DEVELOPING AN APP
TO PROVIDE SELF-HELP FOR ANXIETY
By
OKWARE BRIAN SAUL
[S20B13/249]
DEPARTMENT OF COMPUTING AND TECHNOLOGY
FACULTY OF ENGINEERING, DESIGN AND TECHNOLOGY
Email Address; brian.okware@gmail.com
+256775926970
A concept paper Submitted to the Faculty of Engineering, Design and Technology for the Study Leading
to a Project in Partial Fulfillment of the Requirements for the Award of the Degree in Computer Science
of Uganda Christian University.
SUPERVIOR
Ms. Atukunda Doreen
Email: datukunda@ucu.ac.ug
Phone: +256 772431006
19th January 2023
INTRODUCTION AND BACKGROUND
1.1 Mental health in Uganda is an increasingly important public health issue. Mental illness is a major
contributor to disability in the country, and mental health services are inadequate. The Government of
Uganda has made mental health a priority in its national health care system and is committed to
addressing mental health issues in the country. The prevalence of mental disorders in Uganda is estimated
to be around 10 percent, although the rate is likely to be higher due to the stigma associated with mental
health issues. Common mental health conditions include depression, anxiety, post-traumatic stress
disorder, alcohol and substance abuse, and schizophrenia. The Government of Uganda has established a
number of initiatives to improve access to mental health services. These include the Mental Health and
Counselling Centre, a public-private partnership between the Ministry of Health and the World Health
Organization (WHO); the Uganda Mental Health Network, which provides support for people with mental
disorders; and the Mental Health Uganda Project, an initiative supported by the World Bank to improve
access to mental health services in the country. The Government of Uganda is also taking steps to ensure
that mental health services are provided in an integrated manner with other health services. This includes
the establishment of mental health departments in health facilities, the training of health workers on
mental health issues
Mental health which is an important issue in Uganda and the world at large today. Mental health is an
active state of mind which enables a person to use their abilities in coordination with the common human
tenets of society. Mental health is the pivot of human life. However, despite its importance, it is often the
least prioritized amongst health conditions. In low- and medium-income countries like Uganda where
disease, ignorance, and poverty are common, a demand for a steadfast mental healthcare can seem a
luxury (WHO, 2019). With a large population now working and studying from home and staying away from
loved ones, the mental health situation has deteriorated greatly due to the rise in stress levels and anxiety
and the main aim of this project is to make a mental health app that will help with anxiety, worry, stress
and panic through thought adjustments, guided exercises, motivation and progress tracking.
1.2 Background
In Uganda, mental, neurological and substance use disorders are a major public health burden (Mugisha,
et al., 2019). Depression, anxiety disorders, and elevated stress levels are the most common, sometimes
leading to suicide attempts (Farzaei, et al., 2016). Uganda is ranked among the top six countries in Africa
in rates of depressive disorders, 4.6%; (Miller, et al., 2020), while 2.9% live with anxiety disorders (WHO,
2017). About 5.1% of females and 3.6% of males are affected.
E-health expresses itself in a number of fields of therapy along the various paths of care. Mental health
being one major aspect of e-health defined as medical and public health practice can be supported by
mobile devices such as mobile phones and patient monitoring devices.
In Uganda, the use of mobile health technology may represent real opportunities; insofar as development
of the Ugandan health system is subject to constraints related to a progressive increase in healthcare
demand for all various issues regarding population health including mental health with a shortage of
healthcare professionals and therapy personnel. (WHO-AIMS, 2006) Financially, Molodynski, et al., (2017)
found that Uganda spends 9.8% of its gross domestic product on healthcare, or US$246 annually per
person, but just 1% of this goes into mental healthcare. The majority of national mental health funding
goes to the national mental health referral hospital, Butabika Hospital.
