IMPORTANCEDepression is a leading contributor to disease burden globally. Digital mental health interventions can address the treatment gap in low-and middle-income countries, but the effectiveness in these countries is unknown.OBJECTIVE To investigate the effectiveness of a digital intervention in reducing depressive symptoms among people with diabetes and/or hypertension. DESIGN, SETTING, AND PARTICIPANTSParticipants with clinically significant depressive symptoms (Patient Health Questionnaire-9 [PHQ-9] score Ն10) who were being treated for hypertension and/or diabetes were enrolled in a cluster randomized clinical trial (RCT) at 20 sites in

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).

Background: Behavioral Activation (BA) is an evidence-based treatment that aims to help the individual to stay active and reduce avoidance behaviors, as a means to reduce depressive symptoms. This study aims to describe the adaptation process and evaluate the psychometric properties of the Behavioral Activation for Depression Scale Short Form (BADS-SF) in its Brazilian and Peruvian version.Methods: Data were collected as part of a randomized trial with 880 participants in Brazil and 432 in Peru. The content validity was assessed using the Content Validity Index (CVI). Principal Component Analysis (PCA) method was applied to evaluate the factorial distribution. Sampling adequacy was assessed by Bartlett’s test of Sphericity and Kaiser-Meyer-Olkin measure. Cronbach’s alpha coefficient was calculated to assess internal consistency.Results: CVI in Brazil was 0.92 and in Peru 0.87. The two-factor solution of the original scale is sustained (activation and avoidance), accounting for 50.6 and 54% of the total variance in Brazil and Peru, respectively. Cronbach’s alpha in Brazil was 0.55 and 0.66 in Peru for the overall scale. KMO was 0.769 and 0.790 for Brazil and Peru, respectively. Bartlett’s test of Sphericity had significance of 0.000 for both samples. Conclusion: Both studied versions of the BAD-SF showed coherent structure and internal consistency. We recommend different distribution of the items into the subscales.

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 was 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

Esta dissertação ou tese está de acordo com as seguintes normas, em vigor no momento desta publicação:Referências: adaptado de International Committee of Medical Journals Editors (Vancouver).