A community health volunteer delivered problem-solving therapy mobile application based on the Friendship Bench ‘Inuka Coaching’ in Kenya: A pilot cohort study
Open accessAbstract
Background: Sub-Saharan Africa (SSA) has the largest care gap for common mental disorders (CMDs) globally, heralding the use of cost-cutting approaches such as task-shifting and digital technologies as viable approaches for expanding the mental health workforce. This study aims to evaluate the effectiveness of a problem-solving therapy (PST) intervention that is delivered by community health volunteers (CHVs) through a mobile application called ‘Inuka coaching’ in Kenya. Methods: A pilot prospective cohort study recruited participants from 18 health centres in Kenya. People who self-screened were eligible if they scored 8 or higher on the Self-Reporting Questionnaire-20 (SRQ-20), were aged 18 years or older, conversant in written and spoken English, and familiar with the use of smart mobile devices. The intervention consisted of four PST mobile application chat-sessions delivered by CHVs. CMD measures were administered at baseline, 4-weeks (post-treatment), and at 3-months follow-up assessment. Results: In all, 80 participants consented to the study, of which 60 participants (female, n = 38; male, n = 22) completed their 4-week assessments, and 52 participants completed their 3-month follow-up assessment. The results showed a significant improvement over time on the Self-Reporting Questionnaire-20 (SRQ-20). Higher-range income, not reporting suicidal ideation, being aged over 30 years, and being male were associated with higher CMD symptom reduction. Conclusion: To our knowledge, this report is the first to pilot a PST intervention that is delivered by CHVs through a locally developed mobile application in Kenya, to which clinically meaningful improvements were found. However, a randomised-controlled trial is required to robustly evaluate this intervention.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Holding training in a health center allowed for easier interaction and troubleshooting while participants used the application.
“Doukani et al. (41) however, mentioned the importance of holding the training in a health center as it allowed for easier interaction and troubleshooting while the participants used the application.”
From Digital Solutions for Community and Primary Health Workers: Lessons From Implementations in Africa (2022) · cites this paper as Doukani et al. (41)
The Methods (Inuka coaching) say that holding intervention sessions at the health centre enabled participants to get help using the app and resolving technical issues. The cited passage describes intervention sessions, not training held at the health centre; it also does not specifically describe easier interaction. (LLM, conf=0.86)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
The PHQ-9: Validity of a brief depression severity measure
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001) · Journal of General Internal Medicine · doi:10.1046/j.1525-1497.2001.016009606.x · Cited by 44,910 · see citing works
Curran, G. M., Bauer, M., Mittman, B., Pyne, J. M., & Stetler, C. (2012) · Medical Care · doi:10.1097/mlr.0b013e3182408812 · Cited by 4,058 · cited 1× · see citing works
“The current study formed one of many phases of ‘ testing ’ , in an ongoing iterative process of developing, improving and testing the intervention (Curran et al ., 2012).”
MethodWalker, E. R., McGee, R. E., & Druss, B. G. (2015) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2014.2502 · Cited by 2,976 · see citing works
Men, masculinity, and the contexts of help seeking
Addis, M. E., & Mahalik, J. R. (2003) · American Psychologist · doi:10.1037/0003-066x.58.1.5 · Cited by 2,761 · see citing works
Poverty and common mental disorders in low and middle income countries: A systematic review
Lund, C., Breen, A., Flisher, A. J., Kakuma, R., Corrigall, J., Joska, J. A., Swartz, L., & Patel, V. (2010) · Social Science & Medicine · doi:10.1016/j.socscimed.2010.04.027 · Cited by 1,375 · see citing works
Mackenzie, C. S., Gekoski, W. L., & Knox, V. J. (2006) · Aging & Mental Health · doi:10.1080/13607860600641200 · Cited by 878 · cited 1× · see citing works
“…treat-ment in men, is also reflected in the wider literature around help-seeking behaviours, in which men were found to hold more negative attitude towards the utilisation of mental health services when compared to women (Addis and Mahalik, 2003; Mackenzie et al ., 2006; Yousaf and Popat, 2015).”
