Perception of healthcare workers on mobile app-based clinical guideline for the detection and treatment of mental health problems in primary care: a qualitative study in Nepal

Probably not a substantial claim: may not pass S3 (load-bearing).

Health workers stated that due to limited consultation time, there might be a possibility of having incorrect patients data collected in the app during rushed time.

“They also stated that due to limited consultation time, there might be a possibility of having incorrect patients data collected in the app during rushed time.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The study participants reported that the app could increase patients' trust in the treatment.

“increasing patients’ trust in the treatment”

Probably not a substantial claim: may not pass S3 (load-bearing).

The study participants reported that the app could enable remote supervision.

“enabling remote supervision”

Probably not a substantial claim: may not pass S3 (load-bearing).

Health workers recommended that the app need to be able to work in offline mode because some remote health facilities lack reliable internet connection.

“As some of the remote health facilities lack reliable internet connection, they also recommended that the app need to be able to work in offline mode.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Health workers suggested that the app should use short and simple sentences.

“Short and simple sentences with large font size”

Classified as probably not a substantial claim.

Health workers reported that dropout rate of patients receiving mental health treatment in primary care is relatively higher than general healthcare.

“Health workers reported that dropout rate of patients receiving mental health treatment in primary care is relatively higher than general healthcare.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Several participants (n=4) articulated that because the general public is exposed to the latest technology, when used for treatment some patients may trust the treatment provided to them, which in turn may increase the chance of treatment adherence.

“Several participants (n = 4) also articulated that because the general public is also exposed to the latest technology, when used for treatment some patients may trust the treatment provided to them, which in turn may increase the chance of treatment adherence.”

Classified as probably not a substantial claim. May combine two claims.

Health care workers reported being often confident in making diagnosis for straightforward cases of depression but found it difficult to diagnose patients presenting with co-morbid symptoms, e.g., depression with psychotic symptoms.

“They shared that they are often confident in making diagnosis for ‘straightforward cases’ of depression, but found it difficult to diagnose patients presenting with co-morbid symptoms, e.g. depression with psychotic symptoms.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Health workers suggested that the app should include a clinical data recording system.

“Inclusion of patient record system in the app”

Probably not a substantial claim: may not pass S3 (load-bearing).

Health care workers highlighted compatibility of the app with both Android and iOS operating systems as important for incorporation into working practices.

“Compatibility of the app was highlighted as another important aspect of its incorporation into working practices. As health care workers often use their personal mobile phones to access apps for work, it is imperative that apps compatible with both Android and iOS operating systems.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Health workers reported that pictures and videos could be useful demonstration materials to deliver psychosocial interventions.

“They reported that the pictures and videos could be useful demonstration materials to deliver psychosocial interventions.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Health workers suggested that the app should have minimal typing options.

“Minimal typing function”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Participants proposed that the app should have fewer typing features and that pre-defined responses would be helpful to reduce time spent entering information and maintain accuracy of patients' data.

“Therefore participants proposed that the app should have fewer typing features and that pre-defined responses would be helpful to reduce the time spent entering information and maintaining the accuracy of the patients' data.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The step-by-step functionality of the original mhGAP-IG app was considered very helpful, especially for health care workers with limited experience in mental health case management.

“As a result, the step by step functionality of the original mhGAP-IG app was considered to be very helpful, especially for health care workers with limited experience in mental health case management.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Health workers reported that the app would remove the need to carry a cumbersome paper version of the guidance which could be easily misplaced.

“This would remove the need to carry a cumbersome paper version of the guidance which could be easily misplaced.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Health workers reported that the app might be very helpful to access patients' medical records when patients forget or lose their OPD card or medical reports.

“Health workers reported that many patients forget to bring their Out Patient Department (OPD) card (i.e. clinical notes) in the follow-up visits, or sometimes even lose their medical reports; app might be very helpful to access patients’ medical records.”

May combine two claims.

Health care workers in the study reported preferring phone calls over text messages because making phone calls is easier than sending text messages, even though message services are cheaper.

“They reported that they prefer making phone calls more often even though message service are much cheaper because making phone calls is easier than sending text messages.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Health workers suggested that the app content should be available in Nepali language.

“Content in both English and Nepali languages”

Probably not a substantial claim: may not pass S3 (load-bearing).

Some health workers endorsed including pictures of Community Informants Detection Tools (CIDT) for assessment and videos of psychosocial intervention.

“Some of the health workers also endorsed including the pictures of Community Informants Detection Tools (CIDT), a vignette-based tool for pro-active case detection of people with priority mental disorders [44], for assessment, and videos of psychosocial intervention.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

A few health workers put forward that when using the app in front of patients, other patients' records would also be visible to them, which may break confidentiality.

