Technology-assisted peer therapy: a new way of delivering evidence-based psychological interventions

• Main Authors: Najia Atif (Author), Huma Nazir (Author), Zoone Hasan Sultan (Author), Rabia Rauf (Author), Ahmed Waqas (Author), Abid Malik (Author), Siham Sikander (Author), Atif Rahman (Author)
• Format: Book
• Published: BMC, 2022-06-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.
• Notes: 10.1186/s12913-022-08233-6; 1472-6963
• Keywords: Perinatal depression; Perinatal mental health; Digital intervention; App for depression; Task-sharing; Public aspects of medicine; RA1-1270
• Source: BMC Health Services Research, Vol 22, Iss 1, Pp 1-12 (2022)

Abstract In low-income settings, ninety percent of individuals with clinical depression have no access to evidence-based psychological interventions. Reasons include lack of funds for specialist services, scarcity of trained mental health professionals, and the stigma attached to mental illness. In recent years there have been many studies demonstrating effective delivery of psychological interventions through a variety of non-specialists. While these interventions are cost-effective and less stigmatising, efforts to scale-up are hampered by issues of quality-control, and what has been described by implementation scientists as 'voltage-drop' and 'programme-drift.' Using principles of Human Centred Design in a rural setting in Pakistan, we worked with potential users to co-design a Tablet or Smartphone-based App that can assist a lay-person deliver the Thinking Healthy Programme, a World Health Organization-endorsed evidence-based intervention for perinatal depression. The active ingredients of this cognitive-therapy based intervention are delivered by a virtual 'avatar' therapist incorporated into the App which is operated by a 'peer' (a woman from the neighbourhood with no prior experience of healthcare delivery). Using automated cues from the App, the peer reinforces key therapeutic messages, helps with problem-solving and provides the non-specific but essential therapeutic elements of empathy and support. The peer and App therefore act as co-therapists in delivery of the intervention. The peer can deliver the intervention with good fidelity after brief automated in-built training. This approach has the potential to be applied to other areas of mental health and help bridge the treatment gap, especially in resource-poor settings. This paper describes the process of co-development with end-users and key features of the App.