Readiness for mHealth interventions in Jordan: Refugee camp and urban community survey.

Jordan hosts one of the largest populations of refugees in the world. This study evaluated the capacity, infrastructure, and interest in mobile health interventions to address unmet mental health needs among refugees and non-refugees in Jordan. We surveyed 209 (141 refugees) adults and youth in urban, rural, and refugee camp settings. Survey results indicated that mobile device ownership was lower among refugees than non-refugees (71 % vs. 100 %, respectively). Refugee phone users had less access to smartphones than non-refugees (75 % vs. 96 %, respectively). Refugees and non-refugees reported using mobile devices for diverse activities including calling (83 % vs. 100 %, respectively), texting (28 % vs. 87 %, respectively) social media (45 % vs. 94 %, respectively), watching videos (23 % vs. 90 %, respectively), and studying (34 % vs. 72 %, respectively). Most respondents had reliable access to electricity (75 % vs. 99 %, respectively) and to mobile-cellular service (67 % vs. 97 %, respectively). Refugees and non-refugees differed substantially in their access to WiFi (14 % vs. 91 %, respectively). Both groups identified anger, anxiety, depression, traumatic memories, and eating problems as the most common mental health problems in their communities. Approximately half of refugees (44 %) and non-refugees (50 %) reported that their communities had insufficient or no access to mental health resources. Most refugees (78 %) and non-refugee (87 %) believed that using mobile devices to provide support for people with mental health conditions would be helpful. Overall, both groups' reported access to mobile technologies and openness to digital mental health treatment options suggest that mHealth interventions may be feasible and welcomed in these communities.

Combining mHealth Technology and Pharmacotherapy to Improve Mental Health Outcomes and Reduce Human Rights Abuses in West Africa: Intervention Field Trial.

Background: In West Africa, healers greatly outnumber trained mental health professionals. People with serious mental illness (SMI) are often seen by healers in "prayer camps" where they may also experience human rights abuses. We developed "M&M," an 8-week-long dual-pronged intervention involving (1) a smartphone-delivered toolkit designed to expose healers to brief psychosocial interventions and encourage them to preserve human rights (M-Healer app), and (2) a visiting nurse who provides medications to their patients (Mobile Nurse). Objective: We examined the feasibility, acceptability, safety, and preliminary effectiveness of the M&M intervention in real-world prayer camp settings. Methods: We conducted a single-arm field trial of M&M with people with SMI and healers at a prayer camp in Ghana. Healers were provided smartphones with M-Healer installed and were trained by practice facilitators to use the digital toolkit. In parallel, a study nurse visited their prayer camp to administer medications to their patients. Clinical assessors administered study measures to participants with SMI at pretreatment (baseline), midtreatment (4 weeks) and post treatment (8 weeks). Results: Seventeen participants were enrolled and most (n=15, 88.3%) were retained. Participants had an average age of 44.3 (SD 13.9) years and 59% (n=10) of them were male. Fourteen (82%) participants had a diagnosis of schizophrenia and 2 (18%) were diagnosed with bipolar disorder. Four healers were trained to use M-Healer. On average, they self-initiated app use 31.9 (SD 28.9) times per week. Healers watched an average of 19.1 (SD 21.2) videos, responded to 1.5 (SD 2.4) prompts, and used the app for 5.3 (SD 2.7) days weekly. Pre-post analyses revealed a significant and clinically meaningful reduction in psychiatric symptom severity (Brief Psychiatric Rating Scale score range 52.3 to 30.9; Brief Symptom Inventory score range 76.4 to 27.9), psychological distress (Talbieh Brief Distress Inventory score range 37.7 to 16.9), shame (Other as Shamer Scale score range 41.9 to 28.5), and stigma (Brief Internalized Stigma of Mental Illness Scale score range 11.8 to 10.3). We recorded a significant reduction in days chained (1.6 to 0.5) and a promising trend for reduction in the days of forced fasting (2.6 to 0.0, P=.06). We did not identify significant pre-post changes in patient-reported working alliance with healers (Working Alliance Inventory), depressive symptom severity (Patient Health Questionnaire-9), quality of life (Lehman Quality of Life Interview for the Mentally Ill), beliefs about medication (Beliefs about Medications Questionnaire-General Harm subscale), or other human rights abuses. No major side effects, health and safety violations, or serious adverse events occurred over the course of the trial. Conclusions: The M&M intervention proved to be feasible, acceptable, safe, and clinically promising. Preliminary findings suggest that the M-Healer toolkit may have shifted healers' behaviors at the prayer camp so that they commit fewer human rights abuses.

Mental Health Priorities in the Arab World: Insights From Jordan.

War, geopolitical instability, and natural disasters have contributed to enormous unmet mental health needs in the Middle East and North Africa. Jordan is a middle-income country that needs internal and international stakeholder engagement and support to effectively provide mental health services to its citizens and to the millions of immigrants and refugees who reside there. This column presents a snapshot of the state of mental health care in Jordan and outlines areas for future investment. Potentially high-yield areas for development include digital health technology, integrated care, and youth-focused interventions.