“a few health workers also put forward that when using the app in front of the patients, other patients’ record would also be visible to them, which may break the confidentiality.”

Classified as probably not a substantial claim.

Health care workers often use their personal mobile phones to access apps for work.

“As health care workers often use their personal mobile phones to access apps for work”

Probably not a substantial claim: may not pass S3 (load-bearing).

Health workers recommended a messaging feature through the app for improving treatment adherence among patients receiving mental health services.

“Therefore, health workers recommended messaging feature through the app for improving treatment adherence among patients receiving mental health services.”

Classified as probably not a substantial claim.

The study participants reported that the app could help in bringing uniformity in diagnosis and management of mental disorders across all health facilities.

“The study participants reported that the app could help in bringing uniformity in diagnosis and management of mental disorders across all health facilities”

Probably not a substantial claim: may not pass S3 (load-bearing).

Health workers suggested that the app should allow offline functions.

“Offline function”

Probably not a substantial claim: may not pass S3 (load-bearing).

Almost every health worker reported that their pre-service training was taught in Nepali medium.

“Almost every health worker reported that their pre-service training was taught in Nepali medium (Nepali language).”

May combine two claims.

Medical officers found the e-mhGAP prototype easy to use whereas the paramedics required a lot of support and guidance, as validated by observations during data collection.

“These results were also validated by our observations during the data collection, where medical officers found the e-mhGAP prototype easy to use whereas the paramedics required lot of support and guidance.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Health workers suggested that the app should include suggestive diagnosis and treatment options.

“Suggestive diagnosis and treatment after entering the symptoms of a particular disorder”

Classified as probably not a substantial claim. May combine two claims.

Health workers reported that patients may feel that health workers are not paying attention to their concerns if they use the app during consultation, which may obstruct rapport building.

“They reported that patients may feel that health workers are not paying attention to their concerns if they use the app during consultation, which may obstruct rapport building”

Probably not a substantial claim: may not pass S3 (load-bearing).

Health workers suggested that the app should have large font size.

“Short and simple sentences with large font size”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Health workers reported that entering patients' data and clinical notes in the app during consultation might take longer time, and may not be possible during high number of patient clinic appointments.

“Health workers reported that entering patients’ data and clinical notes in the app during consultation might take longer time, and it also may not be possible during high number of patient clinic appointments.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Some health workers suggested a data sharing feature for sharing patients' data to supervisors for remote supervision.

“In addition, some of the health workers also suggested a data sharing feature for sharing patients’ data to the supervisors in order to use in the remote supervision.”

Classified as probably not a substantial claim.

Primary health care workers reported an increase in treatment coverage of mental health services from primary care as a potential benefit of using the app.

“A number of potential benefits have been reported by primary health care workers in using the app which included: (1) minimization of the barriers related to low detection of mental health disorders in primary care; (2) possibility of remote supervision of the trained health care workers; (3) increase in the treatment coverage of mental health services from primary care;”

Probably not a substantial claim: may not pass S3 (load-bearing).

A few participants (n=5) reported that the app might be much easier and appropriate for medical officers in comparison to paramedics because of the higher level of education of medical officers.

“A few participants (n = 5) also reported that the app might be much easier and appropriate for medical officers in comparison to paramedics (a healthcare worker who has undertaken 18 months to 3 years training) because of the higher level of education of medical officers.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Health workers suggested that the app should include other relevant reference material (e.g. videos of psychosocial support, deep breathing exercise).

“Inclusion of other relevant reference material (e.g. videos of psychosocial support, deep breathing exercise) in the app”

Probably not a substantial claim: may not pass S3 (load-bearing).

Health workers suggested that the app should send reminder messages to patients about follow-up appointments.

“Send reminder messages to the patients about the follow-up appointments”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Health care workers had a concern about the storage space the app will take on the phone and recommended that the app should take minimal memory space.

“Additionally, health care workers also had a concern about the storage space that the app will take in the phone. Due to limited storage space of some mobile devices, health workers also recommended that the app should take minimal memory space.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Health workers suggested that large font size and short sentences will make the app easily readable and will not take up longer time for health care workers when reading the app-based guideline in OPD.

“Furthermore, the large font size and short sentences as these will make it easily readable and will not take up longer time for health care workers when reading the app based guideline in Outpatient Department (OPD).”

The quote only partly states this claim.

Most health workers use Android mobile.

“First, the results demonstrated that most of the health workers use android mobile, and are experienced in using technology in health care.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Health care workers suggested collection of patients' socio-demographic and clinical data as a feature in the app-based clinical guide.

