Welcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: Kaya Guides Pilot Results, published by RachelAbbott on June 16, 2024 on The Effective Altruism Forum.

Summary

Who We Are: Kaya Guides runs a self-help course on WhatsApp to reduce depression at scale in low and middle-income countries. We help young adults with moderate to severe depression. Kaya currently operates in India. We are the world's first nonprofit implementer of Step-by-Step, the World Health Organization's digital guided self-help program, which was proven effective in two RCTs.

Pilot: We ran a pilot with 103 participants in India to assess the feasibility of implementing our program on WhatsApp with our target demographic and to generate early indicators of its effectiveness.

Results: 72% of program completers experienced depression reduction of 50% or greater. 36% were depression-free. 92% moved down at least a classification in severity (i.e. they shifted from severe to moderately severe, moderately severe to moderate, etc). The average reduction in score was 10 points on the 27-point PHQ-9 depression questionnaire.

Context: To offer a few points of comparison, two studies of therapy-driven programs found that 46% and 57.5% of participants experienced reductions of 50% or more, compared to our result of 72%. For the original version of Step-by-Step, it was 37.1%. There was an average PHQ-9 reduction of 6 points compared to our result of 10 points.

Effect Size: Our effect size is estimated at 0.54, compared to an effect size of 0.48 for the original version of Step-by-Step. This is likely to be an upper bound.

Cost-Effectiveness: We estimate that the pilot was 7x as cost-effective as direct cash transfers at increasing subjective well being. This accounts for the initial effect, not duration of effects. The cost per participant was $96.27. We project that next year we will be 20x as cost-effective as direct cash transfers. These numbers don't reflect our full impact, as we may be saving lives. Four participants said overtly that the program reduced their suicidal thinking.

Impacts: Participants reported that the program had profound impacts on their lives, ranging from improved well-being to regaining control over their lives and advancing in their education and careers.

Recruitment: We were highly successful at recruiting our target population. 97% of people who completed the baseline depression questionnaire scored as having depression. 82% scored moderate to severe. Many of our participants came from lower-income backgrounds even though we did not explicitly seek out this group. Participants held professions such as domestic worker, construction and factory worker and small shopkeeper. 17% overtly brought up financial issues during their guide calls.

Retention: 27% of participants completed all the program content, compared to 32% in the WHO's most recent RCT. In the context of a digitally-delivered mental health intervention, which are notorious for having extremely low engagement, this is a strong result. Guide call retention was higher: 36% of participants attended at least four guide calls.

Participant Feedback: 96% of program completers said they were likely or very likely to recommend the program. Participant feedback on guide calls was overwhelmingly positive and their commentary gave the sense that guide calls directly drive participant engagement. Negative feedback focused on wanting more interaction with guides. Feedback on the videos was mixed. For the chatbot, it was neutral.

Feedback on the exercises was generally positive for the exercises, although there were signs of lack of engagement with some exercises. The stress reduction exercises were heavily favored.

Support Kaya Guides: To support us, donate here or contact Rachel Abbott at [email protected]. Per our most recent assessment, it costs us $96 to provide mental healthcare t...