Adapting WHO's Step‐By‐Step Digital Intervention for Anxiety and Depression for Delivery Via Radio: Development, Piloting and Mixed‐Methods Evaluation of the Lumuno Radio Campaign In Zambia

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ABSTRACT Introduction Digital self‐help interventions for mental health can improve symptoms of common mental disorders such as depression and anxiety. However, such online interventions remain inaccessible to the majority of people in LMICs due to a lack of smartphone access, internet signal and/or affordability of data. However, radio persists as a key form of information and entertainment, and remains the most popular form of mass media in Africa. This study aimed to improve the accessibility of a well‐evidenced online self‐help intervention (WHO's Step‐by‐Step) by adapting it for delivery over radio. The objectives were to a) explore the feasibility of adapting the intervention to radio and b) evaluate impacts on mental health symptoms in adults with mild‐moderate depression and/or anxiety. Methods The Lumuno radio campaign was adapted from WHO's Step‐by‐Step intervention using formative research with mental health researchers, clinical professionals, community groups and people with lived experience of mental illness. The resulting radio campaign was broadcast daily, at high intensity, for 26 weeks. A mixed‐methods pilot study, including a pre‐post panel of 440 individuals recruited from Mazabuka town, Zambia, was used to evaluate the campaign's impact on depression and anxiety levels. Results Mean depression score (PHQ‐9) decreased by 19.7% (effect size −0.65, p < 0.001) and mean anxiety score (GAD‐7) dropped by 10.7% (effect size −0.22, p < 0.05). At endline, 41% and 54% respectively of those who had moderate to moderately severe depression, or moderate anxiety at baseline achieved a clinically significant reduction in symptoms. Conclusions This is the first study to indicate that a radio campaign promoting self‐help for depression and anxiety is feasible and may significantly improve mental health outcomes, however, a more rigorous trial is needed to confirm these promising pilot results. Radio may provide an accessible and cost‐effective platform for delivering mental health support in Zambia and, potentially, other LMIC contexts where radio listenership is high.

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