Implementation and scalability of a digital intervention to reduce depressive symptoms in people with diabetes, hypertension or both in Brazil and Peru: a qualitative study of health system’s stakeholders’ perspectives

World Health Organization. Depression and other common mental disorders: global health estimates. Geneva: WHO; 2017.

Khaledi M, Haghighatdoost F, Feizi A, Aminorroaya A. The prevalence of comorbid depression in patients with type 2 diabetes: an updated systematic review and meta-analysis on huge number of observational studies. Acta Diabetol. 2019;56(6):631–50.

Correll CU, Solmi M, Veronese N, Bortolato B, Rosson S, Santonastaso P, Thapa-Chhetri N, Fornaro M, Gallicchio D, Collantoni E, et al. Prevalence, incidence and mortality from cardiovascular disease in patients with pooled and specific severe mental illness: a large-scale meta-analysis of 3,211,768 patients and 113,383,368 controls. World Psychiatry. 2017;16(2):163–80.

Diez-Canseco F, Ipince A, Toyama M, Benate-Galvez Y, Galan-Rodas E, Medina-Verastegui JC, Sanchez-Moreno D, Araya R, Miranda JJ. Integration of mental health and chronic non-communicable diseases in Peru: challenges and opportunities for primary care settings. Rev Peru Med Exp Salud Publica. 2014;31(1):131–6.

Patel V, Maj M, Flisher AJ, De Silva MJ, Koschorke M, Prince M, Tempier R, Riba M, Sanchez M, Campodonico FD, et al. Reducing the treatment gap for mental disorders: a WPA survey. World Psychiatry. 2010;9(3):169–76.

Munhoz TN, Nunes BP, Wehrmeister FC, Santos IS, Matijasevich A. A nationwide population-based study of depression in Brazil. J Affect Disord. 2016;192:226–33.

Instituto Nacional de Salud. Comorbilidad de la depresión y enfermedades crónicas en la población peruana. In: Análisis Secundario de Datos N° 01-2016. Lima: INS, Unidad de Análisis y Generación de Evidencias; 2016.

Menezes P, Quayle J, Garcia Claro H, da Silva S, Brandt LR, Diez-Canseco F, Miranda JJ, Price LN, Mohr DC, Araya R. Use of a mobile phone app to treat depression comorbid with hypertension or diabetes: a pilot study in Brazil and Peru. JMIR Ment Health. 2019;6(4): e11698.

Brandt LR, Hidalgo L, Diez-Canseco F, Araya R, Mohr DC, Menezes PR, Miranda JJ. Addressing depression comorbid with diabetes or hypertension in resource-poor settings: a qualitative study about user perception of a nurse-supported smartphone app in Peru. JMIR Mental Health. 2019;6(6): e11701.

Araya R, Menezes PR, Claro HG, Brandt LR, Daley KL, Quayle J, Diez-Canseco F, Peters TJ, Vera Cruz D, Toyama M, et al. Effect of a digital intervention on depressive symptoms in patients with comorbid hypertension or diabetes in Brazil and Peru. JAMA. 2021;325(18):1852.

Stirman SW, Gutner CA, Langdon K, Graham JR. Bridging the gap between research and practice in mental health service settings: an overview of developments in implementation theory and research. Behav Ther. 2016;47(6):920–36.

Patel V. Scale up task-sharing of psychological therapies. The Lancet. 2022;399(10322):343–5.

Milat A, Newson R, King L, Rissel C, Wolfenden L, Bauman A, Redman S, Giffin M. A guide to scaling up population health interventions. Public Health Res Pract.

Wagenaar BH, Hammett WH, Jackson C, Atkins DL, Belus JM, Kemp CG. Implementation outcomes and strategies for depression interventions in low- and middle-income countries: a systematic review. Global Mental Health. 2020. https://doi.org/10.1017/gmh.2020.1.

Massuda A, Hone T, Leles FAG, De Castro MC, Atun R. The Brazilian health system at crossroads: progress, crisis and resilience. BMJ Glob Health. 2018;3(4): e000829.

