A Digital Mental Health Intervention (Inuka) for Common Mental Health Disorders in Zimbabwean Adults in Response to the COVID-19 Pandemic: Feasibility and Acceptability Pilot Study

Jermaine Dambi; Clara Norman; Asmae Doukani; Stephan Potgieter; Jean Turner; Rosemary Musesengwa; Ruth Verhey; Dixon Chibanda

doi:10.2196/37968

A Digital Mental Health Intervention (Inuka) for Common Mental Health Disorders in Zimbabwean Adults in Response to the COVID-19 Pandemic: Feasibility and Acceptability Pilot Study

JMIR Ment Health. 2022 Oct 7;9(10):e37968. doi: 10.2196/37968.

Authors

Jermaine Dambi^{1

2}, Clara Norman^{2

3}, Asmae Doukani⁴, Stephan Potgieter⁵, Jean Turner^{2

3}, Rosemary Musesengwa⁶, Ruth Verhey², Dixon Chibanda^{2

3

4}

Affiliations

¹ Rehabilitation Sciences Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe.
² Friendship Bench, Harare, Zimbabwe.
³ Research Support Centre, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe.
⁴ Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
⁵ Inuka Foundation, Almere, Netherlands.
⁶ Department of Psychiatry, University of Oxford, London, United Kingdom.

PMID: 35960595
PMCID: PMC9555820
DOI: 10.2196/37968

Abstract

Background: Common mental health disorders (CMDs) are leading causes of disability globally. The ongoing COVID-19 pandemic has further exacerbated the burden of CMDs. COVID-19 containment measures, including lockdowns, have disrupted access to in-person mental health care. It is therefore imperative to explore the utility of digital mental health interventions to bridge the treatment gap. Mobile health technologies are effective tools for increasing access to treatment at a lower cost. This study explores the utility of Inuka, a chat-based app hinged on the Friendship Bench problem-solving therapy intervention. The Inuka app offers double anonymity, and clients can book or cancel a session at their convenience. Inuka services can be accessed either through a mobile app or the web.

Objective: We aimed to explore the feasibility of conducting a future clinical trial. Additionally, we evaluated the feasibility, acceptability, appropriateness, scalability, and preliminary effectiveness of Inuka.

Methods: Data were collected using concurrent mixed methods. We used a pragmatic quasiexperimental design to compare the feasibility, acceptability, and preliminary clinical effectiveness of Inuka (experimental group) and WhatsApp chat-based counseling (control). Participants received 6 problem-solving therapy sessions delivered by lay counselors. A reduction in CMDs was the primary clinical outcome. The secondary outcomes were health-related quality of life (HRQoL), disability and functioning, and social support. Quantitative outcomes were analyzed using descriptive and bivariate statistics. Finally, we used administrative data and semistructured interviews to gather data on acceptability and feasibility; this was analyzed using thematic analysis.

Results: Altogether, 258 participants were screened over 6 months, with 202 assessed for eligibility, and 176 participants were included in the study (recruitment ratio of 29 participants/month). The participants' mean age was 24.4 (SD 5.3) years, and most participants were female and had tertiary education. The mean daily smartphone usage was 8 (SD 3.5) hours. Eighty-three users signed up and completed at least one session. The average completion rate was 3 out of 4 sessions. 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=.08), depression (F_2,73=7.67; P<.001), and anxiety (F_2,73=2.95; P=.06) and a corresponding increase in HRQoL (F_2,73=7.287; P<.001) in both groups.

Conclusions: Study outcomes showed that it is feasible to run a future large-scale randomized clinical trial (RCT) and lend support to the feasibility and acceptability of Inuka, including evidence of preliminary effectiveness. The app's double anonymity and structured support were the most salient features. There is a great need for iterative app updates before scaling up. Finally, a large-scale hybrid RCT with a longer follow-up to evaluate the clinical implementation and cost-effectiveness of the app is needed.

Keywords: COVID-19; Friendship Bench; Inuka; Zimbabwe; acceptability; feasibility; pilot; task-shifting.

©Jermaine Dambi, Clara Norman, Asmae Doukani, Stephan Potgieter, Jean Turner, Rosemary Musesengwa, Ruth Verhey, Dixon Chibanda. Originally published in JMIR Mental Health (https://mental.jmir.org), 07.10.2022.