A mixed-methods evaluation of Inuka, a Friendship Bench digital mental health intervention in the treatment of common mental health disorders in Zimbabwean adults in response to the COVID-19 pandemic: a feasibility and acceptability pilot study.
Dambi J., Norman C., Doukani A., Potgieter S., Turner J., Musesengwa R., Chibanda D.
BACKGROUND: Common mental health disorders (CMDs) are a leading cause 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 healthcare. It is therefore imperative to explore digital mental health interventions' utility to bridge the treatment gap. Mobile health (mHealth) technologies are effective tools for increasing access to treatment at a lower cost. This study explores the utility of Inuka, a chat-based application (app) hinged on the Friendship Bench problem-solving therapy intervention. The Inuka app offers double anonymity, and clients can book and/or cancel a session at their convenience. Inuka services can be accessed either through a mobile app or the web. OBJECTIVE: 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 quasi-experimental design to compare the feasibility, acceptability, and preliminary clinical effectiveness of Inuka (experimental group) compared to WhatsApp chat-based counselling (control intervention). Participants received six problem-solving therapy sessions delivered by lay counsellors. 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. Last, we used administrative data and semi-structured interviews to gather data on acceptability and feasibility; this was analyzed using thematic analysis. RESULTS: Altogether, 258 participants were screened over six months, with 202 assessed for eligibility. 176 participants were assigned to the study giving a recruitment ratio of 29 participants/month. The participants' mean age was 24.4 (SD 5.3) years, and most participants were female (65.8%), had tertiary education (55.3%), with a mean daily smartphone usage of 8 hours (SD 3.5). Eighty-three (83) users signed up and completed at least one session. The average completion rate was three out of four 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=0.079), depression (F (2,73) =7.67; p< .001), anxiety (F (2,73) =2.95; P=0.059) and a corresponding increase in HRQoL (F (2, 73) =7.287; P