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

Abstract

Background: Depression is one of the most prevalent mental disorders and a leading cause of disability, disproportionately affecting specific groups, such as patients with noncommunicable diseases. Over the past decade, digital interventions have been developed to provide treatment for these patients. CONEMO (Emotional Control in Spanish) is an 18-session psychoeducational digital intervention delivered through a smartphone app and minimally supported by a nurse. CONEMO demonstrated effectiveness in reducing depressive symptoms through a randomized controlled trial (RCT) among patients with diabetes, hypertension, or both, in Lima, Peru. However, in addition to clinical outcomes, it is important to explore users' experiences, satisfaction, and perceptions of usability and acceptability, which can affect their engagement with the intervention.Objective: This study aimed to explore the RCT participants' experiences with CONEMO in Peru, complemented with information provided by the nurses who monitored them. Methods:In 2018, semistructured interviews were conducted with a sample of 29 (13.4%) patients from the 217 patients who participated in the CONEMO intervention in Peru and the 3 hired nurses who supported its delivery. Interviewees were selected at random based on their adherence to the digital intervention (0-5, 10-14, and 15-18 sessions completed), to include different points of view. Content analysis was conducted to analyze the interviews.Results: Participants' mean age was 64.4 (SD 8.5) years, and 79% (23/29) of them were women. Most of the interviewed participants (21/29, 72%) stated that CONEMO fulfilled their expectations and identified positive changes in their physical and mental health after using it. Some of these improvements were related to their thoughts and feelings (eg, think differently, be more optimistic, and feel calmer), whereas others were related to their routines (eg, go out more and improve health-related habits). Most participants (19/29, 66%) reported not having previous experience with using smartphones, and despite experiencing some initial difficulties, they managed to use CONEMO. The most valued features of the app were the videos and activities proposed for the participant to perform. Most participants (27/29, 93%) had a good opinion about the study nurses and reported feeling supported by them. A few participants provided suggestions to improve the intervention, which included adding more videos, making the sessions' text simple, extending the length of the intervention, and improving the training session with long explanations.

Understanding how a digital mental health intervention can be optimised to ensure effectiveness in the longer-term: findings from a causal mediation analyses of the CONEMO trials

“…These adaptations could potentially reduce the role of nurses employed on a full-time basis in Lima, that is not feasible if brought to scale. (Toyama, 2022) There has been conflicting evidence to support the role of behavioural activation in mediating the effects of psychological therapies in sessions that are delivered both face to face and through digital mental health interventions. (Domhardt et al, 2021, Lemmens, 2016) However, many of the studies are heterogeneous with differences in the content of sessions, levels of depression, taking place in diverse contexts, often coupled with poor methodological quality making comparisons difficult.…”

“…These adaptations could potentially reduce the role of nurses employed on a full-time basis in Lima, that is not feasible if brought to scale. (Toyama, 2022)…”

Mental Health Digital Interventions Technology: A Systematic Review

“…A smartphone app is used to provide the 18-session psychoeducational digital intervention CONEMO (Emotional Control), which has just minimum nursing assistance. In a randomized controlled trial (RCT) conducted in Lima, Peru, among individuals with hypertension, diabetes, or both, CONEMO showed the potential to lower depressed symptoms [18]. Nevertheless, it is crucial to investigate user experiences, satisfaction, as well as perceptions of usability and acceptability in conjunction with clinical results since these factors may influence how engaged users are with the intervention.…”