Background: The direct and indirect impact of the SARS-CoV-2 virus and its mitigation measures have exacerbated the global mental health crisis. Digital mental health interventions (DMHIs) may have the potential to address health system gaps and global health inequalities in low-and middle-income countries (LMICs). Purpose: This thesis aims to map the current state of DMHIs available in Nigeria and illustrate their progress, limitations, and challenges. This study aims to expand upon the findings of recent studies in LMICs by incorporating the perspectives of individuals who play a prominent role in global mental health. The lessons learned in the Nigerian context can inform the delivery of DMHIs in other low-resource settings. Methods: This research was conducted using case study methodology. Twenty semi-structured interviews were conducted with mental health researchers, healthcare providers, digital health experts and policy makers. Data sources such as news articles, websites, research papers, and interviews were used. Interviews were recorded and transcribed, and data from multiple sources were then converged, coded, and analyzed using Dedoose via thematic analysis. Findings: The vast majority of DMHIs in Nigeria are private mental health service delivery platforms that connect directly to mental health professionals. The target audience for most DMHIs are broad and encompass all mental health conditions and ages. Advantages of DMHIs include increasing efficiency, accessibility, addressing stigma, and filling the mental health service gap. Disadvantages include skepticism in DMHIs, limitations of applicability, lack of accessibility to internet and technology, lack of sustainability, and lack of infrastructure, funding, and policies. Conclusions: There is a need to leverage DMHIs within the Nigerian population for mental health promotion. Future research should examine feedback from users and providers of DMHIs to allow for comparative analysis, more conclusive and replicable results to inform DMHI design and implementation. / Thesis / Master of Science (MSc)

Dans le champ de la protection de l’enfance, le débat sur l’évaluation pour déterminer les besoins et les objectifs d'une intervention socioéducative anime les acteurs de ce champ. Cette recherche s’intéresse à une équipe soignante qui, au sein d’une unité de soins intensifs du soir, accueille après l’école des enfants «agités». Cette équipe peut être amenée à prendre contact avec les services de protection de l'enfance et alors être actrice d'une démarche qui vise à déterminer les objectifs et les besoins d’une intervention des services de protection de l’enfance. Notre démarche compréhensive à partir d’une observation participante appréhende la pratique de ces soignants pour aborder la question de leur relation avec les services de protection de l’enfance. Nous nous sommes appuyée sur l'écologie de la prise de décision pour mettre en relief les différents facteurs qui interagissent dans la décision des soignants de prendre contact avec ces service. Nous définissons les cadres théoriques qui structurent la pratique des soignants et identifions les contraintes et les stratégies des acteurs dans la relation qu'ils construisent pour déterminer les besoins et les objectifs d'une intervention. Nous montrons que les soignants ne s’appuient pas pour s’engager dans un processus de séparation sur des caractéristiques de danger d'une situation mais plutôt sur la capacité des parents à se saisir de l'accompagnement des soignants pour agir sur leurs difficultés. Ces résultats nous conduisent à comprendre à une échelle plus large le passage, dans le travail social, d’une attente de conformisation de l'individu aux attentes sociales à une aptitude de ce dernier à élaborer les difficultés rencontrées pour les anticiper et les surmonter dans une exigence d’autoréalisation. / In the last few decade, in the field of child welfare, the debate on assessment to determine both needs and aims of a social intervention has been developing. This research focuses on a mental health care intervention designed for children with behavioral disorders. The children come to the intervention site once school is finished. The intervention team offers care services, but in some situations the question of a possible intervention of child protection services may emerge. The team of mental health clinicians becomes then actor of the assessment process. A comprehensive methodology based on a participant observation enables us to get a better understanding of the clinicians’ practice and address the question of their relationship with child protection services. To underline the different factors which interact with the decision process of the clinicians we use the decision making ecology. We first define theoretical frameworks which structure the team practice. Then we identify constraints such as the French rules of child protection services and strategies used by clinicians such as their expertise position and by child protection workers such as their intermediate position to understand how their relationship is built. We also highlight that the clinician team rather than stressing out the risk of danger for the child may decide to contact child protection services when parents are not able to elaborate on their difficulties. These results lead to a new understanding of social workers’ intervention. Aims are not anymore to conform individuals to the social rules but to help them to elaborate on their difficulties to anticipate and deal with them with a demand of self-realization in mind.