“One of the features in the app-based clinical guide suggested by the health care workers is collection of patients’ socio-demographic and clinical data which can also be used by a mental health specialist or clinical mentoring and supervision of the trained health workers remotely.”

May combine two claims.

Potential distraction in communication between patients and health workers, and breaking confidentiality of patients' data, were barriers and risk factors in using mobile app-based clinical guidelines identified in the study.

“Other barriers and risk factors in using mobile app-based clinical guidelines identified in our study were potential distraction in the communication between patients and health workers, and breaking confidentiality of the patients’ data.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The most common barriers for mental health care utilization include low perceived needs, stigma and discrimination associated with mental illness, inability to afford the treatment cost, poor identification and referral system, and shortage of human resources.

“The most common barriers for mental health care utilization include low perceived needs, stigma and discrimination associated with mental illness, inability to afford the treatment cost, poor identification and referral system, and shortage of human resources [4–10].”

• cites [4] Demyttenaere K, Bruffaerts R, Posada-Villa J, Gasquet I, Kovess V, Lepine JP, Angermeyer MC, Bernert S, de Girolamo G, Morosini P. Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. JAMA J Am Med Assoc. 2004;291(21):2581. sourceNot checked yet

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• cites [5] Edlund MJ, Unutzer J, Curran GM. Perceived need for alcohol, drug, and mental health treatment. Soc Psychiatry Psychiatr Epidemiol. 2006;41(6):480–7. sourceNot checked yet

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• cites [6] Saraceno B, van Ommeren M, Batniji R, Cohen A, Gureje O, Mahoney J, Sridhar D, Underhill C. Barriers to improvement of mental health services in low-income and middle-income countries. Lancet (London, England). 2007;370(9593):1164–74. sourceNot checked yet

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• cites [7] Shidhaye R, Kermode M. Stigma and discrimination as a barrier to mental health service utilization in India. Int Health. 2013;5(1):6–8. sourceNot checked yet

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• cites [8] van Beljouw I, Verhaak P, Prins M, Cuijpers P, Penninx B, Bensing J. Reasons and determinants for not receiving treatment for common mental disorders. Psychiatr Serv (Washington, DC). 2010;61(3):250–7. sourceNot checked yet

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• cites [9] Murphy A, Chikovani I, Uchaneishvili M, Makhashvili N, Roberts B. Barriers to mental health care utilization among internally displaced persons in the republic of Georgia: a rapid appraisal study. BMC Health Serv Res. 2018;18(1):306. sourceNot checked yet

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• cites [10] Ali SH, Agyapong VIO. Barriers to mental health service utilisation in Sudan—perspectives of carers and psychiatrists. BMC Health Serv Res. 2016;16:31. sourceNot checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

86.3% of people with anxiety, mood or substance disorders in low or middle-income countries (LMICs) received no treatment in the past 12 months.

“The recent World Health Organization (WHO) World Mental Health Survey initiative reported that 86.3% of people with anxiety, mood or substance disorders in low or middle-income countries (LMICs) received no treatment in the past 12 months [1].”

• cites [1] Evans-Lacko S, Aguilar-Gaxiola S, Al-Hamzawi A, Alonso J, Benjet C, Bruffaerts R, Chiu WT, Florescu S, de Girolamo G, Gureje O, et al. Socio-economic variations in the mental health treatment gap for people with anxiety, mood, and substance use disorders: results from the WHO World Mental Health (WMH) surveys. Psychol Med. 2018;48(9):1560–71. sourceNot checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

Among people who do receive treatment, many receive inadequate treatment.

“Among people who do receive treatment, many receive inadequate treatment [2].”

• cites [2] Wang PS, Aguilar-Gaxiola S, Alonso J, Angermeyer MC, Borges G, Bromet EJ, Bruffaerts R, de Girolamo G, de Graaf R, Gureje O, et al. Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys. Lancet (London, England). 2007;370(9590):841–50. sourceNot checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

Only 1-in-27 people living with major depressive disorder in LMICs receives minimally adequate treatment.

“a recent study conducted in 21 countries found that only 1-in-27 people living with major depressive disorder in LMICs receives minimally adequate treatment [3].”

• cites [3] Thornicroft G, Chatterji S, Evans-Lacko S, Gruber M, Sampson N, Aguilar-Gaxiola S, Al-Hamzawi A, Alonso J, Andrade L, Borges G, et al. Undertreatment of people with major depressive disorder in 21 countries. Br J Psychiatry. 2017;210(2):119–24. sourceNot checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

The codes identified by each researcher were discussed with other members of the research team and differences were finalized in consensus.

“The codes identified by each researcher were discussed further with other members of the research team and the differences in the codes of two researchers were finalized in consensus.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Mobile app-based clinical guidelines can increase health workers morale.

