Akhtar Samina, Rabbani Fauziah, Nafis Javeria, Siddiqui Amna, Merali Zul
Department of Community Health Sciences, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan.
Brain and Mind Institute, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan.
BMC Psychiatry. 2025 Jan 6;25(1):16. doi: 10.1186/s12888-024-06459-8.
With a shortage of mental health specialists and a significant rural population in Pakistan, leveraging community-based healthcare workers becomes crucial to address mental health needs. Equipping the healthcare workers with digital tools such as mobile applications have the potential to increase access to mental health support in low-resource areas. This study examines the acceptability, appropriateness, barriers, and facilitators to implementing a technology-assisted mental health intervention (mPareshan) delivered by Lady Health Workers (LHWs) in rural Pakistan.
This is a qualitative study embedded within a larger implementation research trial assessing the feasibility of an mHealth intervention aimed at improving anxiety and depression. 8 focus group discussions and 18 in-depth interviews were conducted. Perceptions were sought before and after intervention from stakeholders comprising of policymakers, LHWs, Lady Health Supervisors (LHSs), and community participants. Data underwent thematic analysis using the RE-AIM framework.
Six main themes emerged from the data. All participants had realization of rising burden of mental illnesses and identified key determinants for mental ill-health. Delivery of mental health counselling by LHWs through a technology-assisted intervention was deemed acceptable and appropriate. LHWs were considered capable and trustworthy by the community to deliver a home-based mHealth intervention, given their easy accessibility as residents of the same community. The technology demonstrated potential for easy adoption as these frontline health workers were already familiar with smartphone technology. Some barriers identified during implementation roll-out included heavy workload of LHWs and difficulty in internet connectivity. Use of videos for counselling, and supportive supervision by LHSs emerged as key facilitators for implementation.
This study highlights that a technology-focused mental health intervention is feasible, acceptable, and appropriate to be implemented by community frontline workers in resource-constrained rural Pakistani settings. The mPareshan intervention can be easily adopted within the LHW-P. Further research should investigate how implementation barriers can be addressed for successful delivery.
由于巴基斯坦心理健康专家短缺且农村人口众多，利用社区医护人员来满足心理健康需求至关重要。为医护人员配备移动应用程序等数字工具，有可能增加资源匮乏地区获得心理健康支持的机会。本研究探讨了在巴基斯坦农村地区由女性健康工作者（LHWs）实施一项技术辅助心理健康干预措施（mPareshan）的可接受性、适宜性、障碍和促进因素。
这是一项定性研究，嵌入在一项更大的实施研究试验中，该试验评估了一项旨在改善焦虑和抑郁的移动健康干预措施的可行性。进行了8次焦点小组讨论和18次深入访谈。在干预前后，征求了政策制定者、女性健康工作者、女性健康监督员（LHSs）和社区参与者等利益相关者的看法。使用RE-AIM框架对数据进行了主题分析。
数据中出现了六个主要主题。所有参与者都意识到精神疾病负担日益加重，并确定了心理健康不良的关键决定因素。女性健康工作者通过技术辅助干预提供心理健康咨询被认为是可接受和适宜的。鉴于女性健康工作者作为同一社区的居民容易接触到，社区认为她们有能力且值得信赖来提供基于家庭的移动健康干预。由于这些一线医护人员已经熟悉智能手机技术，该技术显示出易于采用的潜力。在实施推广过程中发现的一些障碍包括女性健康工作者工作量大以及互联网连接困难。使用视频进行咨询以及女性健康监督员的支持性监督成为实施的关键促进因素。
本研究强调，以技术为重点的心理健康干预措施在资源有限的巴基斯坦农村地区由社区一线工作者实施是可行、可接受且适宜的。mPareshan干预措施可以在女性健康工作者项目中轻松采用。进一步的研究应调查如何解决实施障碍以成功提供该干预措施。
