Adaptation and pilot implementation of the WHO guideline on digital intervention to strengthen mental health systems in Lagos state, Nigeria.

backgroundThe uptake and implementation of cost-effective interventions and programs for mental health problems are often threatened by weakened health systems (HS) in low- and middle-income countries (LMICs). Digital technologies provide concrete opportunities to tackle these HS challenges. This study aimed to adapt and conduct a pilot implementation of the "WHO Guideline: recommendations on digital interventions for health system strengthening" (WHO-GRDI) for mental health systems in Nigeria.

methodsThe AGREE-II was used to appraise the WHO-GRDI by a team of five independent raters, and the ADAPTE framework was followed in adaptation of the WHO-GRDI to the local setting. The pilot implementation of the recommendations of the adapted WHO-GRDI was carried out within five randomly selected primary care systems. Assessment of the acceptability (using acceptability of intervention measure), appropriateness (using intervention appropriateness measure), feasibility (using feasibility of intervention measure) and perceived effectiveness of the WHO-GRDI recommendations was conducted. In addition, the stakeholders' readiness to implement change was evaluated using the Organizational Readiness for Implementing Change scale.

resultsThe overall assessment of the WHO-GRDI using the AGREE-II was 79.3%. The final draft of the adapted guideline has eight recommendations. During the pilot implementation, the recommendations regarding drug stock notification, health workers' supervision and communication and targeted client communication were considered quite effective (score range 80.0-92.0%), acceptable (score range 80.5-91.0%) and appropriate (score range 84.0-90.0%), and could be feasibly implemented (score range 81.0-90.0%) for mental health services in the local setting with a focus on mobile technology. However, the health workers expressed some concerns with recommendations on "Client-to-health-provider communication" (score range 65.6-73.4%) and "clinical decision support" (score range 78.0-79.0%).

conclusionsOur study detailed the process involved in the adaptation and pilot implementation of a newly released HS guideline for mental health services in a LMIC. There is a need for further research that will embrace the views and experiences of end-users of health systems guidelines to understand and contextualize the balance between generalizability and local adaptability of health systems guidelines in LMICs.