Implementation and scalability of a digital intervention to reduce depressive symptoms in people with diabetes, hypertension or both in Brazil and Peru: a qualitative study of health system’s stakeholders’ perspectives

Abstract

Two randomized controlled trials (RCTs) in Brazil and Peru demonstrated the effectiveness of CONEMO, a digital intervention supported by trained nurses or nurse assistants (NAs), to reduce depressive symptoms in people with diabetes and/or hypertension. This paper extends the RCTs findings by reflecting on the conditions needed for its wider implementation in routine care services. A qualitative study using semi-structured interviews and content analysis was conducted with nurses/NAs, clinicians, healthcare administrators, and policymakers. Informants reported that CONEMO would be feasible to implement in their health services, but some conditions could be improved before its scale-up: reducing workloads of healthcare workers; raising mental health awareness among clinicians and administrators; being able to inform, deliver and accompany the intervention; assuring appropriate training and supervision of nurses/NAs; and supporting the use of technology in public health services and by patients, especially older ones. We discuss some suggestions on how to overcome these challenges.

Participants’ and Nurses’ Experiences With a Digital Intervention for Patients With Depressive Symptoms and Comorbid Hypertension or Diabetes in Peru: Qualitative Post–Randomized Controlled Trial Study

“…Considering the participants' positive feedback regarding acceptability and usability, CONEMO can be easily adapted and implemented within the health system for patients with other health conditions or multimorbidity. The positive feedback has been echoed by other stakeholders who were interviewed, who consider CONEMO to be feasible to implement within the local health system [30]. In the current context of the COVID-19 pandemic, the population had to adapt relatively quickly to the use of technology to communicate with other people, work, and study, among other activities.…”

Digital footprints as a new translational approach for mental health care: a commentary

“…Their pilot study results demonstrate the feasibility of an immersive VR intervention designed to increase valuation of the future by enhancing future self-continuity and leveraging future self-discrepancy with personalized future selves as SUD recovery support [ 5 ]. An international South American partnership, reported by Cavero et al addressed issues related to the implementation and scalability of a digital intervention to reduce depressive symptoms in people with diabetes, hypertension or both in Brazil and Peru, with a focus a qualitative study of the perspectives of stakeholders in those health systems [ 6 ].…”

Avaliação econômica de uma intervenção por tecnologia móvel para sintomas de depressão em pacientes com doenças crônicas em países de baixa e média renda

“…No PMBOK®, os processos foram divididos em nove áreas de conhecimento: gerenciamento de integração, de escopo, de tempo, de custos, de qualidade, de recursos humanos, de comunicações, de riscos e de aquisições (92). O discernimento e a experiência da equipe de gerenciamento de projeto poderão determinar aquilo que deve ou não ser utilizado do guia (92).…”

“…Coletamos exemplos claros dos tipos e variedade de atividades que eles realizam para serem mais vitais e melhorarem sua saúde física e mental. Os resultados do estudo apoiam o uso de intervenções digitais baseadas na ativação comportamental para tratar pacientes com sintomas depressivos [92]. Além disso, está alinhado com as evidências existentes sobre o uso de intervenções digitais para introduzir mudanças no estilo de vida, principalmente para adultos mais velhos.…”