Feasibility of an interactive voice response system for monitoring depressive symptoms in a lower-middle income Latin American country.
BACKGROUND
Innovative, scalable solutions are needed to address the vast unmet need for mental health care in low- and middle-income countries (LMICs).


METHODS
We conducted a feasibility study of a 14-week automated telephonic interactive voice response (IVR) depression self-care service among Bolivian primary care patients with at least moderately severe depressive symptoms. We analyzed IVR call completion rates, the reliability and validity of IVR-collected data, and participant satisfaction.


RESULTS
Of the 32 participants, the majority were women (78 % or 25/32) and non-indigenous (75 % or 24/32). Participants had moderate depressive symptoms at baseline (PHQ-8 score mean 13.3, SD = 3.5) and reported good or fair general health status (88 % or 28/32). Fifty-four percent of weekly IVR calls (approximately 7 out of 13 active call-weeks) were completed. Neither PHQ-8 scores nor IVR call completion differed significantly by ethnicity, education, self-reported depression diagnosis, self-reported overall health, number of chronic conditions, or health literacy. The reliability for IVR-collected PHQ-8 scores was good (Cronbach's alpha = 0.83). Virtually every participant (97 %) was "mostly" or "very" satisfied with the program. Many described the program as beneficial for their mood and self-care, albeit limited by some technological difficulties and the lack of human interaction.


CONCLUSIONS
Findings suggest that IVR could feasibly be used to provide monitoring and self-care education to depressed patients in Bolivia. An expanded stepped-care service offering contact with lay health workers for more depressed individuals and expanded mHealth content may foster greater patient engagement and enhance its therapeutic value while remaining cost-effective. Trial registration ISRCTN ISRCTN 18403214. Registered 14 September 2016. Retrospectively registered.
Center for Managing Chronic Disease, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109 USA.
Mary R
MR
Janevic
Universidad Católica Boliviana, Ave 14 de Septiembre 2, La Paz, 4807 Bolivia.
Amparo C
AC
Aruquipa Yujra
Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Mail Stop 152, Ann Arbor, MI 48105 USA.
Nicolle
N
Marinec
Estado Plurinacional de Bolivia Ministerio de Salud, La Paz, Bolivia.
Juvenal
J
Aguilar
School of Medicine, University of Michigan, 1018 Fuller St., Ann Arbor, MI 48104 USA.
James E
JE
Aikens
QUANTICA Organización Profesional para el Avance de la Salud Mental, La Paz, Bolivia.
Rosa
R
Tarrazona
Center for Managing Chronic Disease, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109 USA.
John D
JD
Piette
Depression; Depression self-care support; Global mental health; mHealth
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