Expanding Access to Depression Treatment in Kenya

Posted on
January 6, 2020


Depression during pregnancy and in the postpartum period is associated with a number of poor outcomes for women and their children. Although effective interventions exist for common mental disorders that occur during pregnancy and the postpartum period, most cases in low- and middle-income countries go untreated because of a lack of trained professionals. Task-sharing models such as the Thinking Healthy Program have shown great potential in feasibility and efficacy trials as a strategy for expanding access to treatment in low-resource settings, but there are significant barriers to scale-up. We are addressing this gap by adapting Thinking Healthy for automated delivery via a mobile phone. This new intervention, Healthy Moms, uses an existing artificial intelligence system called Tess (Zuri in Kenya) to drive conversations with users.


The objective of this pilot study is to test the Healthy Moms perinatal depression intervention using a single-case experimental design with pregnant women and new mothers recruited from public hospitals outside of Nairobi, Kenya.


We will invite patients to complete a brief, automated screening delivered via text messages to determine their eligibility. Enrolled participants will be randomized to a 1- or 2-week baseline period and then invited to begin using Zuri. Participants will be prompted to rate their mood via short message service every 3 days during the baseline and intervention periods. We will review system logs and conduct in-depth interviews with participants to study engagement with the intervention, feasibility, and acceptability. We will use visual inspection, in-depth interviews, and Bayesian estimation to generate preliminary data about the potential response to treatment.


Our team adapted the intervention content in April and May 2018 and completed an initial prepilot round of formative testing with 10 women from a private maternity hospital in May and June. In preparation for this pilot study, we used feedback from these users to revise the structure and content of the intervention. Recruitment for this protocol began in early 2019. Results are expected toward the end of 2019.


The main limitation of this pilot study is that we will recruit women who live in urban and periurban centers in one part of Kenya. The results of this study may not generalize to the broader population of Kenyan women, but that is not an objective of this phase of work. Our primary objective is to gather preliminary data to know how to build and test a more robust service. We are working toward a larger study with a more diverse population.

Posted on
January 12, 2020
Contact us
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.

You Might Also Like

Company Updates

X2 collaborates with Balance from Johns Hopkins

The Johns Hopkins Balance program uses Tess - learn more about how they implemented it.


Ethical Artificial Intelligence for Digital Health Organizations

This report id on the methods undertaken by X2 to develop an ethical code for organizations delivering emotional artificial intelligence (AI) services.


On-Demand Support to Patients and Their Caregivers Through Tess

This technical report highlights how one mental health chatbot, or psychological artificial intelligence service named Tess, has been customized to deliver on-demand support for caregiving professionals, patients, and family caregivers at a non-profit organization.


Feasibility of pediatric obesity and pre-diabetes treatment support through Tess, the AI behavioral coaching chatbot

As a partner to clinicians, Tess can continue the therapeutic interaction outside office hours while maintaining patient satisfaction. Due to Tess‘s capacity for continuous learning, future iterations may have additional features to increase the user experience


Mental Health Care and AI As Solution

This is a paper review of the World Health Organization (WHO) on the mental health system and presents AI as an affordable. on-demand solution to the communities.


Innovations in Consumer-Driven Care

Healthcare providers are encouraged to explore the benefits and drawbacks of digital solutions for mental health, and consider the new skills, ethical implications and research opportunities that are needed when supporting patients who use these digital tools.


Expanding Access to Depression Treatment in Kenya

Expanding Access to Depression Treatment in Kenya Through Automated Psychological Support: Protocol for a Single-Case Experimental Design Pilot Study


Reducing Depression and Anxiety in Argentine University Students through AI

This study includes a randomized controlled trial that examined the use of Tess, the chatbot, vs. a self service psychoeducation intervention delivered in Argentina.


Duke University Postpartum Depression support

Study on a perinatal depression intervention including a customized version of Tess to support pregnant women and new mothers in Kenya.