Symposia
Dissemination & Implementation Science
Noah S. Triplett, M.S. (he/him/his)
Graduate Student
University of Washington
Seattle, Washington
Bernard Nabalia, B.A. (he/him/his)
Supervisor
Ace Africa Kenya
Bungoma, Western, Kenya
Daisy Okoth, B.A. (she/her/hers)
Supervisor
Ace Africa Kenya
Bungoma, Western, Kenya
Omariba Nyaboke, B.A. (she/her/hers)
Supervisor
Ace Africa Kenya
Bungoma, Western, Kenya
Lucy Liu, B.S. (she/her/hers)
Research Assistant
University of Washington, Seattle
Seattle, Washington
Jacinto Silva-Alvarez, B.A. (he/him/his)
Research Assistant
University of Washington, Seattle
Seattle, Washington
Sharon Kiche, MPH (she/her/hers)
Research Consultant
University of Washington
Seattle, Washington
Anne Mbwayo, Ph.D. (she/her/hers)
Professor
University of Nairobi
Nairobi, Nairobi Area, Kenya
Cyrilla Amanya, MS (she/her/hers)
Research Director
Ace Africa Kenya
Bungoma, Western, Kenya
Shannon Dorsey, PhD (she/her/hers)
Professor Department of Psychology
University of Washington
Seattle, Washington
Background: A primary barrier to the sustainability of task shifting is ensuring that lay providers can feasibly access clinical supervision. Opportunities may exist to leverage mobile phones to replace or supplement in-person supervision of lay providers in lower-resourced settings; however, contextual variables, such as network connectivity and provider preferences, must be considered and addressed.
Methods: This study builds from a stepped-wedge cluster-randomized-trial in Western Kenya, wherein teachers and community health volunteers have been trained as lay counselors to provide a culturally-adapted, group-based trauma-focused cognitive behavioral therapy (TF-CBT). Using an iterative and mixed methods approach, we co-designed implementation guidelines alongside experienced lay counselors and supervisors to optimize the use of mobile phones for supervision. The guidelines were intended to be flexible tools to facilitate problem solving around mobile phone supervision while allowing lay counselors to select and adapt potential strategies that met their unique needs and preferences. Guidelines were then shared and discussed with newly trained lay counselors in educational outreach visits led by supervisors. We evaluated the impact of guidelines and outreach on the acceptability, feasibility, and usability of mobile phone supervision using a QUAN → qual mixed methods approach for data explanation, wherein qualitative data served to contextualize quantitative results. Counselors that received guidelines (n=30) were compared to a control sequence (n=29) that neither received guidelines nor participated in co-development activities.
Results: Guidelines were associated with significant improvements in acceptability [t(57) = -2.1, p = 0.04] and usability [t(57) = -2.3, p = 0.02] of mobile phone supervision. There was no evidence of a significant difference in feasibility [t(57) = –1.9, p = 0.06]. Qualitative interviews contextualized how guidelines impacted acceptability and feasibility—by setting expectations for mobile phone supervision, emphasizing importance, increasing comfort, and sharing strategies to improve mobile phone supervision.
Conclusion: Introducing and discussing co-developed implementation guidelines significantly improved the acceptability and usability of mobile phone supervision. This approach may provide a flexible and scalable model to address challenges with implementing EBPs and implementation strategies in lower-resourced areas.