Recruitment, training and supervision of nurses and nurse assistants for a task-shifting depression intervention in two RCTs in Brazil and Peru

Abstract

Background Task-shifting and technology in psychological interventions are two solutions to increasing access to mental health intervention and overcoming the treatment gap in low and middle-income countries. The CONEMO intervention combines a smartphone app with support from non-specialized professionals, aiming to treat depression in patients with diabetes and/or hypertension. The aim of this paper is to describe the process of recruitment, training and supervision of the non-specialized professionals who participated in the CONEMO task-shifting intervention in Brazil and Peru. Methods We described and analyzed data related to the recruitment, training and supervision of 62 nurse assistants from the health system in Sao Paulo, Brazil, and three hired nurses in Lima, Peru. The data were collected from information provided by nurses and nurse assistants, supervisor records from supervision meetings and the CONEMO platform database. Results We found that task-shifting was feasible using existing resources in Sao Paulo and additional human resources in Lima. Training and supervision were found to be crucial and well received by the staff; however, time was a limitation when using existing human resources. Ensuring technological competence prior to the start of the intervention was essential. Group supervision meetings allowed non-specialized professionals to learn from each other’s experiences. Conclusion Carefully considering recruitment, training and supervision of non-specialized professionals is important for effective task-shifting when delivering an mHealth intervention for depression. Opportunities and challenges of working in different health systems are described, which should be considered in future implementation, either for research or real settings. Trial registration NCT028406662 (Sao Paulo), NCT03026426 (Peru).

Understanding how a digital mental health intervention can be optimised to ensure effectiveness in the longer-term: findings from a causal mediation analyses of the CONEMO trials

“…Further details on the role of nurses can be found elsewhere. (Rocha, Aschar and Hidalgo-Padilla, 2021) Participants in both study arms received enhanced usual care that consisted of being assessed for depression symptoms up to four times during the first month of the trial, and again during research follow-up assessments. (Araya et al, 2021) To assess whether any short-term (three-months) improvements were maintained over time, all participants in both arms were assessed again at six-months.…”

Participants’ and Nurses’ Experiences With a Digital Intervention for Patients With Depressive Symptoms and Comorbid Hypertension or Diabetes in Peru: Qualitative Post–Randomized Controlled Trial Study

“…During the RCT in Peru, each study nurse had between 72 and 74 participants assigned to them over a period of 9 months. The nurses' activities are described in further detail in another publication [20].…”

The regulation of healthcare professions and support workers in international context

“…The challenge of regulating health professions in other such societies has been met by providing additional educational infrastructure. This can be illustrated in Brazil by the recent federal government requirement that doctors undertake substantial additional training if they are to practise recognised forms of complementary and alternative medicine [ 31 ]—as well as the dictum that non-specialised nurses need to be developed further to fulfil wider roles in healthcare [ 32 ]. Although COVID-19 has interrupted quality improvement for already qualified healthcare professionals in LMICs, as in their modern neo-liberal counterparts, there have been ways to maintain this through distance learning and other methods despite their usually more limited technological infrastructure [ 33 ].…”