Toyama Mauricio, Cavero Victoria, Araya Ricardo, Menezes Paulo Rossi, Mohr David C, Miranda J Jaime, Diez-Canseco Francisco
CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.
Centre for Global Mental Health, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom.
JMIR Hum Factors. 2022 Sep 15;9(3):e35486. doi: 10.2196/35486.
Depression is one of the most prevalent mental disorders and a leading cause of disability, disproportionately affecting specific groups, such as patients with noncommunicable diseases. Over the past decade, digital interventions have been developed to provide treatment for these patients. CONEMO (Emotional Control in Spanish) is an 18-session psychoeducational digital intervention delivered through a smartphone app and minimally supported by a nurse. CONEMO demonstrated effectiveness in reducing depressive symptoms through a randomized controlled trial (RCT) among patients with diabetes, hypertension, or both, in Lima, Peru. However, in addition to clinical outcomes, it is important to explore users' experiences, satisfaction, and perceptions of usability and acceptability, which can affect their engagement with the intervention.
This study aimed to explore the RCT participants' experiences with CONEMO in Peru, complemented with information provided by the nurses who monitored them.
In 2018, semistructured interviews were conducted with a sample of 29 (13.4%) patients from the 217 patients who participated in the CONEMO intervention in Peru and the 3 hired nurses who supported its delivery. Interviewees were selected at random based on their adherence to the digital intervention (0-5, 10-14, and 15-18 sessions completed), to include different points of view. Content analysis was conducted to analyze the interviews.
Participants' mean age was 64.4 (SD 8.5) years, and 79% (23/29) of them were women. Most of the interviewed participants (21/29, 72%) stated that CONEMO fulfilled their expectations and identified positive changes in their physical and mental health after using it. Some of these improvements were related to their thoughts and feelings (eg, think differently, be more optimistic, and feel calmer), whereas others were related to their routines (eg, go out more and improve health-related habits). Most participants (19/29, 66%) reported not having previous experience with using smartphones, and despite experiencing some initial difficulties, they managed to use CONEMO. The most valued features of the app were the videos and activities proposed for the participant to perform. Most participants (27/29, 93%) had a good opinion about the study nurses and reported feeling supported by them. A few participants provided suggestions to improve the intervention, which included adding more videos, making the sessions' text simple, extending the length of the intervention, and improving the training session with long explanations.
The findings of this qualitative study provide further support and contextualize the positive results found in the CONEMO RCT, including insights into the key features that made the intervention effective and engaging. The participants' experience with the smartphone and CONEMO app reveal that it is feasible to be used by people with little knowledge of technology. In addition, the study identified suggestions to improve the CONEMO intervention for its future scale-up.
ClinicalTrials.gov NCT03026426; https://clinicaltrials.gov/ct2/show/NCT03026426.
抑郁症是最常见的精神障碍之一，也是导致残疾的主要原因，对特定群体的影响尤为严重，比如非传染性疾病患者。在过去十年里，人们开发了数字干预手段来为这些患者提供治疗。CONEMO（西班牙语为“情绪控制”）是一种通过智能手机应用程序提供的、为期18节的心理教育数字干预，由护士提供最少支持。CONEMO在秘鲁利马针对患有糖尿病、高血压或两者皆有的患者进行的一项随机对照试验（RCT）中，证明了其在减轻抑郁症状方面的有效性。然而，除了临床结果外，探索用户的体验、满意度以及对可用性和可接受性的看法也很重要，因为这些会影响他们对干预措施的参与度。
本研究旨在探索秘鲁CONEMO随机对照试验参与者的体验，并辅以监测他们的护士提供的信息。
2018年，对参与秘鲁CONEMO干预的217名患者中的29名（13.4%）患者以及3名支持该干预实施的聘用护士进行了半结构化访谈。根据他们对数字干预的依从性（完成0 - 5节、10 - 14节和15 - 18节）随机选择受访者，以纳入不同观点。对访谈进行了内容分析。
参与者的平均年龄为64.4（标准差8.5）岁，其中79%（23/29）为女性。大多数受访参与者（21/29，即72%）表示CONEMO达到了他们的期望，并指出使用后身心健康有积极变化。其中一些改善与他们的思想和感受有关（例如，以不同方式思考、更乐观、感觉更平静），而其他改善与他们的日常活动有关（例如，更多外出并改善与健康相关的习惯）。大多数参与者（19/29，即66%）报告此前没有使用智能手机的经验，尽管最初遇到了一些困难，但他们成功使用了CONEMO。该应用程序最受重视的功能是为参与者提议执行的视频和活动。大多数参与者（27/29，即93%）对研究护士评价良好，并表示得到了他们的支持。少数参与者提出了改进干预措施的建议，包括增加更多视频、简化课程文本、延长干预时间以及改进解释冗长的培训课程。
这项定性研究的结果为CONEMO随机对照试验中的积极结果提供了进一步支持和背景信息，包括对使干预有效且有吸引力的关键特征的见解。参与者使用智能手机和CONEMO应用程序的体验表明，技术知识较少的人也可以使用。此外，该研究还确定了改进CONEMO干预措施以便未来扩大规模的建议。
ClinicalTrials.gov NCT03026426；https://clinicaltrials.gov/ct2/show/NCT03026426
