Developing an mHealth intervention to strengthen the community mental health system in the context of the COVID-19 pandemic in Peru

The COVID-19 pandemic and the measures of mandatory social distancing presented a challenge to the Peruvian health system, which is not equipped to provide remote care to patients. This situation worsened an already fragile health system, limiting the population's access to adequate care. People with mental disorders are particularly vulnerable in this context, due to the impact of the pandemic on their mental health, as well as the limitations in accessing mental health services.

This proposal aims to (1) assess the impact of the COVID-19 pandemic on the provision of mental health services in Peru, (2) identify the strategies used to address this situation, particularly those involving mobile technology, as well as the main advantages and challenges faced, (3) design and test an intervention based on mobile technology (i.e. mobile phones, tablets) to provide mental health care, with the input from health providers, patients, and policymakers.

To achieve our objectives we will conduct a 2-year project with 3 phases: (1) Phase 1: We will examine the impact of the pandemic on the public mental health services and the strategies used to continue the provision of care, through the review of guidelines and protocols, as well as interviews with the patients, health providers and policymakers; (2) Phase 2: We will design and develop our technological intervention based on the information collected in the previous phase. In this process, users, health providers, managers and policymakers will provide their opinions to make the intervention acceptable, feasible and adaptable to the Peruvian public mental health care system; (3) Phase 3: We will perform a pilot study to field test the developed intervention in 3 community mental health centers in Lima, Peru.

The results of this 2-year project will help us to understand the viability of our idea, and potentially an implementation at a larger scale. Additionally, we will organize regular meetings with mental health policymakers to share our findings and discuss how they could be integrated within the public health system. Our research team, consisting of researchers from Peru and the United Kingdom, will also share the project results with an international audience, through conferences and publications in specialized journals.

The COVID-19 pandemic and the mandatory social distancing have made visible the challenges the Peruvian health system faces to provide remote care. People with mental disorders are particularly vulnerable in this context, due to the impact of the pandemic on their health, as well as the limitations in accessing services. As a result, the Ministry of Health in Peru published guidelines to providing mental health care through telemedicine.

In this context, which is simultaneously a great challenge and opportunity for the community mental health system in Peru, we proposed a two-year project with the following objectives: (1) To assess the impact of the pandemic on the community mental health system in Peru, (2) To identify the strategies implemented to preserve the provision of mental health care during the pandemic and assess, using the Learning Health Systems framework, the readiness to deliver remote mental care, (3) To co-design and evaluate the performance of an mHealth intervention to deliver remote care within the community mental health system in Peru.

To achieve this, the study comprises 3 phases: (1) the formative phase, centered around the first two aims, will involve the review of local and international guidelines and evidence produced during the pandemic and a qualitative study with stakeholders. (2) The intervention development phase to co-design along with stakeholders the mHealth intervention based on the formative phase. Finally, (3) the pilot of our intervention, assessing implementation and clinical outcomes.
The pilot will recruit 60 participants (30 users and 30 relatives) who will receive the intervention delivered by 15 health providers. Recruitment will take place at 3 Community Mental Health Centers. Data will be collected at 3 different time points: (i) before starting, (ii) during and (iii) after finishing the intervention, through questionnaires, in-depth interviews, as well as data generated through the mHealth platform.