mHealth Tools to Improve Service Delivery Quality of an Evidence-Based Family Home Visiting Intervention to Prevent Family Violence among High Risk Families in Sierra Leone

National Institute of Mental Health (NIMH), R21MH124071

8/17/20 – 8/16/23

Alethea Desrosiers, PhD (Boston College)

Rebecca Esliker, PhD (Co-Investigator); Rev. Father Joseph Bangura, PhD (Co-Investigator); Theresa Betancourt, ScD (Senior Co-Investigator); Lisa A. Marsch, PhD (Consultant); David Sengeh, PhD (Collaborator); Diana Bowser, ScD (Consultant); Chokdee Rutirasiri (Consultant); Dr. Indrani Saran, ScD (Collaborator); Sunand Bhattacharya (Collaborator)

The proposed exploratory research will pilot a family-focused, behavioral health intervention while also developing and piloting innovative and cost-effective mHealth tools to support Community Health Workers in Sierra Leone’s underserved, rural Western region. This dual focus will help build urgently needed capacity both for delivery of evidence-based mental health services to reduce family violence and harsh parenting practices, and for effective use of mHealth strategies to improve healthcare delivery and quality. The Government of Sierra Leone has invested heavily in its Community Health Worker Programme and has identified innovative use of technology to improve performance monitoring, surveillance data collection, and health data usage as a high priority. This study will leverage government investments in community health initiatives and mHealth innovations as a strategy to address critical healthcare workforce limitations that plague delivery of evidence-based interventions to vulnerable families in post-conflict Sierra Leone. The study will pilot mHealth-supported delivery of a culturally adapted version of the Family Strengthening Intervention for Early Childhood Development (FSI-ECD). The FSI-ECD has demonstrated effectiveness in improving parental emotion regulation and reducing family violence and harsh parenting practices. Study aims are to:

Aim 1. Employ a five-stage user-centered design approach to develop and test mHealth tools to improve training, supervision, and fidelity monitoring of Community Health Workers.

Aim 2. Conduct a Type II Implementation-Effectiveness Randomized Controlled Pilot Study to assess feasibility, acceptability, and preliminary effects of mHealth-supported delivery of FSI-ECD on parent mental health, emotion regulation, and familial violence in high risk families with children aged 6–36 months (n=40) in comparison to control families (n=40) who receive standard care. Parental mental health, emotion regulation, household violence, and parenting practices will be assessed at baseline, post-intervention and 6-month follow-up. Feasibility, acceptability, and adoption of the FSI-ECD and mHealth tools will be assessed via quantitative measures and key informant interviews. The pilot study will also integrate a cost-effectiveness analysis to assess the economic value of the mHealth-supported delivery of the FSI-ECD vs. standard care.

Aim 3. Leverage well-established relationships and government partners to strengthen capacity for mHealth research and quality healthcare delivery in Sierra Leone. Partners include the University of Makeni, the Directorate of Science, Technology and Innovation, and the Ministry of Health and Sanitation.

This study will provide a foundation for expanding knowledge, fostering collaboration, and developing local research expertise in Sierra Leone. Study findings will inform a planned R01-funded Hybrid Implementation Effectiveness trial to study mHealth-supported mental health services integrated into existing delivery platforms and to scale up mHealth-supported training and supervision of service providers in low resource settings.

This exploratory study aligns with NIMH strategic priorities and will advance and build capacity for mental health, implementation science, and health data science research. It will provide preliminary data on feasibility, acceptability, and effects of a family-based, home-visiting behavioral health intervention to improve parental mental health and functioning to reduce family violence and improve child development outcomes in Sierra Leone. Study aims will explore innovative use of technology to support lay Community Health Workers and to improve health data collection and usage. Study results will inform future investments in mHealth strategies to improve the delivery of mental health services to vulnerable families in rural and low-resource regions.