Poudyal Anubhuti, Lewis Delta-Marie, Taha Sarah, Martinez Alyssa J, Magoun Lauren, Ho Y Xian, Carmio Natali, Naslund John A, Sanchez Katherine, Lesh Neal, Patel Vikram
Department of Sociomedical Sciences, Columbia Mailman School of Public Health, New York, NY, United States.
Dimagi, Inc, Cambridge, MA, United States.
JMIR Form Res. 2024 Mar 11;8:e55205. doi: 10.2196/55205.
The unmet need for mental health care affects millions of Americans. A growing body of evidence in implementation science supports the effectiveness of task sharing in the delivery of brief psychosocial interventions. The digitization of training and processes supporting supervision can rapidly scale up task-shared interventions and enable frontline health workers (FLWs) to learn, master, and deliver interventions with quality and support.
We aimed to assess the perceived feasibility and acceptability of a novel mobile and web app designed and adapted to support the supervision, training, and quality assurance of FLWs delivering brief psychosocial interventions.
We followed human-centered design principles to adapt a prototype app for FLWs delivering brief psychosocial interventions for depression, drawing from an app previously designed for use in rural India. Using a multimethod approach, we conducted focus group sessions comprising usability testing and group interviews with FLWs recruited from a large health system in Texas to assess the feasibility and acceptability of the app. The positive System Usability Scale was used to determine the app's overall usability. We also calculated the participants' likelihood of recommending the app to others using ratings of 0 to 10 from least to most likely (net promoter score). Focus group transcripts were coded and analyzed thematically, and recommendations were summarized across 4 key domains.
A total of 18 FLWs varying in role and experience with client care participated in the study. Participants found the app to be usable, with an average System Usability Scale score of 72.5 (SD 18.1), consistent with the industry benchmark of 68. Participants' likelihood of recommending the app ranged from 5 to 10, yielding a net promoter score of 0, indicating medium acceptability. Overall impressions of the app from participants were positive. Most participants (15/18, 83%) found the app easy to access and navigate. The app was considered important to support FLWs in delivering high-quality mental health care services. Participants felt that the app could provide more structure to FLW training and supervision processes through the systematic collection and facilitation of performance-related feedback. Key concerns included privacy-related and time constraints regarding implementing a separate peer supervision mechanism that may add to FLWs' workloads.
We designed, built, and tested a usable, functional mobile and web app prototype that supports FLW-delivered psychosocial interventions in the United States through a structured supervision mechanism and systematic collection and review of performance measures. The app has the potential to scale the work of FLWs tasked with delivering these interventions to the hardest-to-reach communities they serve. The results of this project will inform future work to evaluate the app's use and efficacy in real-world settings to support task-shared mental health programs across the United States.
心理健康护理需求未得到满足影响着数百万美国人。实施科学领域越来越多的证据支持任务分担在提供简短心理社会干预方面的有效性。支持监督的培训和流程数字化可以迅速扩大任务分担干预的规模，并使一线卫生工作者（FLW）能够学习、掌握并高质量地提供干预措施并获得支持。
我们旨在评估一款新颖的移动应用程序和网络应用程序的可感知可行性和可接受性，该应用程序经过设计和调整，以支持提供简短心理社会干预的一线卫生工作者的监督、培训和质量保证。
我们遵循以用户为中心的设计原则，从先前为印度农村地区设计的一款应用程序中汲取经验，为提供抑郁症简短心理社会干预的一线卫生工作者改编了一个应用程序原型。我们采用多方法途径，与从德克萨斯州一个大型卫生系统招募的一线卫生工作者进行了焦点小组会议，包括可用性测试和小组访谈，以评估该应用程序的可行性和可接受性。使用积极的系统可用性量表来确定该应用程序的整体可用性。我们还使用从0（最不可能）到10（最有可能）的评分计算参与者向他人推荐该应用程序的可能性（净促进者得分）。对焦点小组记录进行编码并进行主题分析，并在4个关键领域总结了建议。
共有18名在客户护理方面角色和经验各异的一线卫生工作者参与了该研究。参与者发现该应用程序可用，系统可用性量表平均得分为72.5（标准差18.1），与行业基准68一致。参与者推荐该应用程序的可能性从5到10不等，净促进者得分为0，表明可接受性中等。参与者对该应用程序的总体印象是积极的。大多数参与者（15/18，83%）发现该应用程序易于访问和操作。该应用程序被认为对支持一线卫生工作者提供高质量心理健康护理服务很重要。参与者认为该应用程序可以通过系统收集和促进与绩效相关的反馈，为一线卫生工作者的培训和监督流程提供更多结构。主要担忧包括与隐私相关的问题以及实施单独的同伴监督机制可能增加一线卫生工作者工作量的时间限制。
我们设计、构建并测试了一个可用的、功能齐全的移动应用程序和网络应用程序原型，该原型通过结构化监督机制以及系统收集和审查绩效指标，支持美国一线卫生工作者提供心理社会干预。该应用程序有可能扩大负责将这些干预措施提供给他们所服务的最难接触社区的一线卫生工作者的工作规模。该项目的结果将为未来评估该应用程序在实际环境中的使用和效果的工作提供信息，以支持美国各地的任务分担心理健康项目。
