Chatbot use and mental wellbeing of health workers

INTERVENTION: The study is a two‐arm, parallel randomized controlled trial with a pre‐treatment assessment, 8‐week intervention period and mid‐study assessments at 4‐5 weeks and an end‐of‐study assessment at 9 weeks. Interested study participants will be randomly assigned to either the treatment or control group at the time of registration. Vitalk, the developer of the app, will create a study web portal where study participants register, give their consent, are assigned to one of the study arms, are given a unique study identification number, and enter their demographic information. Depending on the random assignment, participants will be taken to either the treatment app, Vitalk, or the website for the control group. This is a single‐blinded design because only the research team will be blinded to the study arm assignments; all participants in both study arms will be told they are participating in ‘an online self‐help for mental wellbeing’. Originating from Brazil, Vitalk is an automated chatbot delivering mental health content to its users using a conversational format, with the aim of improving well‐being by reducing stress, anxiety and depression using a preventative approach to mental health (Daley, Hungerbuehler et al., 2020). The Vitalk app uses psychoeducation, cognitive restructuring, behavioral activation, gratitude, and practical exercises (such as breathing, relaxation and meditation) to bring about improvements in users’ mental health (ibid). These techniques and strategies are rooted in CBT and Positive Psychology, two commonly used psychotherapy methodologies that have been used widely in various settings and have registered high effectiveness among patients presenting with various psychological challenges (Beck, 2011; Seligman, 1998; CONDITION: Mental health outcomes (including depression, anxiety, burnout, loneliness, and resilience) among health workers in Malawi ; Mental and Behavioural Disorders PRIMARY OUTCOME: ; Measurements at baseline, 4‐5 weeks, and 9 weeks:; 1. Anxiety symptoms are measured using the Generalized Anxiety Disorder (GAD‐7) scale.; 2. Depression symptoms are measured using the Patient Health Questionnaire (PHQ‐9).; 3. Burnout is measured using the Oldenburg Burnout Inventory (OLBI).; 4. Loneliness is measured using the UCLA Short Loneliness Scale.; 5. Resilience is measured using the 14‐item Resilience Scale (RS‐14).; SECONDARY OUTCOME: ; 1. Resilience building behaviors measured through questionnaires in Vitalk at baseline, 4‐5 weeks, and 9 weeks; 2. Frequency and use of treatment app and control website, measured throughout the trial through app and website usage data; 3. Qualitative patient experiences measured using an anonymous online survey at 9 weeks; INCLUSION CRITERIA: 1. Currently employed as one of the types of service providers (cadres) listed: doctors, nurses, medical assistants, clinical officers, laboratory technicians, physiotherapy technicians, pharmacists, physiotherapists 2. Employed in public or private primary, secondary, or tertiary care facility in Blantyre and Lilongwe districts of Malawi 3. Possess some degree of English language proficiency 4. Own a smartphone with an Android operating system 5. No history – past or current – of counseling or therapy for severe mental health disorders 6. Not have self‐reported suicidal ideation 7. Score below “very high risk” levels on the initial assessments for anxiety and depression 8. Diploma in their respective fields of specialization, in adherence to the Ministry of Health employment criteria for the respective cadres of he