A mixed-methods evaluation of Inuka, a Friendship Bench digital mental health intervention in the treatment of common mental health disorders in Zimbabwean adults in response to the COVID-19 pandemic: a feasibility and acceptability pilot study. (Preprint)
Authors: Dambi Jermaine , Norman Clara , Doukani Asmae , Potgieter Stephan , Turner Jean , Musesengwa Rosemary , Verhey Ruth , Chiabnda Dixon 
Published: March 2022

BACKGROUND

Common mental health disorders (CMDs) are a leading cause of disability globally. The ongoing COVID-19 pandemic has further exacerbated the burden of CMDs. Despite the high burden of CMDs, a vast mental health care gap still exists in low-resourced settings. COVID-19 containment measures, including lockdowns, have further disrupted access to in-person mental healthcare. It is imperative to explore digital mental health interventions' utility to bridge the treatment gap. This study set to explore the utility of Inuka, a chat-based application hinged on the Friendship Bench problem-solving therapy intervention.

OBJECTIVE

To explore the feasibility of conducting a future clinical trial, including the feasibility, acceptability appropriateness, scalability, and preliminary effectiveness of Inuka.

METHODS

Concurrent mixed methods were used simultaneously to glean data on implementation and clinical parameters. We used a pragmatic non-equivalent control group quasi-experimental design to compare the feasibility, acceptability, and preliminary clinical effectiveness of Inuka (experimental group) compared to WhatsApp chat-based counselling (control intervention). Participants received six (6) problem-solving therapy sessions delivered by lay counsellors. A reduction in CMDs was the primary clinical outcome, and this was measured using the; Shona Symptoms Questionnaire, Patient Health Questionnaire (PHQ-9), and the generalised anxiety and depression scale (GAD-7). Health-related quality of life (HRQoL), disability and functioning, and social support were the secondary outcomes and were measured using the EQ-5D, WHO Disability Assessment Schedule and multidimensional scale of perceived social support, respectively. Quantitative outcomes were analysed using both descriptive and bivariate statistics. Last, we used administrative data and semi-structured interviews to gather data on acceptability and feasibility; this was analysed using descriptive statistics and thematic analysis.

RESULTS

Altogether, 258 participants were screened over six (6) months, with 202 assessed for eligibility. 176 participants were assigned to the study giving a recruitment ratio of 29 participants per month. The participants' mean age was 24.4 (SD 5.3) years, and most participants were females (65.8%), enrolled or completed tertiary education (55.3%) with a mean daily smartphone usage of 8 hours (SD 3.5). Eighty-three (83) users signed up and completed at least one session. The average completion rate was three sessions per participant. Inuka was deemed feasible and acceptable in the local context, with connectivity challenges, app instability, expensive mobile data and power outages cited as potential barriers to scale-up. Generally, there was a decline in CMDs (F (2,73) =2.63; P=0.079), depression (F (2,73) =7.67; p< .001), anxiety (F (2,73) =2.95; P=0.059 and a corresponding increase in HRQoL (F (2, 73) =7.287; P<. 001) in both groups.

CONCLUSIONS

Overall, study outcomes show it is feasible to run a future large-scale RCT and lend support to the feasibility and acceptability of Inuka, including evidence of preliminary effectiveness.

CLINICALTRIAL

N/A