ResultDiagnostic accuracy of the mood module of the patient health questionnaire: a systematic review
Wittkampf, K. A., Naeije, L., Schene, A. H., Huyser, J., & van Weert, H. C. (2007) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2007.06.004 · Cited by 493 · see citing works
The mental health workforce gap in low- and middle-income countries: a needs-based approach
Bruckner, T. A., Scheffler, R. M., Shen, G., Yoon, J., Chisholm, D., Morris, J., Fulton, B. D., Dal Poz, M. R., & Saxena, S. (2011) · Bulletin of the World Health Organization · doi:10.2471/blt.10.082784 · Cited by 433 · see citing works
Mental health: there’s an app for that
Anthes, E. (2016) · Nature · doi:10.1038/532020a · Cited by 333 · see citing works
Chibanda, D., Mesu, P., Kajawu, L., Cowan, F., Araya, R., & Abas, M. A. (2011) · BMC Public Health · doi:10.1186/1471-2458-11-828 · Cited by 319 · see citing works
Self-citationKaryotaki, E., Ebert, D. D., Donkin, L., Riper, H., Twisk, J., Burger, S., Rozental, A., Lange, A., Williams, A. D., Zarski, A. C., et al. (2018) · Clinical Psychology Review · doi:10.1016/j.cpr.2018.06.007 · Cited by 303 · see citing works
Sagar-Ouriaghli, I., Godfrey, E., Bridge, L., Meade, L., & Brown, J. S. L. (2019) · American Journal of Men’s Health · doi:10.1177/1557988319857009 · Cited by 274 · see citing works
Torok, M., Han, J., Baker, S., Werner-Seidler, A., Wong, I., Larsen, M. E., & Christensen, H. (2020) · The Lancet Digital Health · doi:10.1016/s2589-7500(19)30199-2 · Cited by 273 · see citing works
Seidman, G., & Atun, R. (2017) · Human Resources for Health · doi:10.1186/s12960-017-0200-9 · Cited by 231 · see citing works
Qualitative Meta-Synthesis of User Experience of Computerised Therapy for Depression and Anxiety
Knowles, S. E., Toms, G., Sanders, C., Bee, P., Lovell, K., Rennick-Egglestone, S., Coyle, D., Kennedy, C. M., Littlewood, E., Kessler, D., et al. (2014) · PLoS ONE · doi:10.1371/journal.pone.0084323 · Cited by 177 · see citing works
Hoek, W., Schuurmans, J., Koot, H. M., & Cuijpers, P. (2012) · PLoS ONE · doi:10.1371/journal.pone.0043485 · Cited by 90 · see citing works
The bolstering effect of conceptual priming on psychological help-seeking attitudes in men
Yousaf, O., & Popat, A. (2015) · Journal of Mental Health · doi:10.3109/09638237.2014.998808 · Cited by 7 · see citing works
Flagged first, then by citations
Research works printed but not linked: 23
- Abaza H and Marschollek M (2017) Mhealth application areas and technology combinations: a comparison of literature from high and low/middle income countries. Methods of Information in Medicine 56, Issue MethodsOpen, e105– e122. 28925418 PMC6291822
- Amati F, Banks C, Greenfield G and Green J (2017) Predictors of outcomes for patients with common mental health disorders receiving psychological therapies in community settings: a systematic review. Journal of Public Health 40, 375– 387. 29253218
- Andersson G and Titov N (2014) Advantages and limitations of internet-based interventions for common mental disorders. World Psychiatry 13, 4– 11. 24497236 PMC3918007
- Arjadi R, Nauta MH, Scholte WF, Hollon SD, Chowdhary N, Suryani AO, Uiterwaal CSPM and Bockting CLH (2018) Internet-based behavioural activation with lay counsellor support versus online minimal psychoeducation without support for treatment of depression: a randomised controlled trial in Indonesia. The Lancet Psychiatry 5, 707– 716. 30006262
- Becker AE and Kleinman A (2013) Mental health and the global agenda. New England Journal of Medicine 369, 66– 73. 23822778
- Büscher R, Torok M, Terhorst Y and Sander L (2020) Internet-based cognitive behavioral therapy to reduce suicidal ideation: a systematic review and meta-analysis. JAMA Network Open 3, e203933. 32343354 PMC7189224
- Chibanda D, Weiss HA, Verhey R, Simms V, Munjoma R, Rusakaniko S, Chingono A, Munetsi E, Bere T, Manda E, Abas M and Araya R (2016) Effect of a primary care–based psychological intervention on symptoms of common mental disorders in Zimbabwe. JAMA 316, 2618. 28027368
- Dhadphale M, Ellison RH and Griffin L (1983) The frequency of psychiatric disorders among patients attending semi-urban and rural general out-patient clinics in Kenya. British Journal of Psychiatry 142, 379– 383. 6850176
- Forkmann T, Gauggel S, Spangenberg L, Brähler E and Glaesmer H (2013) Dimensional assessment of depressive severity in the elderly general population: psychometric evaluation of the PHQ-9 using Rasch analysis. Journal of Affective Disorders 148, 323– 330. 23411025
- Hampshire K, Porter G, Owusu SA, Mariwah S, Abane A, Robson E, Munthali A, DeLannoy A, Bango A, Gunguluza N and Milner J (2015) Informal m-health: how are young people using mobile phones to bridge healthcare gaps in Sub-Saharan Africa? Social Science and Medicine 142, 90– 99. 26298645
- Lund C. (2012) Poverty and mental health: a review of practice and policies. Neuropsychiatry 2, 213– 219.
