准差3.5）小时。83名用户注册并完成了至少一次会话。平均完成率为4次会话中的3次。Inuka在当地环境中被认为是可行和可接受的，连接挑战、应用程序不稳定、昂贵的移动数据和停电被认为是扩大规模的潜在障碍。总体而言，两组的CMDs（F = 2.63；P = 0.08）、抑郁（F = 7.67；P < 0.001）和焦虑（F = 2.95；P = 0.06）均有所下降，HRQoL相应增加（F = 7.287；P < 0.001）。
研究结果表明，开展未来的大规模随机临床试验（RCT）是可行的，并支持Inuka的可行性和可接受性，包括初步有效性的证据。该应用程序的双重匿名性和结构化支持是最显著的特征。在扩大规模之前，非常需要对应用程序进行迭代更新。最后，需要进行一项大规模混合RCT，并进行更长时间的随访，以评估该应用程序的临床实施情况和成本效益。
