Triplett Noah S, Johnson Clara, Kiche Sharon, Dastrup Kara, Nguyen Julie, Daniels Alayna, Mbwayo Anne, Amanya Cyrilla, Munson Sean, Collins Pamela Y, Weiner Bryan J, Dorsey Shannon
Department of Psychology, University of Washington, Seattle, WA, United States.
Department of Psychiatry, University of Nairobi, Nairobi, Kenya.
JMIR Form Res. 2023 Feb 2;7:e38822. doi: 10.2196/38822.
Task shifting is an effective model for increasing access to mental health treatment via lay counselors with less specialized training that deliver care under supervision. Mobile phones may present a low-technology opportunity to replace or decrease reliance on in-person supervision in task shifting, but important technical and contextual limitations must be examined and considered.
Guided by human-centered design methods, we aimed to understand how mobile phones are currently used when supervising lay counselors, determine the acceptability and feasibility of mobile phone supervision, and generate solutions to improve mobile phone supervision.
Participants were recruited from a large hybrid effectiveness implementation study in western Kenya wherein teachers and community health volunteers were trained to provide trauma-focused cognitive behavioral therapy. Lay counselors (n=24) and supervisors (n=3) participated in semistructured interviews in the language of the participants' choosing (ie, English or Kiswahili). Lay counselor participants were stratified by supervisor-rated frequency of mobile phone use such that interviews included high-frequency, average-frequency, and low-frequency phone users in equal parts. Supervisors rated lay counselors on frequency of phone contact (ie, calls and SMS text messages) relative to their peers. The interviews were transcribed, translated when needed, and analyzed using thematic analysis.
Participants described a range of mobile phone uses, including providing clinical updates, scheduling and coordinating supervision and clinical groups, and supporting research procedures. Participants liked how mobile phones decreased burden, facilitated access to clinical and personal support, and enabled greater independence of lay counselors. Participants disliked how mobile phones limited information transmission and relationship building between supervisors and lay counselors. Mobile phone supervision was facilitated by access to working smartphones, ease and convenience of mobile phone supervision, mobile phone literacy, and positive supervisor-counselor relationships. Limited resources, technical difficulties, communication challenges, and limitations on which activities can be effectively performed via mobile phone were barriers to mobile phone supervision. Lay counselors and supervisors generated 27 distinct solutions to increase the acceptability and feasibility of mobile phone supervision. Strategies ranged in terms of the resources required and included providing phones and airtime to support supervision, identifying quiet and private places to hold mobile phone supervision, and delineating processes for requesting in-person support.
Lay counselors and supervisors use mobile phones in a variety of ways; however, there are distinct challenges to their use that must be addressed to optimize acceptability, feasibility, and usability. Researchers should consider limitations to implementing digital health tools and design solutions alongside end users to optimize the use of these tools.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s43058-020-00102-9.
任务转移是一种有效的模式，可通过接受较少专业培训的非专业咨询师在监督下提供护理，从而增加获得心理健康治疗的机会。手机可能提供了一个低技术手段的机会，以取代或减少任务转移中对面对面监督的依赖，但必须研究和考虑重要的技术和背景限制。
以以人为本的设计方法为指导，我们旨在了解在监督非专业咨询师时手机目前是如何使用的，确定手机监督的可接受性和可行性，并生成改进手机监督的解决方案。
参与者从肯尼亚西部一项大型混合有效性实施研究中招募，在该研究中，教师和社区卫生志愿者接受了以创伤为重点的认知行为疗法培训。非专业咨询师（n = 24）和监督员（n = 3）以参与者选择的语言（即英语或斯瓦希里语）参加了半结构化访谈。非专业咨询师参与者按监督员评定的手机使用频率分层，以便访谈中包括高频、中频和低频手机用户各占相同比例。监督员根据与同行相比的电话联系频率（即通话和短信）对非专业咨询师进行评级。访谈进行了转录，必要时进行翻译，并使用主题分析法进行分析。
参与者描述了手机的一系列用途，包括提供临床最新情况、安排和协调监督及临床小组，以及支持研究程序。参与者喜欢手机如何减轻负担、便于获得临床和个人支持以及使非专业咨询师更具独立性。参与者不喜欢手机如何限制信息传递以及监督员与非专业咨询师之间的关系建立。通过获得可用的智能手机、手机监督的轻松和便利、手机知识以及积极的监督员 - 咨询师关系，促进了手机监督。资源有限、技术困难、沟通挑战以及通过手机可有效执行哪些活动的限制是手机监督的障碍。非专业咨询师和监督员提出了27种不同的解决方案，以提高手机监督的可接受性和可行性。策略在所需资源方面各不相同，包括提供手机和通话时间以支持监督、确定进行手机监督的安静和私密场所，以及划定请求面对面支持的流程。
非专业咨询师和监督员以多种方式使用手机；然而，在使用手机方面存在明显挑战，必须加以解决以优化可接受性、可行性和可用性。研究人员应考虑实施数字健康工具的限制，并与最终用户一起设计解决方案，以优化这些工具的使用。
国际注册报告标识符（IRRID）：RR2 - 10.1186/s43058 - 020 - 00102 - 9。
