# Acceptability and feasibility of Community-based mHealth Motivational Interviewing Tool for Depression (COMMIT-D) to improve adherence to treatment

> **NIH NIH R21** · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · 2020 · $177,593

## Abstract

Project Summary
Poor adherence to treatment is a global problem in depression care, with one-third of patients discontinuing
antidepressants in the first month of treatment. Community healthcare workers (CHWs) have successfully used
Motivational Interviewing (MI) to improve treatment adherence for various illnesses in the US and globally.
However, persistent challenges include: 1) lack of real-time support for communication skills (such as MI) as
the CHWs are talking to the patients; and 2) decay of MI skills among CHWs through time in the absence of
ongoing supervision because CHWs work away from facilities, traveling from one patient's home to another.
Mobile health (mHealth) tools have the potential to address these challenges by: 1) providing MI decision-
support in the community; and 2) creating patient-CHW audio recordings, which can then be used by
supervisors to help CHWs maintain MI skills, preventing skill decay. Building on our work over the last ten
years in rural Nepal, we will develop an mHealth app for CHWs—Community-based mHealth Motivational
Interviewing Tool for Depression (COMMIT-D)—that will provide decision-support for MI and capture
consented audio recordings of patient interactions for review and feedback by facility-based MI specialists.
The scientific premise is based on three well-established behavioral principles: five-step design thinking
(iterative stakeholder inputs enhance acceptability and feasibility), social psychology (intrinsic, rather than
extrinsic, motivation correlate with positive behaviors), and the MI causal chain model
(MI-consistent statements made by CHWs improve patient outcomes). We have already developed facility-
and mobile-based digital decision-support tools for depression and other chronic conditions in Nepali.
Whereas our existing tools focus on knowledge-based skills, the proposed intervention will focus on
communication skills (e.g., assessing the patient’s stage of change and responding in an MI-consistent
manner). Using the five-step human-centered design thinking, we will iteratively develop and test COMMIT-D
with frequent, structured input from stakeholders. We will then conduct a 6-month pilot trial to study its
acceptability and feasibility among patients, CHWs, and their supervisors. We will assess pathways to impact
by measuring CHW fidelity to MI principles (using the standard tool MITI), treatment adherence
(antidepressants and clinic appointments), and the overall impact on depression outcomes (Patient Health
Questionnaire-9 scores). Our team constitutes a ten-year-long collaboration between the research team, the
Nepali non-profit healthcare provider Possible, and the Nepal Government. This study will develop and sustain
research capacity-building in Nepal by supporting researchers via in-person workshops, online lectures, and
mentored research in mHealth, MI, depression, manuscript writing, and ethical conduct of research. If
successful, the results from this study will inform a...

## Key facts

- **NIH application ID:** 9984545
- **Project number:** 5R21MH116728-02
- **Recipient organization:** UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
- **Principal Investigator:** Bibhav Acharya
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $177,593
- **Award type:** 5
- **Project period:** 2019-08-01 → 2023-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9984545

## Citation

> US National Institutes of Health, RePORTER application 9984545, Acceptability and feasibility of Community-based mHealth Motivational Interviewing Tool for Depression (COMMIT-D) to improve adherence to treatment (5R21MH116728-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9984545. Licensed CC0.

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