AniMovil mHealth Support for Depression Management in a Low-Income Country
Condition: Depression
MeSH terms: Depression; Depressive Disorder
Study type: Interventional

Summary: 
      Depression is a huge public health problem in low and middle-income countries (LMICs). Mental
      health care systems in most LMICs are extremely limited, impeding the dissemination of
      WHO-recommended models for improving care via "task-shifting" services to community health
      workers (CHWs) who deliver evidence-based treatments such as cognitive behavioral therapy
      (CBT). This comprehensive intervention will use IVR and text messaging (SMS) to support
      effective depression care. Intervention patients will receive weekly automated (IVR) calls
      and daily text messages (SMS) throughout the 12 week intervention. Patients with more severe
      depression will receive up to 12 weekly CHW-delivered telephone CBT sessions, based on WHO
      recommendations and a treatment model developed and tested in India. CHWs will use patients'
      IVR contacts to enhance psychoeducation and they will use SMS plus web-based reports based on
      patients' IVR calls to identify individuals needing additional follow-up. The CHWs' clinical
      supervisor will use SMS messages to CHWs to reinforce best practices and monitor service
      delivery.

      Patients will be enrolled from Colombian clinics associated with the Universidad de Los Andes
      in Bogota, Colombia. 114 patients will be randomized to either a usual enhanced care or
      intervention group. Intervention group patients will receive weekly automated (IVR) calls and
      daily text messages throughout the duration of the 12 week intervention. Patients with more
      severe depression will receive up to 12 weekly CHW-delivered telephone CBT sessions, based on
      WHO recommendations and a treatment model developed and tested in India. CHWs will use
      patients' IVR contacts to enhance psychoeducation and they will use SMS plus web-based
      reports based on patients' IVR calls to identify individuals needing additional follow-up.
      The CHWs' clinical supervisor will use SMS messages to CHWs to reinforce best practices and
      monitor service delivery. Program components will be modified to fit the local culture and
      clinical environment via iterative engagement of health professionals and patients with
      depression.

      Those patients in usual enhanced care will receive the study manual and daily text messages
      and feedback throughout the duration of the program. Patients in the enhanced usual care
      group who present with more severe depression will be referred to the national program office
      for depression services support - a free service available to all citizens diagnosed with
      depression.
    


Intervention name(s): IVR/SMS; SMS
Intervention type(s): Other; Other
Intervention description(s): Daily SMS messages asking participants to report their mood on a 1 to 9 scale; An automated phone system for monitoring and improving self-care and health outcomes; Daily SMS messages asking participants to report their mood on a 1 to 9 scale
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Health Services Research