Depression, Depression in Old Age
Conditions
Brief summary
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.
Detailed description
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.
Interventions
None listed
Sponsors
National Institute of Mental Health (NIMH)
University of Washington
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
60 Years to No maximum
Healthy volunteers
No
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.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Usability (qualitative interviews) | after 2 week usability trial | usability of MPATI intervention among provider end-users |
| Usability (system usability scale) | after 2 week usability trial | usability of MPATI intervention among provider end-users |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| acceptability -- patient retention | end of pilot trial (2 weeks per patient) | acceptability of MPATI intervention for geriatric depression in primary care |
| functioning (patient) | pre-post 2 week pilot trial | Sheehan Disability Scale (SDS) total scores to assess functional impairment; total scores range from 0 (unimpaired) to 30 (highly impaired). |
| depressive symptoms (patient) | pre-post 2 week pilot trial | Patient Health Questionnaire (PHQ-9) total scores to assess depressive symptoms (total score range 0-27; higher scores reflect greater depressive symptoms) |
| feasibility -- patient recruitment | end of pilot trial (2 weeks per patient) | feasibility of MPATI intervention for geriatric depression in primary care |
Other
| Measure | Time frame | Description |
|---|---|---|
| user burden | end of 2 week pilot trial | user burden of technology-enabled intervention for patients and providers |
Countries
United States
Outcome results
None listed