- Maselko J (2017) Social epidemiology and global mental health: expanding the evidence from high-income to low- and middle-income countries. Current Epidemiology Reports 4, 166– 173. 28680795 PMC5488107
- Monahan PO, Shacham E, Reece M, Kroenke K, Ong'Or WO, Omollo O, Yebei VN and Ojwang C (2009) Validity/reliability of PHQ-9 and PHQ-2 depression scales among adults living with HIV/AIDS in Western Kenya. Journal of General Internal Medicine 24, 189– 197. 19031037 PMC2629000
- Naslund JA, Aschbrenner KA, Araya R, Marsch LA, Unützer J, Patel V and Bartels SJ (2017) Digital technology for treating and preventing mental disorders in low-income and middle-income countries: a narrative review of the literature. The Lancet. Psychiatry 4, 486– 500. 28433615 PMC5523650
- Naslund JA, Shidhaye R and Patel V (2019) Digital technology for building capacity of nonspecialist health workers for task sharing and scaling up mental health care globally. Harvard Review of Psychiatry 27, 181– 192. 30958400 PMC6517068
- Ndetei DM, Ongetcha FA, Mutiso V, Kuria M, Khasakhala LA and Kokonya DA (2007) The challenges of human resources in mental health in Kenya. African Journal of Psychiatry 10, 33– 36.
- Patel V, Saxena S, De Silva M and Samele C (2013) Transforming lives, enhancing communities: innovations in mental health. In Report of the Mental Health Working Group. Available at https://www.imperial.ac.uk/media/imperial-college/institute-of-global-health-innovation/public/WISH_Mental_Health_Report.pdf. 24428425
- Shah PB (2011) Intention-to-treat and per-protocol analysis. CMAJ: Canadian Medical Association Journal = Journal de l'Association Medicale Canadienne 183, 696; author reply 696. PMC3071397 21464181
- Sijbrandij M, Bryant RA, Schafer A, Dawson KS, Anjuri D, Ndogoni L, Ulate J, Hamdani SU and van Ommeren M (2016) Problem management Plus (PM+) in the treatment of common mental disorders in women affected by gender-based violence and urban adversity in Kenya; study protocol for a randomized controlled trial. International Journal of Mental Health Systems 10, 44. 27252778 PMC4888633
- Spitzer RL, Kroenke K, Williams JBW and Löwe B (2006) A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of Internal Medicine 166, 1092– 1097. 16717171
- van Ginneken N, Tharyan P, Lewin S, Rao GN, Meera S, Pian J, Chandrashekar S and Patel V (2013) Non-specialist health worker interventions for the care of mental, neurological and substance-abuse disorders in low- and middle-income countries. Cochrane Database of Systematic Reviews 11, CD009149. 24249541
- von Brachel R, Teismann T, Feider L and Margraf J (2019) Suicide ideation as a predictor of treatment outcomes in cognitive-behavioral therapy for unipolar mood disorders. International Journal of Clinical and Health Psychology 19, 80– 84. 30619501 PMC6300714
- Walker ER, McGee RE and Druss BG (2015) Mortality in mental disorders and global disease burden implications. JAMA Psychiatry 72, 334. 25671328 PMC4461039
Cited by
Sorted by citations
Digital Solutions for Community and Primary Health Workers: Lessons From Implementations in Africa
Owoyemi, A., Osuchukwu, J. I., Azubuike, C., Ikpe, R. K., Nwachukwu, B. C., Akinde, C. B., Biokoro, G. W., Ajose, A. B., Nwokoma, E. I., Mfon, N. E., et al. (2022) · Frontiers in Digital Health · doi:10.3389/fdgth.2022.876957 · Cited by 78 · see citing works
“…and fixing both software related problems (related to applications) and hardware related problems (related to phones and sim cards) were provided by the local research team including installing the phone system applications, protocol forms and dealing with any queries (12, 13, 17, 21, 27, 41).”
BackgroundMethodMudiyanselage, K. W. W., De Santis, K. K., Jörg, F., Saleem, M., Stewart, R., Zeeb, H., & Busse, H. (2024) · BMC Public Health · doi:10.1186/s12889-023-17417-6 · Cited by 48 · see citing works
- Authors
- Doukani, A., van Dalen, R., Valev, H., Njenga, A., Sera, F., & Chibanda, D.
- Affiliations
- London School of Hygiene & Tropical Medicine (GB)
- Philips (Netherlands) (NL)
- University of Florence (IT)
- Corresponding author
- Doukani, Asmae
- Venue
- Global Mental Health
- Publisher
- Cambridge University Press (CUP)
- Published
- 2021
- Volume
- 8
- Pages
- e9-e9
- ISSN
- 2054-4251 (ISSN-L)
- PMC
- PMC8127638
- OpenAlex
- W3133802444
- Cited by
- 31
- References
- 17
- Citations by year
- 2026: 7 · 2025: 6 · 2024: 7 · 2023: 6 · 2022: 4 · 2021: 1
- FWCI
- 4.04
- Type
- journal article
- Language
- en
- Update notices
- correction (2021-03-10)
- Open access
- gold
- doi.org
- Locations
- Cambridge Prisms Global Mental Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Lancaster EPrints (Lancaster University) (acceptedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- Florence Research (University of Florence) (submittedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- Grand Challenges Canada
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Keywords
- problem-solving therapy, community health volunteers, mobile application, Friendship Bench, task shifting, common mental disorders, mental health professionals, Kenya, predictors of treatment response
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
