Feasibility, experiences and outcomes of using DIALOG+ in primary care to improve quality of life and mental distress of patients with chronic conditions: an exploratory non-controlled trial in Bosnia and Herzegovina, Colombia and Uganda

Loggerenberg, Francois van; McGrath, Michael; Akena, Dickens; Birabwa-Oketcho, Harriet; Méndez, Camilo Andrés Cabarique; Gómez‐Restrepo, Carlos; Kulenoviĉ, Alma Džubur; Muhić, M.; Sewankambo, Nelson K.; Sikira, Hana; Priebe, Stefan

doi:10.1186/s40814-021-00914-z

Cited by 4 publications

(7 citation statements)

References 39 publications

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“…The details of the study development, protocol, design and background have been published elsewhere [22]. An exploratory non-controlled multi-site study was conducted in each of Bosnia and Herzegovina, Colombia and Uganda, with a target enrolment of at least 30 patients in each country.…”

Section: Methodsmentioning

confidence: 99%

“…These approaches have been labelled resource-oriented [21], and DIALOG+ is one such intervention. The content and development of the DIALOG+ intervention have been described in detail elsewhere [22]. In brief, DIALOG+ is a resource-oriented and evidence-based intervention, which leverages existing social and personal resources in order to improve the quality of life, originally developed for patients with severe mental illnesses [23].…”

Section: The Dialog+ Interventionmentioning

confidence: 99%

“…At the time of planning for this study, it was not clear what the impact of ongoing and potentially changing pandemic restrictions would be [22]. It was anticipated, for example, that initially all sessions in Colombia would have been delivered remotely.…”

Section: Covid Adjustmentsmentioning

confidence: 99%

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Feasibility and outcomes of using DIALOG+ in primary care to improve quality of life and mental distress of patients with long-term physical conditions: an exploratory non-controlled study in Bosnia and Herzegovina, Colombia and Uganda

van Loggerenberg,

Akena,

Alinaitwe

et al. 2023

BMC Prim. Care

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Introduction The management of long-term physical conditions is a challenge worldwide, absorbing a majority resources despite the importance of acute care. The management of these conditions is done largely in primary care and so interventions to improve primary care could have an enormous impact. However, very little data exist on how to do this. Mental distress is frequently comorbid with long term physical conditions, and can impact on health behaviour and adherence, leading to poorer outcomes. DIALOG+ is a low-cost, patient-centred and solution-focused intervention, which is used in routine patient-clinician meetings and has been shown to improve outcomes in mental health care. The question arises as to whether it could also be used in primary care to improve the quality of life and mental health of patients with long-term physical conditions. This is particularly important for low- and middle-income countries with limited health care resources. Methods An exploratory non-controlled multi-site trial was conducted in Bosnia and Herzegovina, Colombia, and Uganda. Feasibility was determined by recruitment, retention, and session completion. Patient outcomes (quality of life, anxiety and depression symptoms, objective social situation) were assessed at baseline and after three approximately monthly DIALOG+ sessions. Results A total of 117 patients were enrolled in the study, 25 in Bosnia and Herzegovina, 32 in Colombia, and 60 in Uganda. In each country, more than 75% of anticipated participants were recruited, with retention rates over 90% and completion of the intervention exceeding 92%. Patients had significantly higher quality of life and fewer anxiety and depression symptoms at post-intervention follow-up, with moderate to large effect sizes. There were no significant improvements in objective social situation. Conclusion The findings from this exploratory trial suggest that DIALOG+ is feasible in primary care settings for patients with long-term physical conditions and may substantially improve patient outcomes. Future research may test implementation and effectiveness of DIALOG+ in randomized controlled trials in wider primary care settings in low- and middle-income countries. Trial registration All studies were registered prospectively within the ISRCTN Registry. ISRCTN17003451, 02/12/2020 (Bosnia and Herzegovina), ISRCTN14018729, 01/12/2020 (Colombia) and ISRCTN50335796, 02/12/2020 (Uganda).

