R03 – mHealth in West Africa: Developing An Evidence-Based Psychosocial Intervention Toolkit
Principal Investigators
Dror Ben-Zeev, PhD, Professor, Psychiatry and Behavioral Sciences
Jaime Snyder, PhD, Assistant Professor, Information School and Human-Centered Design and Engineering
Project Description
Worldwide, serious mental illnesses (SMI) such as schizophrenia and bipolar disorder are major causes of impairment and disability. The majority of people with SMI in West Africa receive care from traditional and faith healers who have no formal training in the etiology, assessment, or evidence-based treatment of mental illness. Our multidisciplinary team is partnering with regional stakeholders in West Africa to co-develop mHealer, a mobile health system that will deliver multimedia Evidence-Based Psychosocial Intervention (EBPI) training, educational information about psychiatric illness, and content designed to increase healers’ awareness of human rights and preservation of human dignity in practice. We will employ user-centered mixed-method data collection strategies to conduct a targeted needs assessment In Ghana. Activities include direct observation, contextual inquiry, and healer interviews to uncover potential barriers to EBPI learnability in LMIC settings. We will design and develop an mHealer prototype and gather user feedback to identify testable solutions to EBPI learnability challenges. The project will constitute the first step in a staged program of research to develop, refine, deploy, adapt, and evaluate a user-centered technology-based system to support EBPI delivery capacity in West Africa. More broadly, the project will directly contribute to the mission and objectives of the UW ALACRITY center by identifying EBPI modification needs to improve clinical capacity, EBPI usability, and sustained quality in under-resourced contexts.
| Setting | Ghana |
| Population | Traditional and faith healers who treat people with serious mental illness (SMI) such as schizophrenia and bipolar disorder |
Intervention and/or Implementation Strategy Designed or Redesigned
| Intervention | mHealer, a mobile health system that will deliver multimedia Evidence-Based Psychosocial Intervention (EBPI) training, educational information about psychiatric illness, and content designed to increase healers’ awareness of human rights and preservation of human dignity in practice |
| Implementation Strategy | User-centered mixed-method data collection strategies to conduct a targeted needs assessment including direct observation, contextual inquiry, and healer interviews to uncover potential barriers to EBPI learnability in LMIC settings. Design and develop an mHealer prototype and gather user feedback to identify testable solutions to EBPI learnability challenges. |
Impact
The project will constitute the first step in a staged program of research to develop, refine, deploy, adapt, and evaluate a user-centered technology-based system to support EBPI delivery capacity in West Africa. More broadly, the project will directly contribute to the mission and objectives of the UW ALACRITY center by identifying EBPI modification needs to improve clinical capacity, EBPI usability, and sustained quality in under-resourced contexts. The project addresses the problem that people with serious mental illness (SMI) in Ghana are treated by traditional and faith healers who have no training in evidence-based practices by working with stakeholders in Ghana to develop a mobile health system designed to improve the quality of care that healers provide to vulnerable individuals with SMI.
Project Publications
A Digital Toolkit (M-Healer) to Improve Care and Reduce Human Rights Abuses Against People With Mental Illness in West Africa: User-Centered Design, Development, and Usability Study
JMIR Mental Health · PubMed · Publisher
Authors
Dror Ben-Zeev, Suzanne Meller, Jaime Snyder, Dzifa A Attah, Liam Albright, Hoa Le, Seth M Asafo, Pamela Y Collins, Angela Ofori-Atta
Abstract
Background: The resources of West African mental health care systems are severely constrained, which contributes to significant unmet mental health needs. Consequently, people with psychiatric conditions often receive care from traditional and faith healers. Healers may use practices that constitute human rights violations, such as flogging, caging, forced fasting, and chaining.
Objective: The aim of this study is to partner with healers in Ghana to develop a smartphone toolkit designed to support the dissemination of evidence-based psychosocial interventions and the strengthening of human rights awareness in the healer community.
Methods: We conducted on-site observations and qualitative interviews with healers, a group co-design session, content development and prototype system build-out, and usability testing.
Results: A total of 18 healers completed individual interviews. Participants reported on their understanding of the causes and treatments of mental illnesses. They identified situations in which they elect to use mechanical restraints and other coercive practices. Participants described an openness to using a smartphone-based app to help introduce them to alternative practices. A total of 12 healers participated in the co-design session. Of the 12 participants, 8 (67%) reported having a smartphone. Participants reported that they preferred spiritual guidance but that it was acceptable that M-Healer would provide mostly nonspiritual content. They provided suggestions for who should be depicted as the toolkit protagonist and ranked their preferred content delivery modality in the following order: live-action video, animated video, comic strip, and still images with text. Participants viewed mood board prototypes and rated their preferred visual design in the following order: religious theme, nature motif, community or medical, and Ghanaian culture. The content was organized into modules, including an introduction to the system, brief mental health interventions, verbal de-escalation strategies, guided relaxation techniques, and human rights training. Each module contained several scripted digital animation videos, with audio narration in English or Twi. The module menu was represented by touchscreen icons and a single word or phrase to maximize accessibility to users with limited literacy. In total, 12 participants completed the M-Healer usability testing. Participants commented that they liked the look and functionality of the app and understood the content. The participants reported that the information and displays were clear. They successfully navigated the app but identified several areas where usability could be enhanced. Posttesting usability measures indicated that participants found M-Healer to be feasible, acceptable, and usable.
Conclusions: This study is the first to develop a digital mental health toolkit for healers in West Africa. Engaging healers in user-centered development produced an accessible and acceptable resource. Future field testing will determine whether M-Healer can improve healer practices and reduce human rights abuses.