An mHealth communication framework for caregivers of adolescents with mental health issues
This study focused on developing an mHealth communication framework for rural caregivers of adolescents with mental health issues. Adolescents carry a high burden of mental health issues. Their caregivers, usually parents, relatives or community members, play a pivotal role in caring for these adolescents, which causes challenges for the caregivers. Caregivers in rural settings face specific challenges relating to adolescents with mental health issues, leading to unmet support needs. The potential value of using communication technology to support rural caregivers has been recognised by research. The aim of the study was to develop an mHealth communication framework for caregivers of adolescents with mental health issues in the Kopanong municipality of the Free State province of South Africa. This study is best conceptualised as the developmental phase of a complex intervention. A pragmatic study was undertaken by employing a multiple method design and harnessing a three-phase approach that was guided by the theory-of-change logic model, while the integrated model of behaviour prediction (IMBP) served as a conceptualisation of the programme that targeted rural caregivers. Phase 1 implemented a visual-based narrative inquiry that collected data through the Mmogomethod®, and aimed to explore caregivers’ interest in using communication technology in two towns of the Kopanong municipality in the Free State province of South Africa. The researcher collected data from rural caregivers (n=17) comprising three groups in the towns of Springfontein and Trompsburg. Through a stepwise literature-based process for investigating textual and visual data, the researcher identified four themes. Three themes represent challenges facing caregivers, namely, psychosocial, social resources and informational challenges. Interest in communication technology was the fourth theme. Caregivers favoured using SMS (short messaging service), phone calls and computers. In Phase 2, literature was reviewed systematically to find the best evidence available to strengthen positive behaviour by caregivers of adolescents with mental health issues by using communication technology interventions. Five articles out of an initial 1 746 articles met the eligibility criteria and were included in the data synthesis. The researcher derived three thematic conclusions: 1) The target population included parents and family members serving as caregivers; 2) Caregivers experienced improved IMBP determinants (self-efficacy, knowledge, parent/child communication, parental skills), which was reflected in positive behaviour; and 3) Caregivers used various types of communication technologies (SMS, emails, phone calls, online communication, social media). Findings from these two phases were triangulated to develop a draft framework based on the theory-of-change logic model components. The completed draft framework was presented to expert stakeholders in the third phase during a workshop. Phase 3 comprised a one-day validation workshop that was attended by nine expert stakeholders involved in various adolescent healthcare settings. An experienced facilitator coordinated the workshop, thereby enabling a discussion on each component suggested in the theory-of-change logic model, using forward and backward mapping. Expert stakeholders contributed to three theory-of-change components depicted in the framework, specifically, community needs, desired results, and evidence-based strategies, to finalise the framework. This validation workshop concluded after consensus was reached on the final framework. Through evidence-based research, the framework can facilitate a programme for supporting caregivers through an mHealth initiative that results in positive caregiver behaviour change. This framework for an mHealth initiative for rural caregivers of adolescents with mental health issues illustrates the development phase of a complex intervention. Piloting this framework will be the next phase. The researcher will participate in the piloting, with the Free State Department of Health being a key stakeholder.