According to an AIMS report by the World Health Organization, these imbalances in the number of people
with mental health issues as compared to the number of people available to help in various ways including
therapy and companionship has led a large number of people in the country who have been lost to various
mental health situations. (WHO-AIMS, 2006) The idea is to come in to cut on the numbers using a simple
mobile app companion, “Wecare”
1.3 Problem Statement
During the opening of mental health month (May, 2022), officials from the Ministry of Health in Uganda
stated that about 14 million people of the 43·7 million population have a mental illness. The approximate
prevalence of about 32·0% was higher than in previous national estimates of 24·2%; 1the prevalence might
be higher due to the pervasive social stigma and taboos associated with accessing mental health services
and the impact of the COVID-19 pandemic. The primary care system in Uganda is poorly resourced,
inadequately funded, and ill-equipped to address mental health concerns. 2 Nationwide, there are only 53
psychiatrists—approximately one psychiatrist per 1 million population. These psychiatrists are mostly
located in urban centres and are employed as university lecturers and researchers, leaving few to serve
as clinicians. Additionally, during the COVID-19 pandemic, the mental health units of most hospitals were
converted to COVID-19 isolation units until May, 2022, which reduced the provision of mental health care
services in this period. 3The following approaches might address some of the systemic challenges
described, to reduce the burden of mental illness and ensure better care. The first strategy is to increase
knowledge of mental health among service providers by ensuring that all general practitioners receive
routine medical education about psychiatric patient care, and by adding mandatory psychiatry rotations
to the traditional four medical internship programmes as a minor rotation. This could be added by
reducing the duration of the major rotation in favour of a 1-month psychiatry rotation; Uganda's medical
internship rotations programme is divided into majors (5-month rotation) and minors (1-month rotation).
This strategy will increase the workforce to care for patients with mental illness and might increase the
interns’ and general practitioners’ interest in enrolling in psychiatry. Additionally, educational incentives,
such as scholarships and specialised training opportunities, should be provided to attract interested
medical students, interns, general practitioners, and postgraduate trainees to psychiatry. Second, to
increase the number of psychiatrists in clinical practice, the government should introduce fee-for-service
incentives that reward time spent with patients, and revise policies to ensure that clinical work pays more
than alternative pathways for psychiatrists. Finally, patient-led efforts should be supported and
strengthened for better mental health advocacy.4
1.4Main objective
The main objective is to reduce anxiety among patients by developing a mental health system which will
enhances self-awareness by controlling their mood, maintaining good habits and breaking bad ones, and
generally cultivating positive thinking.
1.5 Specific objectives
1. To conduct a literature review, various field studies and research in order to identify major
system requirements.
2. To design a model of the proposed mobile application system.
3. To implement the Wecare mental health mobile application system.
4. Testing and validating the fully designed companion mobile application system.
Methodology
This section presents a detailed description of the tools, instruments, approaches, processes, data
collection techniques, and technologies, which will be used to achieve the specific objectives of the
project. It gives a description of the methods, techniques, tools that will be used to achieve the specific
objectives of the research study. These methodologies will be employed in data collection, analysis,
design, implementation, testing and validation of the system. Thereby, presenting a discussion of how
the specific objectives of this research will be achieved.
Data collection
Data collection is the process of gathering and measuring information on targeted variables in an
established system, which then enables one to answer relevant questions and evaluate outcomes.
(Wikipedia, 2017). The purpose of data gathering is to collect sufficient, relevant, and appropriate data
so that a set of stable requirements can be produced (Sharp and Preece, 2014). Before indulging into
data collection, it is important to first determine the sampling method and an appropriate sample size
which will be used. The following data collection techniques will be used in this research:
Interviews.
An interview is a structured conversation where one participant asks questions, and the other provides
answers (Merriam, 2016). In this technique, two types of interviews will be used. Closed interviews
where a predefined set of questions are asked and Open interviews, which will not have an already set
agenda. This technique will be used because it is the best source of qualitative information with an
edge in allowing personal contact. This will either be face to face in a physical setting, online via zoom
meetings or through set phone calls. The intention is to interview some psychiatrists in the country that
is at Butabika National Referral Hospital and at the centre of counselling and guidance at Uganda
Christian University to get more insights and overviews about mental health services in the country
and how they engage with most of their clients. This will provide a number of strong well-informed
ideas to be applied to the proposed mobile application.
Questionnaires and surveys.
A questionnaire is the term used to describe the set of questions you’re asking an individual. A survey
is the process of collecting, analyzing and interpreting data from many individuals. (SmartSurvey,
2022). The intention here is to carry out an online survey on a number of individuals around Kampala
and Uganda Christian University students and a few more people who can access the survey
questionnaire as the sample space to understand what positive social and private activities they prefer
doing whenever they feel emotionally distressed and mentally depressed. Survey Monkey, an online
platform for carrying out online surveys will be used to collect this data with a well-versed
questionnaire.
