USING MOBILE PHONES TO EMPOWER THE FRONTLINE HEALTHCARE WORKERS TO MANAGE DEPRESSION AT THE POINT OF CARE IN KENYA (mHEALTH)
KEY STUDY FINDINGS
mHealth successfully developed and utilized a mobile phone application software version of the WHO Mental Health Treatment Gap Intervention Guide (mhGAP-IG), to screen and manage depression in patients attending four rural health centres in Makueni County.
- mHealth showed that healthcare workers without specialized training in mental health operating in resource-limited settings can be successfully trained using modern smartphone technology to screen and manage depression at primary health care level. 14 health care workers in 4 rural health centres (Kalulini, Masongaleni, Ngwata and Mtito Andei) in Makueni County were successfully trained to screen and manage depression using the WHO mental health Treatment Gap Intervention Guide (mhGAP-IG). The trainees also received monthly supervision and monitoring as post-training support.
- A total of 1664 patients in the health facilities were successfully screened for depression by the trained health workers using the mhGAP-IG mobile app. Depression was identified in 25% of the screened patients. 22% of those with depression also had suicidal behaviour. The mobile app facilitated accurate diagnoses by:
- Ensuring complete data collection – It was not possible to move forward to the next section without first completing the previous section.
- Real time data transfer to a central location – All entered data was instantly uploaded to a central server for aggregation and monitoring.
- Mobile phone consultation with a mental health specialist – The trained health care workers were allowed to consult a mental health specialist on phone which enabled immediate response to questions likely to result into medical errors and reduced travel barriers involved in consultation between the health care workers and mental health professionals as clinicians could always revisit the application and communicate in a timely manner in cases of ambiguity.
- Three months after intervention using the mhGAP-IG mobile app that was delivered by the trained healthcare workers, there was a 39% reduction in symptoms of depression as measured using Becks Depression Inventory scale.
mHealth sought to evaluate the applicability of a model that utilized mobile technology to train, supervise, support and monitor application of mhGAP-IG depression module on non-mental health workers.
- To develop a software matrix on mhGAP-IG that can be uploaded on a smart phone.
- To train health care workers on mhGAP-IG and how to use the software.
- To determine the applicability of the technology among the health care workers.
The study was conducted in four rural health facilities in Makueni County (Kalulini, Masongaleni, Ngwata and Mtito Andei) where health workers without specialization in mental health were trained to identify patients with depression using the mhGAP-IG component on depression and offer intervention as indicated in the mhGAP-IG. Health outcomes and improvements in the quality of life of patients were measured using the BECKs Depression Inventory Scale after receiving intervention. The trained health workers received monthly supervision and monitoring for the duration of the study as well as on-phone support by a mental health specialist to make accurate diagnosis in cases of ambiguity.