Implementing Psychological Interventions Through Nonspecialist Providers and Telemedicine in High-Income Countries: Qualitative Study from a Multistakeholder Perspective

Daisy Radha Singla; Sasha Lemberg-Pelly; Andrea Lawson; Nika Zahedi; Tyla Thomas-Jacques; Cindy-Lee Dennis

doi:10.2196/19271

Implementing Psychological Interventions Through Nonspecialist Providers and Telemedicine in High-Income Countries: Qualitative Study from a Multistakeholder Perspective

JMIR Ment Health. 2020 Aug 27;7(8):e19271. doi: 10.2196/19271.

Authors

Daisy Radha Singla^#^{1

2}, Sasha Lemberg-Pelly^#³, Andrea Lawson⁴, Nika Zahedi⁵, Tyla Thomas-Jacques³, Cindy-Lee Dennis^{6

7}

Affiliations

¹ Sinai Health, Toronto, ON, Canada.
² Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
³ Division of Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
⁴ Women's College Hospital, Toronto, ON, Canada.
⁵ Department of Psychology, University of Toronto, Toronto, ON, Canada.
⁶ Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.
⁷ Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada.

^# Contributed equally.

PMID: 32852281
PMCID: PMC7484770
DOI: 10.2196/19271

Abstract

Background: Task sharing has been used worldwide to improve access to mental health care, where nonspecialist providers-individuals with no formal training in mental health-have been trained to effectively treat perinatal depressive and anxiety symptoms. Little formative research has been conducted to examine relevant barriers and facilitators of nonspecialist providers and the use of telemedicine in treatment service delivery.

Objective: The primary objective of this study was to examine the main barriers and facilitators of nonspecialist provider-delivered psychological treatments for perinatal populations with common mental health disorders, such as depression and anxiety, from a multistakeholder perspective.

Methods: This study took place in Toronto, Canada. In total, 33 in-depth interviews were conducted with multiple stakeholder groups (women with lived experience and their significant others, as well as health and mental health professionals). Qualitative data were quantified to estimate commonly endorsed themes within and across stakeholder groups.

Results: Psychological treatments delivered by nonspecialist providers were considered acceptable by the vast majority of participants (30/33, 90%). Across all stakeholder groups, nurses (20/33, 61%) and midwives (14/33, 42%) were the most commonly endorsed cadre of nonspecialist providers. The majority of stakeholders (32/33, 97%) were amenable to nonspecialist providers delivering psychological treatment via telemedicine (27/33, 82%), although concerns were raised about the ability to establish a therapeutic alliance via telemedicine (16/33, 48%). Empathy was the most desired characteristic of a nonspecialist provider (61%). Patient and patient advocate stakeholders were more likely to emphasize stigma as an important barrier to accessing psychological treatments (7/12, 58%), compared to clinicians (2/9, 22%) and spouses (1/5, 20%). Clinician stakeholders were more likely to emphasize the importance of ensuring nonspecialist providers were trained to deliver psychological treatments (3/9, 33%), compared to other stakeholder groups.

Conclusions: These results can inform the design, implementation, and integration of nonspecialist-delivered interventions via telemedicine for women with perinatal depressive and anxiety symptoms in high-income country contexts.

Keywords: nonspecialist providers; perinatal depression; perinatal mental health; psychological treatments; task sharing; telemedicine.

©Daisy Radha Singla, Sasha Lemberg-Pelly, Andrea Lawson, Nika Zahedi, Tyla Thomas-Jacques, Cindy-Lee Dennis. Originally published in JMIR Mental Health (http://mental.jmir.org), 27.08.2020.