Documents and records.
Documents and records related research uses existing data for a study. Different kinds of records such
as meeting minutes and financial records can be used to collect data without having to necessarily ask
people. This kind of research can be quite effective and inexpensive at the same time because one uses
research that has already been completed. (Jotform, 2022) Another example of this kind of research in
this study is the literature review that has been noted above. Another scenario of this kind of research
will be done in the development phase of this project which will involve various steps taken to figure
out how to come up with a complete and fully functioning mobile application using the internet as the
main development companion via platforms and websites like GitHub and development
documentations such as flutter, ionic and react depending on what will be needed to be achieved and
how to achieve it. YouTube videos related to the study may also be inclusive as records to be used.
Sampling
Sampling is the selection of a subset of individuals from within a statistical population to estimate
characteristics of the whole population. (Wikipedia, 2022) There are two sampling methods which are
probability and non-probability-based sampling. Probability based sampling will be used in this study
since it allows every unit of the study population to have a chance of being selected in the sample
space.
The population under consideration in the study is the Ugandan one in all age, social, economic and
religious brackets for as long as one can access a smart phone with an internet connection though in
the early stages of research, Uganda Christian University is intended to be the main sample space of
study including students, staff and neighbouring communities for the online based surveys.
Data analysis
Data analysis is the process of inspecting, cleansing, transforming and modelling data with the goal of
discovering useful information, informing conclusions, and supporting decision-making. (Kudyba,
2014)
There are two methods which include: Quantitative and Qualitative methods. Data analysis will be
conducted after the data collection exercise to eliminate inconsistencies, to sieve out useful data and to
update the system requirements. In data analysis, the collected Quantitative data will be processed in
order to eliminate inconsistencies using the SPSS data analysis tool.
The qualitative data collected will be analyzed by looking for similarities and differences of the data
collected as compared to the proposed results in terms of the whole system to be developed and
functioning mobile application not forgetting the subsequent realization of themes and developing of pre-
set categories of the collected data by continuous data exploration and reviews.
System design
System design is the process of defining the components, modules, interfaces, and data for a system to
satisfy specified requirements. (Mitre, 2021) It comprises two types which are; - Process and data design.
Process design.
Process design involves subdividing the system into smaller independent components that can be
developed individually and used in different systems. To be specific, the application system is going to be
object oriented in nature hence, Microsoft Visio will be used to come up with process designs because it
is simple and easy to come up with a blueprint of the design of the system in terms of object interactions
in the shortest time.
Data design (Data modelling)
Data design is the organization of data according to a database model. (Teorey, et al., 2008) This will be
attained by using Entity relationship (ER) modeling through Entity Relationship Diagrams. ER modeling is
a top-down approach to database design that begins by identifying the most important data called entities
which are usually real-life objects such as clients and psychiatrists and the relationships between the data
must be represented in the model. Data flow diagrams will also be designed using Microsoft Visio.
System implementation
System implementation is the process of defining how the information system should be built that is to
say how it is to be physically designed ensuring that it is operational and used and meets quality standard.
(uky.edu, 2020)
The implementation will be aided by various tools right from design and development using Integrated
Development Environments for programming, real time database tools and necessary conversational
Application Programming Interfaces (APIs) and User interface design tools as explained below; -
This study will examine multiple dimensions of mental health related apps available on app store and
google play store. Using a set of keywords such as mental health, mental illness, mental disorder and
healing of mental illness to search apps available in various countries all over the world.
Scrapping of data using various software and programming tools such as ParseHub and Scrapy. Tools such
as GitHub and flutter using dart and java to come up with a working model of the mobile application
integrated with a number of necessary APIs such as Rasa conversational API.
Creativity in design to come up with an intuitive application designed to be appealing to people of all
backgrounds and age brackets using Flutter and Dart plugins.
State management of the application using options such as Streams (BLoC) which has fast, reactive state
management. Constructors to transfer variables between different screens.
Widgets in Flutter to get answers from the user in a fun way to keep the users involved. Tasks to be done
will be displayed as cards in the tasks section with gesture-controlled removal.
