背景:精神健康状况是全球范围内的重大公共卫生问题,每年造成超过800万人死亡。此外,它们导致生产力的损失,加剧身体疾病,并与污名化和侵犯人权有关。乌干达,像许多低收入和中等收入国家一样,在心理健康状况方面面临巨大的治疗缺口,许多社会文化挑战加剧了心理健康状况的负担。
目的:本研究旨在描述数字健康干预措施的发展和形成性评估,以改善乌干达获得精神卫生保健的机会。
方法:这项定性研究使用了以用户为中心的设计和设计科学研究原则。利益相关者,包括患者,看护者,精神卫生保健提供者,和实施专家(N=65),参加了焦点小组讨论,我们探讨了参与者的精神疾病和精神卫生保健的经验,数字干预的经验,以及关于拟议的数字心理健康服务的意见。使用实施研究综合框架分析数据,以得出数字解决方案的要求,它与用户迭代地共同创建并试点。
结果:确定了几个挑战,包括精神卫生设施的严重短缺,未满足的心理健康信息需求,沉重的照顾负担,财务挑战,污名,以及与心理健康相关的消极信念。参与者对数字解决方案的热情是可行的,可接受,并揭示了获得精神卫生服务的便捷方法,以及使服务变得用户友好的建议,负担得起的,并提供24×7并确保匿名。开发了医院呼叫中心服务,通过交互式语音响应以及与医疗保健专业人员和同伴支持人员(正在康复的患者)的实时呼叫,以2种语言提供心理健康信息和建议。在发射后的4个月里,456个电话,从236个独特的数字,是对系统造成的,其中99个(21.7%)电话转到语音邮件(非办公时间)。在剩下的357个电话中,80(22.4%)个呼叫在交互式语音响应时停止,231个(64.7%)电话由呼叫代理接听,22个(6.2%)电话未接。用户反馈是积极的,来电者赞赏分享他们恢复旅程的同行支持工作者的加入。然而,一些参与者的建议(例如,添加视频通话选项)或个性化需求(例如,处方)由于资源限制或技术可行性而无法适应。
结论:这项研究展示了一种系统和理论驱动的方法,可以开发适合环境的数字解决方案,以改善乌干达和类似环境的精神卫生保健。对已实施服务的积极接受强调了其潜在影响。未来的研究应解决已确定的局限性,并评估长期采用的临床结果。
BACKGROUND: Mental health conditions are a significant public health problem globally, responsible for >8 million deaths per year. In addition, they lead to lost productivity, exacerbate physical illness, and are associated with stigma and human rights violations. Uganda, like many low- and middle-income countries, faces a massive treatment gap for mental health conditions, and numerous sociocultural challenges exacerbate the burden of mental health conditions.
OBJECTIVE: This study aims to describe the development and formative evaluation of a digital health intervention for improving access to mental health care in Uganda.
METHODS: This qualitative study used user-centered design and design science research principles. Stakeholders, including patients, caregivers, mental health care providers, and implementation experts (N=65), participated in focus group discussions in which we explored participants\' experience of mental illness and mental health care, experience with digital interventions, and opinions about a proposed digital mental health service. Data were analyzed using the Consolidated Framework for Implementation Research to derive requirements for the digital solution, which was iteratively cocreated with users and piloted.
RESULTS: Several challenges were identified, including a severe shortage of mental health facilities, unmet mental health information needs, heavy burden of caregiving, financial challenges, stigma, and negative beliefs related to mental health. Participants\' enthusiasm about digital solutions as a feasible, acceptable, and convenient method for accessing mental health services was also revealed, along with recommendations to make the service user-friendly, affordable, and available 24×7 and to ensure anonymity. A hospital call center service was developed to provide mental health information and advice in 2 languages through interactive voice response and live calls with health care professionals and peer support workers (recovering patients). In the 4 months after launch, 456 calls, from 236 unique numbers, were made to the system, of which 99 (21.7%) calls went to voicemails (out-of-office hours). Of the remaining 357 calls, 80 (22.4%) calls stopped at the interactive voice response, 231 (64.7%) calls were answered by call agents, and 22 (6.2%) calls were not answered. User feedback was positive, with callers appreciating the inclusion of peer support workers who share their recovery journeys. However, some participant recommendations (eg, adding video call options) or individualized needs (eg, prescriptions) could not be accommodated due to resource limitations or technical feasibility.
CONCLUSIONS: This study demonstrates a systematic and theory-driven approach to developing contextually appropriate digital solutions for improving mental health care in Uganda and similar contexts. The positive reception of the implemented service underscores its potential impact. Future research should address the identified limitations and evaluate clinical outcomes of long-term adoption.