abstract: 'Background: Smartphone apps could constitute a cost-effective strategy

  to overcome health care system access barriers to mental health services

  for people in low- and middle-income countries.

  Objective: The aim of this paper was to explore the patients''

  perspectives of CONEMO (Emotional Control, in Spanish: Control

  Emocional), a technology-driven, psychoeducational, and nurse-supported

  intervention delivered via a smartphone app aimed at reducing depressive

  symptoms in people with diabetes, hypertension or both who attend public

  health care centers, as well as the nurses'' feedback about their role

  and its feasibility to be scaled up.

  Methods: This study combines data from 2 pilot studies performed in

  Lima, Peru, between 2015 and 2016, to test the feasibility of CONEMO.

  Interviews were conducted with 29 patients with diabetes, hypertension

  or both with comorbid depressive symptoms who used CONEMO and 6 staff

  nurses who accompanied the intervention. Using a content analysis

  approach, interview notes from patient interviews were transferred to a

  digital format, coded, and categorized into 6 main domains: the

  perceived health benefit, usability, adherence, user satisfaction with

  the app, nurse''s support, and suggestions to improve the intervention.

  Interviews with nurses were analyzed by the same approach and

  categorized into 4 domains: general feedback, evaluation of training,

  evaluation of study activities, and feasibility of implementing this

  intervention within the existing structures of health system.

  Results: Patients perceived improvement in their emotional health

  because of CONEMO, whereas some also reported better physical health.

  Many encountered some difficulties with using CONEMO, but resolved them

  with time and practice. However, the interactive elements of the app,

  such as short message service, android notifications, and pop-up

  messages were mostly perceived as challenging. Satisfaction with CONEMO

  was high, as was the self-reported adherence. Overall, patients

  evaluated the nurse accompaniment positively, but they suggested

  improvements in the technological training and an increase in the amount

  of contact. Nurses reported some difficulties in completing their tasks

  and explained that the CONEMO intervention activities competed with

  their everyday work routine.

  Conclusions: Using a nurse-supported smartphone app to reduce depressive

  symptoms among people with chronic diseases is possible and mostly

  perceived beneficial by the patients, but it requires context-specific

  adaptations regarding the implementation of a task shifting approach

  within the public health care system. These results provide valuable

  information about user feedback for those building mobile health

  interventions for depression.'
affiliation: 'Diez-Canseco, F (Corresponding Author), Univ Peruana Cayetano Heredia,
  CRONICAS Ctr Excellence Chron Dis, Ave Armendariz 497, Lima, Peru.

  Brandt, Lena R.; Hidalgo, Liliana; Diez-Canseco, Francisco; Jaime Miranda, J., Univ
  Peruana Cayetano Heredia, CRONICAS Ctr Excellence Chron Dis, Ave Armendariz 497,
  Lima, Peru.

  Araya, Ricardo, Kings Coll London, Inst Psychiat Psychol \& Neurosci, Hlth Serv
  \& Populat Res, Ctr Global Mental Hlth \& Primary Care Res, London, England.

  Mohr, David C., Northwestern Univ, Ctr Behav Intervent Technol, Chicago, IL 60611
  USA.

  Menezes, Paulo R., Univ Sao Paulo, Fac Med, Sao Paulo, Brazil.

  Menezes, Paulo R., Univ Sao Paulo, Populat Mental Hlth Res Ctr, Sao Paulo, Brazil.

  Jaime Miranda, J., Univ Peruana Cayetano Heredia, Sch Med, Dept Med, Lima, Peru.'
article-number: e11701
author: Brandt, Lena R. and Hidalgo, Liliana and Diez-Canseco, Francisco and Araya,
  Ricardo and Mohr, David C. and Menezes, Paulo R. and Jaime Miranda, J.
author-email: fdiezcanseco@gmail.com
author_list:
- family: Brandt
  given: Lena R.
- family: Hidalgo
  given: Liliana
- family: Diez-Canseco
  given: Francisco
- family: Araya
  given: Ricardo
- family: Mohr
  given: David C.
- family: Menezes
  given: Paulo R.
- family: Jaime Miranda
  given: J.
da: '2023-09-28'
doi: 10.2196/11701
files: []
issn: 2368-7959
journal: JMIR MENTAL HEALTH
keywords: 'mental health; depression; noncommunicable diseases; mHealth;

  smartphone; developing countries'
keywords-plus: 'BEHAVIORAL ACTIVATION TREATMENT; MENTAL-HEALTH; SELF-HELP; DISORDERS;

  INTERNET; EFFICACY; THERAPY; CARE; INTERVENTIONS; ASSOCIATION'
language: English
month: JUN 18
number: '6'
number-of-cited-references: '90'
orcid-numbers: 'Menezes, Paulo/0000-0001-6330-3314

  Miranda, J. Jaime/0000-0002-4738-5468

  Araya, Ricardo/0000-0002-0420-5148

  Menezes, Paulo R/0000-0001-6330-3314

  Hidalgo-Padilla, Liliana/0000-0001-8451-7215

  Mohr, David/0000-0002-5443-7596

  Diez-Canseco, Francisco/0000-0002-7611-8190

  Brandt, Lena R/0000-0001-7800-8473'
papis_id: 190b400671a045f2e055ccc0a3d3ca4e
ref: Brandt2019addressingdepression
researcherid-numbers: 'Menezes, Paulo/AAM-3529-2021

  Miranda, J. Jaime/A-8482-2008

  Araya, Ricardo/S-3144-2019

  Menezes, Paulo R/C-9985-2010

  '
times-cited: '15'
title: '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'
type: Article
unique-id: WOS:000472679500001
usage-count-last-180-days: '0'
usage-count-since-2013: '14'
volume: '6'
web-of-science-categories: Psychiatry
year: '2019'