Using appropriate local variables to enable toggling of the cards visibility and for storing the answers to
the questions.
The database and possible interaction and conversational APIs will have all the questions and possible
answers to them that will determine the actions of the app towards the user dependent on the response
from the user by determining whether the user is actually depressed or just momentarily sad including
the tasks the user can do some of them being directly integrated into the same app.
In scenarios where the user isn’t showing progress towards their stress, anxiety or depression by feeling
any better even after promptly interacting with the mobile application, the same application will suggest
that they can easily link up with a professional Psychotherapist by setting up an appointment with them
through the same mobile application and can also feel free to share their progress so far from interaction
with the mobile application.
The described tools and software may change according to different factors in the development stage
which may include financial factors for example in cases where the required subscription charges may not
be met, other factors that could lead to change may be issues of reliability, efficiency, flexibility and
readability of programming languages in order to make sure a fully functioning system is produced.
Outcomes
By the end of this project, a beautiful and fast easy to access intelligent and user friendly welcoming
mobile app that is fun to use and also serves the main objective as mentioned before will be availed.
An easy to navigate mobile application with a fun and interesting user interface to keep users around and
happy to interact with the application.
Logic implementation for displaying tasks and checking whether the user has promptly answered their
daily questions as asked by the application. With the same intelligent algorithm, the application should
be able to choose to hide or show the task cards depending on the answers provided by the user.
A fully functioning real time database configured in Firebase as the mobile application backend to hold all
user profiles, progress and logical data used to run the mobile application intelligently through learning
about the user. With the same database, user authentication will be easily done to enhance security of
the mobile application through a registration and log-in screen.
A fully functioning mobile application that can be efficiently used in a real life setting to solve the above-
mentioned mental health issues among Ugandans and that can be deployed to app stores like Google play
store and Apple app store.
Implementation of the best practices while building the app; these will include research and software
development and design practices.
System testing and validation
Validation testing is the process of determining whether the existing system complies with the system
requirements and performs the dedicated functions for which it is designed along with meeting the goals
and needs of an organization that could make use of it. (Test rig, 2020)
Both black box testing which only considers the external behaviour of the system focusing on functional
operations of the application and white box testing which takes into consideration the system internal
functioning will be carried out to ensure that the system can operate smoothly and efficiently. (PractiTest,
2021)
Table 1: Methodologies to be used to achieve each specific objective.
No. Specific Task Tool/technique Deliverable
1 To conduct a literature review Interviews, questionnaires and Software
and conduct a field study to Surveys, documents and records. Requirements
identify system requirements Specification
Tools including; - pens, paper, Document.
Mobile phones and the internet.
2 To design the proposed Microsoft Visio System Design
structure of the Wecare document
mobile application system Process design tools:
● digital flow charts
● Data flow diagram
● Use case Diagram
● Context Diagram
● Architectural diagram
Data design:
● Entity Relationship
diagram
● Data dictionary
3 To implement the Wecare VS code IDE, Firebase database Wecare mobile
mobile application system and authentication, application
conversational APIs.
4 To test and validate the Android emulators, Google A fully functioning
proposed mobile application chrome DevTools, Firebase mobile application
system.
References
1.Opio JN Munn Z Aromataris E
Prevalence of mental disorders in Uganda: a systematic review and meta-analysis.
Psychiatr Q. 2022; 93: 199-226
2.Kigozi F Ssebunnya J Kizza D Cooper S Ndyanabangi S
An overview of Uganda's mental health care system: results from an assessment using the World Health
Organization's Assessment Instrument for Mental health Systems (WHO-AIMS).
Int J Ment Health Syst. 2010; 4: 1
3.Mwesiga EK Nakasujja N Muhwezi WW Musisi S
The COVID-19 pandemic has reinforced the need for community mental health-care models in Uganda.
Lancet Psychiatry. 2021; 8: 362
4.Storm M Edwards A
Models of user involvement in the mental health context: intentions and implementation challenges.
Psychiatr Q. 2013; 84: 313-327
Ayebare, D., Rukundo, A., Mulogo, E., Ntaro, M., Imelda, K., & Ruzaaza, G. (2019). Prediction of
Risky Alcohol Use among Ugandan Youth: A Case Study of Marie Stopes and Youth
Reproductive Health Clinics. Journal of Alcoholism and Drug Dependence, 7(1). 1-4. .
