Participants’ and nurses’ experiences with a digital intervention for patients with depressive symptoms and comorbid hypertension or diabetes in Peru: A qualitative post-randomized controlled trial study (Preprint)

Abstract

Depression is one of the most prevalent mental disorders and a leading cause of disability, disproportionately affecting specific groups, such as patients with non-communicable diseases. Over the last decade, digital interventions have been developed to provide treatment for these patients. CONEMO is an 18-session psycho-educational digital intervention delivered through a smartphone application, and minimally supported by a nurse. CONEMO demonstrated effectiveness in reducing depressive symptoms through a randomized controlled trial (RCT) with 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 impact their engagement with the intervention and reduce the potential effectiveness of the intervention.

To explore the RCT participants’ experiences with CONEMO in Peru, complemented with information provided by the nurses who monitored them.

In 2018, semi-structured interviews were conducted with a sample of 29 patients from the 217 who participated in the CONEMO intervention in Peru and the three 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), in order to include different points of view. A content analysis was conducted to analyze the interviews.

Participants mean age was 64.4 (SD ±8.5) years, and 79% were female. The great majority of interviewed participants 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 (e.g., think differently, be more optimistic, feel calmer), while others were related to their routines (e.g., going out more, improve health-related habits). Most participants reported not having prior experience using smartphones; and, despite experiencing some initial difficulties, managed to use CONEMO. The most valued features of the app were the videos and the activities proposed for the participant to do. The majority of participants 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 simpler, making the intervention last longer, and improving the training session with longer explanations.

The findings of this qualitative study provide further support and contextualize the positive results found in the CONEMO RCT, as well as insights into the key features that made the intervention effective and engaging. The participants’ experience with the smartphone and the CONEMO app reveal it is feasible to be used by people with little knowledge of technology. In addition, the study allowed to identify suggestions to improve the CONEMO intervention for its future scale-up.

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