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Development and feasibility assessment of a collaborative stepped care intervention for management of depression in the mental health in primary care (MeHPriC) project, Lagos, Nigeria

Published online by Cambridge University Press:  17 October 2018

Abiodun O. Adewuya Open the ORCID record for Abiodun O. Adewuya [Opens in a new window] ,
Tomilola Adewumi ,
Olufisayo Momodu ,
Olushola Olibamoyo ,
Olabanji Adesoji ,
Adedayo Adegbokun ,
Suraju Adeyemo ,
Olufikunayo Manuwa  and
Dapo Adegbaju
Abiodun O. Adewuya*
Affiliation:
Department of Behavioural Medicine, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria Centre for Mental Health Research and Initiative, Lagos, Nigeria
Tomilola Adewumi
Affiliation:
Centre for Mental Health Research and Initiative, Lagos, Nigeria
Olufisayo Momodu
Affiliation:
Centre for Mental Health Research and Initiative, Lagos, Nigeria Lagos State Health Services Commission, Lagos, Nigeria
Olushola Olibamoyo
Affiliation:
Department of Psychiatry, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
Olabanji Adesoji
Affiliation:
Lagos State Health Services Commission, Lagos, Nigeria
Adedayo Adegbokun
Affiliation:
Lagos State Health Services Commission, Lagos, Nigeria
Suraju Adeyemo
Affiliation:
Lagos State Health Services Commission, Lagos, Nigeria
Olufikunayo Manuwa
Affiliation:
Lagos State Health Services Commission, Lagos, Nigeria
Dapo Adegbaju
Affiliation:
Federal Neuropsychiatric Hospital, Yaba, Lagos, Nigeria
*
Author for correspondence: Abiodun O. Adewuya, E-mail: [email protected]
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Abstract

Background

This study aimed to develop and test the feasibility of a primary care worker-led psychological intervention as the main feature of a collaborative stepped care for depression that is effective, affordable, culturally acceptable, tailored to patients’ clinical condition and easily integrate-able into the primary care schedule in Nigeria.

Methods

Using the Medical Research Council framework, in the first stage (modelling/theoretical development), experts reviewed and distilled evidence from literature to form the intervention components. In the second (formative) stage, local stakeholders were consulted on the practical application and feasibility of the proposed intervention. The third (piloting) stage involved testing for the clinical efficacy and acceptability of the components of the draft intervention

Results

The final intervention components included a 2-stage screening (red-flagging and further evaluation), psychoeducation, low-intensity psychological therapy (problem-solving therapy for primary care), antidepressant prescription, proactive mobile telephony adherence support and referral to the mental health specialist if needed. At 3 months, 71.6% of depressed patients on the intervention improved. The intervention was perceived to be acceptable and useful by over 70% of health workers and clients and had high ratings (>70% score) by expert panels on intervention simplicity, facilitation strategies, and quality of delivery.

Conclusions

The development and feasibility testing of our integrated intervention encompassed review of current literature, expert opinions and consultation with local stakeholders and end users. Our intervention package was largely deemed acceptable, relevant, useful, and feasible. Important lessons learnt with this process will help in future intervention developments.

Keywords

Collaborative stepped caredepressionfeasibilityNigeriaprimary care
Type
Original Articles
Information
Psychological Medicine , Volume 49 , Issue 13 , October 2019 , pp. 2149 - 2157
Copyright
Copyright © Cambridge University Press 2018 

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