Perception of providers on use of the WHO mental health Gap Action Programme-Intervention Guide (mhGAP-IG) electronic version and smartphone-based clinical guidance in Nigerian primary care settings

Abstract

Background Taking advantage of the rapidly increasing access to digital technology in low- and middle-income countries, the World Health Organization has launched an electronic version of the mental health Gap Action Programme intervention guide (emhGAP-IG). This is suitable for use on smartphones or tablets by non-specialist primary healthcare providers (PHCWs) to deliver evidence-based intervention for priority mental, neurological and substance use disorders. We assessed the perceptions of PHCWs on the feasibility, acceptability, and benefits of using smartphone-based clinical guidance and the emhGAP-IG in the management of people with mental health conditions in Nigeria. Methods Exploration of the views of PHCWs from 12 rural and urban primary health clinics (PHCs) in South-Western Nigeria were carried out using 34 in-depth key informant qualitative interviews with nurses (n = 10), community health officers (n = 13) and community health extension workers (n = 11). An additional two focus group discussions, each comprising eight participants drawn from across the range of characteristics of PHCWs, were also conducted. Thematic analysis was conducted using a three-staged constant comparison technique to refine and categorise the data. Results Three overall themes were identified around the use of clinical guidance and mobile applications (apps) in PHCs. Apps were deployed for purposes other than clinical consultation and decision making. Although paper-based guidance was the expected practice, its utilization is not fully embedded in routine care. An app-based decision-making tool was preferred to paper by PHCWs. Future usage of the emhGAP-IG would be facilitated by training and supporting of staff, helpful design features, and obtaining patients’ buy-in. Conclusion Our findings suggest that the emhGAP-IG could be a viable way to embed clinical guidance and decision-making tools in the management of people with mental health conditions in Nigerian PHCs.

The effectiveness of mental health interventions involving non-specialists and digital technology in low-and middle-income countries – a systematic review

“…This is supported by previous research demonstrating the practical benefits of using technology, such as time-saving for care providers that enable them to engage in other income-generating activities, as seen in two qualitative studies on midwife care in Indonesia [ 62 , 63 ]. Another qualitative study found that non-specialist MHC workers prefer using digital protocols for their convenience during the treatment when adequately trained on using the digital device [ 64 ]. Other studies have shown that digital reminder messages can improve the non-specialist’s management of malaria in children by 24%, and digital decision support tools can increase non-specialist’s adherence to treatment protocols for early childhood disorders [ 65 , 66 ].…”

Participatory development of a home‐based depression care model with lived experience older Nigerians and their caregivers: A theory of change

“…This is despite evidence of its feasibility and adoption as a meaningful tool to scale up mental health care in primary healthcare settings in Nigeria and other lowand middle-income countries. [8][9][10] We sought in the present study to actively capture the voices of older people with lived experience of depression as well as their caregivers. In the view of ToC workshop participants, an effective late-life depression intervention needs to address not only symptoms of depression, but also able to harness care that involves immediate family and neighbours, economic and spiritual (Prayers/faith) support.…”

“…The mhGAP‐IG or its electronic version has not previously been adapted to the specific context of old age. This is despite evidence of its feasibility and adoption as a meaningful tool to scale up mental health care in primary healthcare settings in Nigeria and other low‐ and middle‐income countries 8–10 . We sought in the present study to actively capture the voices of older people with lived experience of depression as well as their caregivers.…”

“…In the present study, we involved older people in a context appropriate adaptation of treatment approaches in the generic emhGAP‐IG which was recently shown by us to be feasible for the care of younger adult depression in Nigerian Primary Healthcare (PHC) facilities 10,11 . Specifically, we: (i) conducted formative qualitative research to obtain data from older Nigerians with lived experience of depression as well as their caregivers and, (ii) c onducted a participatory theory of change (ToC) workshop to frame the results of our qualitative explorations and modelled an intervention package (emhGAP‐Age) appropriate for the specific needs of persons with late‐life depression in Nigeria.…”

Digital psychiatry in Nigeria: A scoping review

“…A good number of these studies ( n = 4) reported on the acceptability and preference of the use of digital technology for treatment by the patients, 21 , 22 , 23 , 24 while one study ( n = 1) reported feasibility and acceptability of same digital resource among primary healthcare workers. 25 Two studies ( n = 2) reported on the feasibility of using machine learning models to predict mental disorders and treatment outcomes. 26 , 27 …”