Submitted by SBI Biblioteca Digital (sbi.bibliotecadigital@puc-campinas.edu.br) on 2018-03-15T13:45:12Z No. of bitstreams: 1 MARIANA PEREIRA DA SILVA.pdf: 1495567 bytes, checksum: cfe3269f86ef6ee276b2a7ebc6ca324d (MD5) / Made available in DSpace on 2018-03-15T13:45:12Z (GMT). No. of bitstreams: 1 MARIANA PEREIRA DA SILVA.pdf: 1495567 bytes, checksum: cfe3269f86ef6ee276b2a7ebc6ca324d (MD5) Previous issue date: 2018-01-30 / Conselho Nacional de Pesquisa e Desenvolvimento Cient?fico e Tecnol?gico - CNPq / This dissertation presents the results of an ?intervention-research?, which is so named due to the relevance of the intervention in the whole process. In this way, the objectives were to promote an intervention in a reflection group about work and health with workers from an automobile industry and to analyze the health-disease process experienced by them. It was attended by 14 workers from the same company whose form of organization of work and the productive processes is characteristic of Toyotism, a model of organization that stimulates individualism, competitiveness, outsourcing, flexibility and thus may favor the processes of work-related mental disorders. These workers shared their daily experiences related to work and reflected on them in a group, performed at CEREST in Campinas ? SP, over 11 meetings, during the period of six months. The group had an open character and was built together to the participants. The information shared by them showed that, initially, they wanted a lot to join the company, and while being admitted, they felt they have achieved a dream. During time, however, that dream has become a nightmare, as they experienced a context of psychological violence and demands for a high rate of production, which ended up favoring the development of physical injuries. As a result, the work-related mental suffering was intensified, as the injured workers were excluded, humiliated and reinserted to work in incompatible functions. In this sense, in the reflection group, subjects such as work under capitalism, flexible speech, the workers? guilt for illness, their life stories, new life projects, the union and solidarity among them, among other examples were discussed through conversation wheels and use of mediating materiality. It is possible to say that this kind of group assisted in the promotion of elements for the development of more critical reflections by the workers, who closed the meetings feeling less blame, stronger, united, in solidarity to each other, more active and responsible for social transformation. / Esta disserta??o apresenta os resultados de uma ?interven??o-pesquisa?, que est? sendo assim denominada devido ? relev?ncia da interven??o em todo o processo. Desse modo, os objetivos foram promover uma interven??o em um grupo de reflex?o sobre trabalho e sa?de com trabalhadores de uma ind?stria automobil?stica e analisar o processo de sa?de-adoecimento vivenciado por eles. Participaram 14 trabalhadores de uma mesma empresa, cuja forma de organiza??o do trabalho e dos processos produtivos ? caracter?stica do Toyotismo, um modelo de organiza??o que estimula o individualismo, a competitividade, a terceiriza??o, a flexibiliza??o e, assim, pode favorecer os processos de adoecimento mental relacionados ao trabalho. Tais trabalhadores compartilharam suas viv?ncias cotidianas relacionadas ao trabalho e refletiram sobre elas em um grupo, realizado no CEREST de Campinas - SP, ao longo de 11 encontros, durante o per?odo de seis meses. O grupo tinha um car?ter aberto e foi constru?do juntamente aos participantes. As informa??es compartilhadas por eles mostraram que, inicialmente, desejavam muito ingressar na empresa e, ao serem admitidos, sentiam ter realizado um sonho. Com o passar do tempo, no entanto, esse sonho se tornou pesadelo, na medida em que vivenciavam um contexto de viol?ncia psicol?gica e exig?ncias por alto ritmo de produ??o, o que acabava favorecendo o desenvolvimento de les?es f?sicas. Com isso, o sofrimento mental relacionado ao trabalho foi se intensificando, pois os trabalhadores lesionados eram exclu?dos, humilhados e reinseridos ao trabalho em fun??es incompat?veis. Nesse sentido, no grupo de reflex?o, se discutiu, por meio de rodas de conversa e utiliza??o de materialidades mediadoras, temas como o trabalho no capitalismo, o discurso flex?vel, a culpabiliza??o dos trabalhadores pelo adoecimento, suas hist?rias de vida, novos projetos de vida, a uni?o e a solidariedade entre eles, entre outros exemplos. Pode-se dizer que essa modalidade de grupo auxiliou na promo??o de elementos para o desenvolvimento de reflex?es mais cr?ticas pelos trabalhadores, que encerraram os encontros sentindo-se menos culpados, mais fortalecidos, unidos, solid?rios uns aos outros, mais ativos e respons?veis pela transforma??o social.