Carrillo-Larco RM, Guzman-Vilca WC, Leon-Velarde F, Bernabe-Ortiz A, Jimenez MM, Penny ME, Gianella C, Leguía M, Tsukayama P, Hartinger SM, et al. Peru—progress in health and sciences in 200 years of independence. Lancet Reg Health Am. 2022;7: 100148.

Ekers D, Webster L, Van Straten A, Cuijpers P, Richards D, Gilbody S. Behavioural activation for depression; an update of meta-analysis of effectiveness and sub group analysis. PLoS ONE. 2014;9(6): e100100.

Rocha TIU, Aschar SCDAL, Hidalgo-Padilla L, Daley K, Claro HG, Martins Castro HC, Dos Santos DVC, Miranda JJ, Araya R, Menezes PR. Recruitment, training and supervision of nurses and nurse assistants for a task-shifting depression intervention in two RCTs in Brazil and Peru. Hum Resour Health. 2021. https://doi.org/10.1186/s12960-021-00556-5.

Palinkas LA, Horwitz SM, Green CA, Wisdom JP, Duan N, Hoagwood K. Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Adm Policy Mental Health Mental Health Serv Res. 2015;42(5):533–44.

Dworkin SL. Sample size policy for qualitative studies using in-depth interviews. Arch Sex Behav. 2012;41(6):1319–20.

Lund C, Alem A, Schneider M, Hanlon C, Ahrens J, Bandawe C, Bass J, Bhana A, Burns J, Chibanda D, et al. Generating evidence to narrow the treatment gap for mental disorders in sub-Saharan Africa: rationale, overview and methods of AFFIRM. Epidemiol Psychiatr Sci. 2015;24(3):233–40.

Bengtsson M. How to plan and perform a qualitative study using content analysis. NursingPlus Open. 2016;2:8–14.

Toyama M, Cavero V, Araya R, Menezes PR, Mohr DC, Miranda JJ, Diez-Canseco F. Participants’ and nurses’ experiences with a digital intervention for patients with depressive symptoms and comorbid hypertension or diabetes in Peru: A qualitative post-randomized controlled trial study. JMIR 2021.

Zomahoun HTV, Ben Charif A, Freitas A, Garvelink MM, Menear M, Dugas M, Adekpedjou R, Légaré F. The pitfalls of scaling up evidence-based interventions in health. Glob Health Action. 2019;12(1):1670449.

Diez-Canseco F, Toyama M, Ipince A, Perez-Leon S, Cavero V, Araya R, Miranda JJ. Integration of a technology-based mental health screening program into routine practices of primary health care services in Peru (The Allillanchu Project): development and implementation. J Med Internet Res. 2018;20(3):e100–e100.

Biff D, De Pires DEP, de Oliveira JSA, Machado FL, Souza DF: Workloads of nurses in the Family Health in Brazil: what the literature says. Int Arch Med 2016; 9.

Hanson K, Ranson MK, Oliveira-Cruz V, Mills A. Expanding access to priority health interventions: a framework for understanding the constraints to scaling-up. J Int Dev J Dev Stud Assoc. 2003;15(1):1–14.

Mangham LJ, Hanson K. Scaling up in international health: what are the key issues? Health Policy Plan. 2010;25(2):85–96.

World Health Organisation. mhGAP intervention guide for mental, neurological and substance use disorders in non-specialized health settings: Mental Health Gap Action Programme (mhGAP). Italy: WHO; 2010.

Bird P, Omar M, Doku V, Lund C, Nsereko JR, Mwanza J. Increasing the priority of mental health in Africa: findings from qualitative research in Ghana, South Africa, Uganda and Zambia. Health Policy Plan. 2011;26(5):357–65.

Sheikh K, Abimbola S, Organization WH. Learning health systems: pathways to progress: flagship report of the alliance for health policy and systems research. 2021.

