Browsing by Author "Bröcker, Erine"

Now showing 1 - 1 of 1
  • Thumbnail Image
    Item
    A randomised controlled trial of a clinician-monitored 'PTSD coach' intervention in a resource-constrained setting
    (Stellenbosch : Stellenbosch University, 2023-11-03) Bröcker, Erine; Seedat, Soraya, 1966-; Olff, Miranda; Suliman, Sharain; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Psychiatry.
    ENGLISH SUMMARY: Posttraumatic stress disorder (PTSD) is a prevalent and impairing mental health condition. Resource-constrained settings face barriers to health care, with individuals not able to access the needed support services. Internet- and mobile-based interventions (IMIs), such as the freely available PTSD Coach mobile application (app), may improve access to and efficiency of care in these settings. The conceptualisation of this doctoral study is based on the high incidence of trauma exposure, PTSD, and its associated sequelae in South Africa exacerbated by healthcare resource constraints. Our overarching aim was to evaluate the feasibility and effectiveness of a four-session counsellor-supported PTSD Coach (PTSD Coach-CS) mobile app intervention in reducing PTSD, depression, anxiety, and stress symptoms in a South African adult community sample. A systematic review and meta-analysis of the PTSD Coach intervention (both webbased and mobile app platforms) supported the feasibility and acceptability of the intervention. Yet, more evidence about the intervention’s effectiveness in lower-middle-income countries, and in larger and more diverse samples, is required. We conducted two pilot studies to evaluate and compare the feasibility, acceptability, and preliminary effectiveness of a counsellor-supported PTSD Coach intervention (web-based compared to the mobile app) in a South African resource-constrained context. The aim of these pilot studies was to shed light on which platform is more feasible and to inform the final procedures of the main study (randomised controlled trial). Findings indicated a clinically significant change in clinician-monitored PTSD symptom severity. However, the counsellor supported PTSD Coach (PTSD Coach-CS) mobile app intervention (compared to the supported web-based PTSD Coach Online) proved to be more feasible in our setting. Both pilot studies supported the involvement of counsellors, as less-specialised mental health services, in intervention delivery as feasible and beneficial in the South African context. The main study (N = 62; female = 89%; black = 77%; aged 19-61 years) indicated a significant reduction in clinician-monitored PTSD symptom severity (primary outcome) over time for the PTSD Coach-CS group compared to the enhanced Treatment-as-Usual group. However, due to the study being underpowered, we could not establish the superiority of the PTSD Coach-CS intervention at post-treatment. The main effect was predominantly driven by significant between-group differences at three-month follow-up. This may point toward a potential lag in intervention effect and/or the benefit of longitudinal engagement with the app on greater symptom reduction over time. We found a significant effect on self-reported stress symptom reduction over time, at post-treatment, and at three-month follow-up. This supports the possibility of longer-term app engagement and a delayed intervention effect on PTSD symptoms mediated through reduced general stress symptoms. Moreover, findings further supported the notion of involving counsellors in intervention delivery as beneficial. A qualitative sub-study, exploring participants’ experience with the PTSD Coach-CS intervention, indicated they were positive about it. Participants valued the counsellor's support, who enabled a practical, effective introduction to and increased engagement with the app. Participants provided insight into intervention-specific and systemic barriers which could increase the value of the PTSD Coach-CS intervention in the South African context. Our study is the first to evaluate the PTSD Coach mobile app intervention in a resource-constrained setting, supplemented with less-specialised mental health services, and contributes to the growing research on IMIs. Our findings underscore that a low-cost counsellor-supported PTSD Coach mobile app intervention is a suitable and potentially effective treatment alternative for adults with PTSD in a resource-constrained setting. This intervention can support trauma survivors and mitigate the burden on the already debilitated healthcare system.