ABSTRACT
BACKGROUND: To evaluate the effectiveness and acceptability of adding a mobile telephone adherence support to a Collaborative Stepped Care (CSC) intervention for primary care management of depression. METHODS: A pilot cluster randomised controlled trial with 10 primary care centres in Lagos Nigeria, randomised into either the mobile telephone supported CSC (mCSC) group or the ordinary CSC (oCSC) group in ratio 1:1. The 5 mCSC clusters received in addition to the CSC intervention, a series of tailored informational text messages and reminders. Participants were adults (18-60 years) with depression. The primary outcome was the rate of adherence to intervention at 6th and 12th months follow up. Analysis was by intention to treat. RESULTS: The mCSC group (nâ¯=â¯439 participants) had significantly better adherence rate compared to oCSC group (nâ¯=â¯456 participants) at 6th month (90.0% vs 67.8%, ARR 1.31, 95% CI 1.22-1.40) and at 12th month follow up (78.1% vs 59.2%, ARR 1.30, 95% CI 1.20-1.43). Compared to the oCSC group, the mCSC had significantly higher recovery rate, better quality of life, retention in treatment, was more cost effective and had high level of acceptance amongst clients LIMITATION: Self rating scales were not used for adherence score. We analysed according to Intention to Treat and we have not included mild depression CONCLUSION: The addition of our mobile telephony support significantly improves adherence and clinical outcomes for CSC intervention and was cost effective and acceptable to clients. Mobile telephone technology can substantially aid the scale up of mental health services in developing countries.