Kruk ME, Gage AD, Arsenault C, Jordan K, Leslie HH, Roder-Dewan S, Adeyi O, Barker P, Daelmans B, Doubova SV, et al. High-quality health systems in the Sustainable Development Goals era: time for a revolution. Lancet Glob Health. 2018;6(11):e1196–252.

Ministerio de Salud. Plan de salud mental en el contexto de COVID-19. In: Resolución Ministerial Nº 363-2020-MINSA. Lima: MINSA; 2020.

Curioso WH, Galán-Rodas E. El rol de la telesalud en la lucha contra el COVID-19 y la evolución del marco normativo peruano. Acta Med Peru. 2020. https://doi.org/10.35663/amp.2020.373.1004.

Ministerio de Salud. Guía técnica para el cuidado de la salud mental de la población afectada, familias y comunidad, en el contexto del COVID-19. In: RM N° 186-2020-MINSA. Lima: MINSA; 2020.

Toyama M, Castillo H, Galea JT, Brandt LR, Mendoza M, Herrera V, Mitrani M, Cutipe Y, Cavero V, Diez-Canseco F, et al. Peruvian mental health reform: a framework for scaling-up mental health services. Int J Health Policy Manag. 2017;6(9):501–8.

De Jesus MJ. Mental healthcare in Brazil: modest advances and major challenges. Adv Psychiatr Treat. 2014;20(2):113–5.

Castillo-Martell H, Cutipé-Cárdenas Y. Implementación, resultados iniciales y sostenibilidad de la reforma de servicios de salud mental en el Perú, 2013–2018. Revista Peruana de Medicina Experimental y Salud Publica. 2019;36:326–33.

World Health Organization. Task shifting: rational redistribution of tasks among health workforce teams: global recommendations and guidelines. 2007.

Phoosuwan N, Lundberg PC. Knowledge, attitude and self-efficacy program intended to improve public health professionals’ ability to identify and manage perinatal depressive symptoms: a quasi-experimental study. BMC Public Health. 2020. https://doi.org/10.1186/s12889-020-10086-9.

Cavero V, Diez-Canseco F, Toyama M, Flórez Salcedo G, Ipince A, Araya R, Miranda JJ. Provision of mental health care within primary care in Peru: a qualitative study exploring the perspectives of psychologists, primary health care providers, and patients. Wellcome Open Res. 2018;3:9–9.

Benítez MA, Velasco C, Sequeira AR, Henríquez J, Menezes FM, Paolucci F. Responses to COVID-19 in five Latin American countries. Health Policy Technol. 2020;9(4):525–59.

Gómez F, Paskulin LMG, Jiménez González MdJ, Sibrian de Martinez RE, Rosset I. Tecnologías digitales y atención al adulto mayor en la atención primaria en salud. 2021.

Rodriguez-Villa E, Rauseo-Ricupero N, Camacho E, Wisniewski H, Keshavan M, Torous J. The digital clinic: implementing technology and augmenting care for mental health. Gen Hosp Psychiatry. 2020;66:59–66.

Wisniewski H, Gorrindo T, Rauseo-Ricupero N, Hilty D, Torous J. The role of digital navigators in promoting clinical care and technology integration into practice. Digital Biomarkers. 2020;4(1):119–35.

Concepción-Breton A, Corrales-Camacho I, Córdoba ME, Acosta-Hernández ME, Larancuent-Cueto OI, De La Cruz-Morel YL. Sondeo de Casos en Personas Mayores sobre Actividades Cotidianas y Utilización de Tecnologías de la Información y la Comunicación (TIC) en Tiempos de Pandemia. Rev Tecnol-Educ Docentes 20. 2020;9(2):132–50.

Johnson LCM, Chwastiak L, Poongothai S, Tandon N, Anjana RM, Aravind S, Sridhar GR, Rao D, Mohan V, Ali MK. Adaptations and patient responses to behavioral intervention components in a depression-focused chronic disease care model implemented in India. Transl Behav Med. 2020;10(1):35–45.