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Section: Methodsmentioning

confidence: 99%

Section: The Dialog+ Interventionmentioning

confidence: 99%

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Feasibility and outcomes of using DIALOG+ in primary care to improve quality of life and mental distress of patients with long-term physical conditions: an exploratory non-controlled study in Bosnia and Herzegovina, Colombia and Uganda

van Loggerenberg,

Akena,

Alinaitwe

et al. 2023

BMC Prim. Care

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“…For the quantitative survey, the pre-designed structured site readiness tool was used. The tool has been previously used in global health studies evaluating the use of psychosocial interventions in routine care across different LMICs ( 25 – 27 ). The questionnaire is designed to assess the readiness of an organization to implement a new psychosocial intervention.…”

Section: Methodsmentioning

confidence: 99%

Implementing psychosocial interventions within low and middle-income countries to improve community-based care for people with psychosis—A situation analysis

et al. 2022

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BackgroundGlobally, a treatment gap exists for individuals with severe mental illness, with 75% of people with psychosis failing to receive appropriate care. This is most pronounced in low and middle-income countries, where there are neither the financial nor human resources to provide high-quality community-based care. Low-cost, evidence-based interventions are urgently needed to address this treatment gap.AimTo conduct a situation analysis to (i) describe the provision of psychosocial interventions within the context of existing care in two LMICs-India and Pakistan, and (ii) understand the barriers and facilitators of delivering a new psychosocial intervention.MethodA situation analysis including a quantitative survey and individual interviews with clinicians, patients and caregivers was conducted. Quantitative survey data was collected from staff members at 11 sites (private and government run hospitals) to assess organizational readiness to implement a new psychosocial intervention. To obtain in-depth information, 24 stakeholders including clinicians and service managers were interviewed about the typical care they provide and/or receive, and their experience of either accessing or delivering psychosocial interventions. This was triangulated by six interviews with carer and patient representatives.Results and discussionThe results highlight the positive views toward psychosocial interventions within routine care and the enthusiasm for multidisciplinary working. However, barriers to implementation such as clinician time, individual attitudes toward psychosocial interventions and organizational concerns including the lack of space within the facility were highlighted. Such barriers need to be taken into consideration when designing how best to implement and sustain new psychosocial interventions for the community treatment of psychosis within LMICs.

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“…Previous studies have shown that using DIALOG+ is effective in improving the quality of life for patients with psychosis in UK community-based settings [8,10]. Furthermore, the effectiveness of DIALOG+ has been extensively studied in mental health care across multiple countries and in different healthcare settings [11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness of implementing a digital psychosocial intervention for patients with psychotic spectrum disorders in low- and middle-income countries in Southeast Europe: Economic evaluation alongside a cluster randomised trial

et al. 2022

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Background DIALOG+ is a digital psychosocial intervention aimed at making routine meetings between patients and clinicians therapeutically effective. This study aimed to evaluate the cost-effectiveness of implementing DIALOG+ treatment for patients with psychotic disorders in five low- and middle-income countries in Southeast Europe alongside a cluster randomised trial. Methods Resource use and quality of life data were collected alongside the multi-country cluster randomised trial of 468 participants with psychotic disorders. Due to COVID-19 interruptions of the trial’s original 12-month intervention period, adjusted costs and quality-adjusted life years (QALYs) were estimated at the participant level using a mixed-effects model over the first 6 months only. We estimated the incremental cost-effectiveness ratio (ICER) with uncertainty presented using a cost-effectiveness plane and a cost-effectiveness acceptability curve. Seven sensitivity analyses were conducted to check the robustness of the findings. Results The average cost of delivering DIALOG+ was €91.11 per participant. DIALOG+ was associated with an incremental health gain of 0.0032 QALYs (95% CI –0.0015, 0.0079), incremental costs of €84.17 (95% CI –8.18, 176.52), and an estimated ICER of €26,347.61. The probability of DIALOG+ being cost-effective against three times the weighted gross domestic product (GDP) per capita for the five participating countries was 18.9%. Conclusion Evidence from the cost-effectiveness analyses in this study suggested that DIALOG+ involved relatively low costs. However, it is not likely to be cost-effective in the five participating countries compared with standard care against a willingness-to-pay threshold of three times the weighted GDP per capita per QALY gained.

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Feasibility, experiences and outcomes of using DIALOG+ in primary care to improve quality of life and mental distress of patients with chronic conditions: an exploratory non-controlled trial in Bosnia and Herzegovina, Colombia and Uganda

Cited by 4 publications

References 39 publications

Feasibility and outcomes of using DIALOG+ in primary care to improve quality of life and mental distress of patients with long-term physical conditions: an exploratory non-controlled study in Bosnia and Herzegovina, Colombia and Uganda

Feasibility and outcomes of using DIALOG+ in primary care to improve quality of life and mental distress of patients with long-term physical conditions: an exploratory non-controlled study in Bosnia and Herzegovina, Colombia and Uganda

Implementing psychosocial interventions within low and middle-income countries to improve community-based care for people with psychosis—A situation analysis

Cost-effectiveness of implementing a digital psychosocial intervention for patients with psychotic spectrum disorders in low- and middle-income countries in Southeast Europe: Economic evaluation alongside a cluster randomised trial

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