Building a contemporary model for integrating digital technologies to improve mental health services and wellbeing in public healthcare system in Nigeria

Abstract

Background The world is constantly experiencing the outbreak of infectious diseases, social unrest and insurgencies in some areas. The World Health Organization (WHO), together with other regulatory authorities, imposed movement restrictions (locally, regionally and internationally) and other preventative measures to alleviate the catastrophic impact of the coronavirus disease (COVID-19). The practice of using digital health technologies to provide mental health services has been generally abysmal; however, with the lockdown and restrictions of movement and physical meetings, it became necessary to adapt and utilize available digital technologies to provide mental health services. Meanwhile, prior to the COVID-19 lockdown in most African countries, mental healthcare services were basically provided through physical meetings of patients with their therapists and psychiatrists for various therapeutic and medical care services. The introduction of digital technology to mental health services presents unprecedented opportunities to provide mental health care services remotely to the affected populace. Advancement in information and communication technology is positively changing the way people interact and accomplish tasks across almost every sector of human endeavour and particularly, the health sector. This can circumvent existing delays in accessing mental health services, and the shortage of healthcare professionals, while supporting remote counselling and consultation and improving timely mental health care response between doctors and patients in case of social distancing measures. This is crucial for Nigeria, and other low- and middle-income countries, in order to manage and mitigate the emerging public mental health crisis caused by the outbreak of infectious diseases, social unrests and insurgencies. Aim The aim of this study was to develop a contemporary model for integrating digital health technologies to improve mental health services and wellbeing in the public healthcare system. Methodology The study was guided by two theoretical frameworks; the Health Belief Model (HBM) and Unified Theory of Acceptance and Use of Technology (UTAUT) model. The study adopted mixed-method convergent design to gain participants’ viewpoints on the study. A purposive sampling technique employing the snowball method was utilized in selecting participants for qualitative study, while the proportional stratified sampling method utilizing probability proportion to size (PPS) technique was adopted in selecting participants for the quantitative study to increase the chances of equal representation. Questionnaires were distributed to three hundred and seventeen (317) Healthcare professionals, selected from four psychiatric Hospitals in South-West Nigeria. A total of 16 participants from the four selected psychiatric hospitals participated in the interview. Descriptive analysis and Structural Equation Modelling (SEM) were computed on quantitative data while thematic analysis was employed to analyse qualitative data in the formulation of themes and sub-themes. The result from both analyses was triangulated to provide an overall picture of the study. Findings The study found several challenges with the provision of adequate and efficient services in public mental healthcare facilities in Nigeria, such as human resource challenges, brain drain, lack of infrastructure and strains on Healthcare professionals (HCPs). Findings from the study indicated that digital technologies are sparingly utilized in public mental healthcare service delivery due to lack of policy and framework. HCPs perceive digital technologies to be beneficial to themselves and their clients. The highlighted benefit to patients reduces levels of stigmatization, decreases the financial burden, enhances easy accessibility to therapists, strengthens adherence, mitigates relapse incidences and improves timely intervention. However, HCPs are concerned that the integration of digital technologies with mental health service delivery may prompt unwanted access, compromise patient data security and also, erratic power supply and network challenges could hamper smooth online therapy sessions. However, the integration of digital technologies in public healthcare can improve the delivery of mental health services remotely, on a wide scale, and most importantly can mitigate the impact of pandemic outbreaks and other health emergencies. Conclusion Findings from the study showed HCPs’ knowledge, perception of digital tools, challenges and barriers to the adoption and utilization of digital tools. The findings aid the development of a model that integrates digital technologies into public mental healthcare to improve service delivery in Nigeria. Transition from traditional/conventional space of mental healthcare service delivery to digital space requires a collaborative approach with Computer scientists (i.e. software developers and database administrators), Data scientists, investors, stakeholders and mental healthcare professionals. The proposed model serves as a contemporary framework that Government, policy makers in the Ministry of Health and Management of mental health facilities in Nigeria can adopt which will provide the needed awareness of the benefit of technological intervention. Furthermore, the model can be utilized to revise the existing policies and Standard Operating Procedures in public mental health sector.