Human-centered design exploration with Kenyan health workers on proposed digital mental health screening and intervention training development: Thematic analysis of user preferences and needs

Background: Health providers’ perceived sense of knowledge, competency, and self-efficacy to support the needs of their patients contributes to optimal patient health outcomes. With regards to mental health service delivery in Kenya, this area needs further exploration. Guided by the e-health technology acceptance mode, the needs and preferences of health care providers around mental health training for clinical management and their ability to intervene in peripartum adolescent mental health care are explored. We probed how well-equipped service providers are, their engagement with technology to learn and offer services. The health care provider’s technology use preferences were also explored. Method: Guided by a human-centered design-focused qualitative inquiry we interviewed 20 specialists around their needs, perspectives, and preferences for digitized mental health screening and intervention. Mean age was 44.2 years, (range of 32–58 years), 25% (5) males and 75% (15) females. After a written consenting process, the online interviews (30−45 min) were conducted in April 2021, once personal information was de-identified interviews were transcribed and coded. Thematic analysis was used and we combined rapid appraisal of Google Jamboard online storyboards to do individual human-centered design personas alongside. Results: Our participants were well-exposed to digital technologies. Prohibitive costs of data bundles, lack of funds for consistent online engagement, high workload, and instability of access to appropriate gadgets were found to be barriers to e-health training. Emerging opportunities were well-identified adolescent mental health service and intervention needs, willingness to take online courses offered on learning platforms, and wish for these to be disseminated through diverse social media. Other recommendations were the need to have a user-friendly interface such as data-light engaging and practical materials including animations, short, group-based learning. Conclusion: Understanding contextual factors that influence perceived usefulness and ease of use of the remote/digital components would be critical for e-training development and its uptake.

The participants were identified at four key facilities—Kenyatta National Hospital (KNH), Mathari National Teaching and Referral Hospital, Pumwani Hospital, and Nairobi Metropolitan Services’ Ngara Health Centre. KNH is the largest of the five National referral hospitals in Kenya with a bed capacity of 1800, receiving patients from all over the country for specialized care. KNH has a fully-fledged department of mental health with 5 psychiatrists, 12 psychologists, and 4 nurses. Mathari national hospital is a national referral mental health facility with mental health staff of 320 nurses, 10 clinical officers, 20 psychiatrists, 19 psychologists, and 5 medical social workers. Pumwani hospital is the biggest maternity hospital in Kenya with close to 200 nurses, 14 clinical officers, 2 psychologists, and 3 medical social workers on ground, but no dedicated mental health department. Ngara Health facility has 5 psychologists, 9 clinical officers, 25 nurses, 1 psychiatrist, and 3 medical social workers. All these facilities run outpatient services with KNH and Mathari offering inpatient services as well. There are no dedicated inpatient services for child and adolescent mental health populations. It provides facilities for medical education and training to colleges and universities as well as participating in national health planning. 29 Mathari National Teaching and Referral Hospital is the only public specialized facility for mental health patients that is also among the five national referral hospitals in Kenya. It offers specialized psychiatric services, drug rehabilitation, forensic services, and training in psychiatric services. It has a bed capacity of 700 and also participates as a national referral hospital in national health planning. 29 Pumwani maternity hospital is the largest obstetric and referral hospital in Kenya for delivery of expectant mothers, with a bed capacity of 354, and the majority of its clients are from the poor socio-economic background. 30 Ngara health center is located just next to the Nairobi Central business district with a population of 31,132 residents living around it. 31 The participants were facility staff carrying out key duties in adolescent, maternal health units as well as those providing mental health services. An interview guide was developed by the team which was refined after two pilot interviews were carried out. The final guide addressed the following areas: (1) dynamics of the COVID-19 pandemic, (2) proposed training, (3) technology’s role, and (4) other considerations. The eHealth TAM focuses on understanding contextual factors that influence perceived usefulness and ease of use of the remote/digital components. These also consider how user experiences, attitudes inform intention and practical use of technology which in this context focuses on digital training. A thematic analysis covering exposure to technology, choice of gadgets for engagement with digital services, online training, or other professional learning exchange was probed. Preferences for digital learning and training including barriers and challenges, choice of social media platforms, provider understanding of mental health needs during pandemic, and needs of adolescents especially peripartum adolescents were probed. The interviews were conducted online after consent forms were physically distributed and collected prior to the interview appointment. Consent forms were read out again during the interview reiterating participant rights and providing an overview of the studies. The interviews were conducted by PM, VN, JK, and MK. VN and MK wrote notes on the open-access Google Jamboard using Zoom’s shared screen option to make the questions more interactive, allowing the respondents to see what was being noted down as the interviewer asked questions to the participants (Box 1). Given that these meetings were online, the Jamboard provided a structure to focus attention on participants’ key experiences and thought processes during the interview. The questions were asked by the lead interviewer and sometimes clarifications were sought by other team members. The Jamboard was to help build personas and stories for every participant that they could further curate and interact with around their engagement with mental health and interaction with digital technology. This also offered our participants an interactive way to process their material given these interviews were carried out online and offered our team to further probe based on responses. VN transcribed the interviews and the authors collected reviewed themes and developed Jamboard prototypical personas (Figures 2a and ​andbb). Interview questions mapped on our conceptual model. (a) Using Google Jamboard to create participant personas and needs assessment. (b) Jamboard of Participant 19.

N/A

• Dima Health