Global Digital Health
Dror Ben Zeev, PhD
Department of Psychiatry and Behavioral Sciences, University of Washington
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Lola Kola, PhD
Department of Psychiatry, University of Ibadan, Nigeria
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Jaime Snyder, PhD
Information School, University of Washington
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Anna Larsen, MPH, PhD
Department of Psychiatry and Behavioral Sciences, University of Washington
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Alexa Beaulieu, MPH
Department of Psychiatry and Behavioral Sciences, University of Washington
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Arya Kadakia, BA
Department of Psychiatry and Behavioral Sciences, University of Washington
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Digital Health: West Africa​
West Africa faces enormous mental health challenges, including lack of sufficient mental health
professionals and clinical infrastructure, limited access to medication, and pervasive societal
stigma around mental illness. People with mental illness often go undiagnosed, untreated, or
chained and confined for weeks, months or years at a time in prayer camps.
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Locally, no one advocates for the continuation of abusive practices; stakeholders from all
sectors, including government, academia, commerce, and healthcare are concerned about
human rights violations. Religious leaders, traditional healers, and those who operate prayer
camps that engage in these controversial practices have expressed openness and willingness
to explore more humane approaches. They need alternative tools.
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Our group has deep partnerships with researchers, mental health advocates, clinicians,
traditional and faith leaders, and people with lived experience of mental illness in West Africa.
Together, we collaborate to develop digital health approaches to combat stigma, support humane
care, and improve mental health outcomes using blended interventions (e.g., Evidence-Based Psychosocial
AND Spiritual; Technological AND Pharmacological; Mental Health Professional AND Paraprofessional/Caregiver).
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A Digital Toolkit (M-Healer) to Improve Mental Health Care
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Working in close collaboration with researchers at the University of Ghana, our team developed a digital toolkit designed to train traditional and faith healers to deliver brief psychosocial interventions to people with mental illness while also discontinuing their use of practices that may constitute human rights violations. Following a series of prayer camp visits and observations, individual interviews, focus groups, and co-design sessions with healers and prayer camp staff, we produced M-Healer. Once the prototype was developed, a usability study was conducted with faith healers in Ghana who found the tool to be feasible, acceptable, and usable. Read more here. ​
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​Combining mHealth and Nurse-Delivered Mental Health Care​
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In West Africa, most people suffering from serious mental illnesses like schizophrenia and bipolar disorder receive care from traditional and faith healers in “prayer camps.” Specialized mental health providers are scarce in the region, yet the prevalence of traditional healers and clustering of individuals with serious mental illness within the prayer camps offer opportunities to deliver evidence-based treatment to this population. Professors Dror Ben-Zeev at the University of Washington and Angela Ofori-Atta at the University of Ghana are co-leading a multinational team of researchers investigating a two-level intervention package involving a mobile health program which trains healers to deliver high-quality mental health interventions (M-Healer), and visiting mobile nurses who deliver medications directly to patients at prayer camps. With funding support from the National Institute of Mental Health (Grant # R01MH127531-01A1), we are evaluating the effectiveness of this intervention in multiple prayer camps throughout the region. Read more about this study here.
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WADMA: Building Capacity for Digital Mental Health Research in West Africa
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Developing and supporting a new generation of digital mental health leaders and innovators in West Africa is vital to improving mental health in the region. Our group at the University of Washington is collaborating with leaders in Ghana and Nigeria to establish the West African Digital Mental Health Alliance (WADMA) – a regional mission-centered network of early-career researchers and trainees with a particular interest in improving mental health through digital interventions. Through WADMA, members will build their network and receive targeted career development in digital mental health research alongside like-minded professionals. WADMA is the first cross-institutional initiative advancing capacity in digital mental health research in the region.
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Responding to Adolescent Perinatal Depression with Patient-Centered Mobile Health in West Africa​​
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Many factors influence the accessibility of health care facilities by perinatal adolescents. Adolescence has distinct developmental challenges, along with self-stigma (i.e., shame relating to getting pregnant at a young age) and public stigma from health care providers and others in the community that can make accessing these services difficult. Effective, flexible, and convenient-to-access interventions are needed to address the health care needs of pregnant adolescents.
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Led by Dr. Lola Kola, this project will build on previous work to scale up efforts for perinatal depression for adolescents in primary care in Nigeria. Dr. Kola will lead efforts utilizing user-centered design (UCD) principles to develop a mobile phone application to complement a face-to-face intervention for perinatal adolescents within routine care. Elements from the WHO mhGAP Evidenced-based Guidelines for Management of Perinatal Depression will be adapted for this work.
Mental Health Needs in the Middle East
War, geopolitical instability, and natural disasters have contributed to enormous unmet mental health needs in the Middle East and North Africa.
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Our group is working with international NGOs, government officials, policymakers, and local stakeholders to evaluate the state of available mental health care, clinical and technological capacities, and potential for development and deployment of digital mental health interventions in the region.
Jordan
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Jordan hosts one of the largest populations of Syrian refugees in the
world. We surveyed 209 (141 refugees) adults and youth in urban,
rural, and refugee camp settings. Survey results indicated that mobile
device ownership was lower among refugees than non-refugees (71 %
vs. 100 %, respectively). Refugee phone users had less access to
smartphones than non-refugees (75 % vs. 96 %, respectively).
Refugees and non-refugees reported using mobile devices for diverse
activities including calling (83 % vs. 100 %, respectively), texting (28 %
vs. 87 %, respectively) social media (45 % vs. 94 %, respectively),
watching videos (23 % vs. 90 %, respectively), and studying (34 % vs.
72 %, respectively). Most respondents had reliable access to electricity
(75 % vs. 99 %, respectively) and to mobile-cellular service (67 % vs.
97 %, respectively). Both groups identified anger, anxiety, depression,
traumatic memories, and eating problems as the most common
mental health problems in their communities. Approximately half of refugees (44 %) and non-refugees (50 %) reported that their communities had insufficient or no access to mental health resources. Most refugees (78 %) and non-refugee (87 %) believed that using mobile devices to provide support for people with mental health conditions would be helpful. Full Article.
West Bank
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Palestinians in the West Bank are at heightened risk for mental health problems. Limited availability of clinicians and a host of geopolitical, topographical, and infrastructural challenges create significant regional barriers to clinic-based care. We surveyed 272 Palestinian adults in urban, rural, and refugee camp settings. Most participants (93.4%) reported owning mobile phones. The penetration of mobile devices was high across all study sites. Males and females did not differ in their access to this resource. Among mobile phone owners, 79.9% had smartphones, 32.2% had basic mobile phones, and 12.2% owned both. Respondents reported having reliable access to electricity (99.6%) and Wi-Fi (80.9%). Almost all mobile phone owners (99.6%) reported using social media such as Facebook, WhatsApp, or Twitter. Two-thirds of participants reported that over half of the people in their communities struggled with depression, posttraumatic stress, or auditory hallucinations. Most participants indicated that they would personally be interested in mHealth for Mental Health options such as bi-directional texting with clinicians (68.8%), smartphone applications (66.5%), unidirectional support texts (64.7%), or web-based interventions (64.0%). Full Article.