Technology-enabled Task-sharing for Depression in Primary Care

University of Washington

Overview

This study will explore and test the feasibility, acceptability, usability, and preliminary effectiveness of a technology-enabled intervention for depression using task-sharing in primary care. We will a) discover barriers and facilitators to task-sharing by frontline primary care staff; b) design an implementation strategy to support task-sharing to deliver a technology-enabled intervention for depression; and c) conduct a small open-label usability trial of the technology-enabled intervention for depression.

Older adults with depression typically present to primary care rather than specialty mental health treatment and are often un- or undertreated, as the demand for mental health services is greater than the supply of trained providers. Technology is one method to improve access to care by making evidence-based psychosocial interventions (EBPIs) readily accessible. A second method comes from global mental health research, demonstrating that task-sharing can equip non-specialists to provide effective mental health care. This study combines these two approaches, exploring how technology-enhanced EBPI could be used by frontline primary care staff (e.g., nurses, medical assistants) to expand workforce capacity to deliver acceptable, sustainable, and effective treatment for depression. Specifically, we will use task-sharing to deliver a mobile Motivational Physical Activity Targeted Intervention (MPATI), which is based on behavioral activation for depression and uses wearable accelerometer technology to trigger personalized activity goal monitoring. This proposal uses the Discover, Design/Build, Test (DDBT) framework, which leverages user-centered design and implementation science to discover implementation barriers to using task-sharing to deliver MPATI in primary care, to design an implementation strategy to support MPATI delivery, and to conduct a pilot usability trial to test the implementation strategy with the most suitable frontline staff.

Study Type

OBSERVATIONAL

Conditions

Depression Depression in Old Age

Eligibility

Sex: ALLMin age: 60 Years

Medical Language ↔ Plain English

Inclusion Criteria: Clinics: 1. have at least 1 full-time registered nurse (RN) and/or medical assistant (MA) on staff 2. include older adults on their patient panels. Clinic administrators 1. have an administrative or leadership role in the clinic 2. have been employed in their current role for at least 6 months. Frontline staff 1. provide care as RN, MA, case manager, behavioral health consultant, or similar role identified by Practice Champion 2. be employed at the participating clinic for at least 6 months. Patients 1. be ≥65 years of age 2. report moderate to moderately severe depressive symptoms based on a PHQ-9 score of 10-20 3. own or have access to a smartphone 4. have internet or cellular data plan 5. receive medical clearance from their primary care provider to participate in unstructured physical activity. Patient exclusion criteria will be based on medical chart review by Practice Champion and include: 1. current suicidality 2. severe vision or hearing impairment 3. pronounced cognitive impairment 4. use of assistive devices that would impede physical activity.

Locations (1)

Univeristy of Washington

Seattle, Washington, United States

Outcomes

Primary Outcomes

Usability (system usability scale)

usability of MPATI intervention among provider end-users

Time frame: after 2 week usability trial

Usability (qualitative interviews)

usability of MPATI intervention among provider end-users

Time frame: after 2 week usability trial

Secondary Outcomes

feasibility -- patient recruitment

feasibility of MPATI intervention for geriatric depression in primary care

Time frame: end of pilot trial (2 weeks per patient)

acceptability -- patient retention

acceptability of MPATI intervention for geriatric depression in primary care

Time frame: end of pilot trial (2 weeks per patient)

depressive symptoms (patient)

Patient Health Questionnaire (PHQ-9) total scores to assess depressive symptoms (total score range 0-27; higher scores reflect greater depressive symptoms)

Time frame: pre-post 2 week pilot trial

functioning (patient)

Sheehan Disability Scale (SDS) total scores to assess functional impairment; total scores range from 0 (unimpaired) to 30 (highly impaired).

Time frame: pre-post 2 week pilot trial

Data from ClinicalTrials.gov

This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.