Farzaei, M., Bahramsoltani, R., Rahimi, R., Abbasabadi, F., & Abdollahi, M. (2016). A Systematic Review
of Plant-Derived Natural Compounds for Anxiety Disorders. Current topics in
medicinal chemistry, 16(17), 1924–1942.
Galderisi, S., Heinz, A., Kastrup, m., Beezhold, J., & Satorius, N. (2015). Toward a new definition
of mental health. World Psychiatry, 231-3.
Health, U. M. (2021, January 26). Results of COVID-19 tests done on 26 January 2021 #STAYSAFEUG.
Retrieved from @MinofHealthUG 19h: http://www.twitter.com
Jotform. (2022, April 20). Data Collection Methods. Retrieved from Jotform:
https://www.jotform.com/data-collection-
methods/#:~:text=Document%2D%20and%20records%2Dbased%20research,that%20has%20alr
eady%20been%20completed.
Kudyba, S. (2014). Big Data, Mining, and AnalyticsComponents of Strategic Decision Making. New York,
USA: Auerbach Publications.
Kuntz, J. (2020). Resilience In Times of Global Pandemic: Steering Recovery and Thriving Trajectories.
Applied Psychology: An International Review, 1-28.
Merriam, W. (2016). Dictionary.
Miller, A., Kintu, M., & Kiene, S. (2020). Challenges in measuring depression among Ugandan fisherfolk: a
psychometric assessment of the Luganda version of the Center for Epidemiologic
Studies Depression Scale (CES-D). BMC Psychiatry, 20, 45.
Mitre. (2021). SYSTEM DESIGN AND DEVELOPMENT. Retrieved from Mitre:
https://www.mitre.org/publications/systems-engineering-guide/se-lifecycle-building-
blocks/system-design-and-
development#:~:text=Definition%3A%20System%20design%20is%20the,methodologies%20use
d%20to%20develop%20them.
Molodynski, A., Cusack, C., & Nixon, J. (2017). Mental healthcare in Uganda: Desparate challenges
but real opportunities. BJPsych International, 14(4).
Mugisha, J., Hanlon, C., Knizek, B., Ssebunnya, J., Kinyanda, E., Kigozi, F., & Kigozi, F. (2019). The
experience of mental health service users in health system strengthening: lessons from Uganda.
International Journal of Mental Health Systems, 13, 60.
PractiTest. (2021). Black Box Vs White Box Testing. Retrieved from PractiTest:
http://www.practitest.com
Sharp, R., & Preece, J. (2014). Interaction Design: Beyond Human Computer Interraction (4th
Edition).
New York, USA: John Wiley & Sons Inc.
SmartSurvey. (2022, April 20). The Difference Between Survey and Questionnaire. Retrieved
from SmartSurvey: https://www.smartsurvey.co.uk/articles/survey-vs-questionnaire
Teorey, T., Buxton, S., Fryman, L., Guting, R., Halfin, T., Harrington, J., . . . Witt, G. (2008).
Database Design: Know It All 1st Edition. Burlington, MA: Morgan Kaufmann.
Testrig. (2020). Validation Testing. Retrieved from Testrig: http://www.testrigtechnologies.com
uky.edu. (2020, April 20). Systems implementation & evaluation. Retrieved from uky.edu:
https://www.uky.edu/~dsianita/695A&D/lecture5.html#:~:text=Systems%20implementation%2
0is%20the%20process,(i.e.%2C%20quality%20assurance).
WHO. (2017). Depression and Other Common Mental Disorders: Global Health Estimates.
Geneva,
Switzerland: World Health Organisation.
WHO. (2019). Mental disorders. Geneva, switzerland: World Health Organisation (WHO).
WHO-AIMS. (2006). Mental Health System in Uganda. Kampala, Uganda: World Health
Organisation.
Wikipedia. (2017, April). Data collection. Retrieved from WIkipedia:
https://en.m.wikipedia.org/wiki/Data_collection#
Wikipedia. (2022, March). Sampling . Retrieved from Wikipedia:
https://en.m.wikipedia.org/wiki/Sampling_(statistics)
