Title : Developing an evidence-based digital mental health framework for improving access to mental health services in Trans Nzoia County, Kenya

Background: Mental health disorders are increasing across Kenya, yet access to care remains severely constrained in rural counties such as Trans Nzoia, where shortages of mental health professionals, long travel distances, stigma, and limited awareness contribute to a substantial treatment gap. Digital technologies, including mobile health platforms, telepsychiatry, and online counselling, offer a means of overcoming these geographic and human-resource barriers. However, no county-specific framework currently exists to guide the integration of digital mental health services into Trans Nzoia County's primary healthcare and community health systems, limiting the extent to which digital innovation can be harnessed to expand equitable access to care.

Objective: This study aims to develop an evidence-based Digital Mental Health Framework for improving access to mental health services in Trans Nzoia County, Kenya, by assessing the availability of mental health services, identifying barriers to access, and evaluating the readiness of communities and healthcare providers to adopt digital mental health solutions.

Methods: The study will use a descriptive cross-sectional mixed-methods design. Quantitative data will be collected using structured questionnaires administered to 500 community members aged 18 years and above, selected through multistage sampling: purposive selection of the county, followed by random selection of sub-counties, wards, and villages, and systematic random sampling of households, with one eligible respondent per household. The sample size was derived using Fisher's (1998) formula for populations exceeding 10,000, then adjusted upward to account for an anticipated 30% non-response/attrition rate and the design effect introduced by multistage sampling. Qualitative data will be gathered through four Focus Group Discussions (8-10 participants each) and ten Key Informant Interviews with Community Health Promoters, nurses, clinical officers, medical officers, psychologists, county mental health coordinators, and health facility in-charges, selected through purposive sampling. Quantitative data will be entered, cleaned, and analyzed using Microsoft Excel, generating frequencies, percentages, cross-tabulations, and stratified and multivariate analyses; qualitative data from the discussions and interviews will be transcribed verbatim and analyzed thematically.

Expected Outcomes: The study is expected to establish the current availability and accessibility of mental health services in Trans Nzoia County, identify the key barriers limiting access, and document the readiness of communities and healthcare providers to adopt digital mental health tools. These findings, together with stakeholder recommendations, will inform the development of a practical, evidence-based Digital Mental Health Framework outlining strategies for integrating digital mental health services into primary and community healthcare.

Conclusion/Significance: By generating locally grounded evidence and a practical implementation framework, this study is expected to support county governments, healthcare providers, and policymakers in Trans Nzoia County, and potentially other rural Kenyan counties, in expanding equitable, technology-enabled access to mental health services and strengthening evidence-informed mental health planning and policy.

Calistus Wekesa is a Public health practitioner, clinician, mental health advocate, researcher, and leader. He is Founder and Executive Director of Afya Care Foundation, advancing mental wellbeing, stigma reduction, youth empowerment, and psychosocial support in communities. He serves as Chief Executive Officer of Tuwan Highway Mission Hospital. Calistus holds Diplomas in Clinical Medicine and Surgery and Environmental Health from Kenya Medical Training College, a BSc in Health Science from University Of The People, and is pursuing a MSc in Public Health and Health Promotion at Brunel University of London. His work focuses on strengthening healthcare systems, community health, mental health, and innovative healthcare solutions across Kenya.