“and can facilitate task-shifting, and increase health workers morale [25, 27].”

• cites [25] Tewari A, Kallakuri S, Devarapalli S, Jha V, Patel A, Maulik PK. Process evaluation of the systematic medical appraisal, referral and treatment (SMART) mental health project in rural India. BMC Psychiatry. 2017;17(1):385. sourceNot checked yet

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• cites [27] Chang LW, Kagaayi J, Arem H, Nakigozi G, Ssempijja V, Serwadda D, Quinn TC, Gray RH, Bollinger RC, Reynolds SJ. Impact of a mHealth intervention for peer health workers on AIDS care in rural Uganda: a mixed methods evaluation of a cluster-randomized trial. AIDS Behav. 2011;15(8):1776–84. sourceNot checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The transcripts were read by two researchers independently to familiarize themselves with the data and generate initial codes.

“The transcripts were all printed and thoroughly read by two researchers independently to familiarize themselves with the data, and generate initial codes.”

Probably not a substantial claim: may not pass S3 (load-bearing).

In Nepal, the number of mobile device contracts (27.85 million in 2020) is more than the total population of the country (26.49 million).

“In Nepal, the number of mobile device contracts (i.e. 27.85 million in 2020) is more than the total population of the country (i.e. 26.49 million) [29].”

• cites [29] Rijal P. Mobile subscriptions outnumber population. Kathmandu: Kantipur Publication; 2016.Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

The interview guides were pilot-tested with two primary healthcare workers in Chitwan prior to the main study.

“The interview guides were pilot-tested with two primary healthcare workers in Chitwan prior to the main study.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The analysis and interpretation of the data were conducted by the same two researchers together.

“Finally, the analysis and interpretation of the data were conducted by the same two researchers together.”

Classified as probably not a substantial claim.

There are many potential barriers to implement m-Health solutions, including suitability and acceptability to both healthcare worker and service user.

“Despite these benefits, there are many potential barriers to implement m-Health solution, including suitability and acceptability to both healthcare worker and service user [26].”

• cites [26] Kruse C, Betancourt J, Ortiz S, Valdes Luna SM, Bamrah IK, Segovia N. Barriers to the use of mobile health in improving health outcomes in developing countries: systematic review. J Med Internet Res. 2019;21(10):e13263. sourceNot checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

A similar advantage of m-health interventions was reported in a study conducted in Uganda and in a systematic review of the feasibility and effectiveness of m-health strategies in LMICs.

“A similar advantage of m-health interventions was also reported in a study conducted in Uganda [27], and in a systematic review of the feasibility and effectiveness of m-health strategies in LMICs [45].”

• cites [27] Chang LW, Kagaayi J, Arem H, Nakigozi G, Ssempijja V, Serwadda D, Quinn TC, Gray RH, Bollinger RC, Reynolds SJ. Impact of a mHealth intervention for peer health workers on AIDS care in rural Uganda: a mixed methods evaluation of a cluster-randomized trial. AIDS Behav. 2011;15(8):1776–84. sourceNot checked yet

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• cites [45] Agarwal S, Perry HB, Long LA, Labrique AB. Evidence on feasibility and effective use of mHealth strategies by frontline health workers in developing countries: systematic review. Trop Med Int Health TM & IH. 2015;20(8):1003–14. sourceNot checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

Developing a mobile app-based clinical guide using Human Centered Design may result in more engaging interventions.

“Developing a mobile app-based clinical guide using Human Centered Design (HCD, or user-centered design) may result in more engaging interventions as HCD actively include concerned stakeholders in the process of intervention development using cutting-edge methods to optimize for end-users and provide a solution for key problems that are being addressed [28].”

• cites [28] IDEO. The field guide to human-centered design. Palo Alto: IDEO; 2015.Not checked yet

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May combine two claims.

This approach could be a viable and effective strategy in building clinical capacity of primary health care providers in mental health care in Nepal.

“This approach, therefore, could be a viable and effective strategy in building clinical capacity of primary health care providers in mental health care in Nepal.”

May combine two claims.

A review of available statistics and evidence of smartphone use among elderly people demonstrated that they use a smartphone for making calls but rarely use downloaded apps.

“Similarly, our results also support the findings of the review of available statistics and evidence of smartphone use among elderly people which demonstrated that they use a smartphone for making calls but rarely did they utilized downloaded apps [47].”

• cites [47] Berenguer A, Goncalves J, Hosio S, Ferreira D, Anagnostopoulos D, Kostakos V. Are smartphones ubiquitous?: An in-depth survey of smartphone adoption by seniors. IEEE Consum Electron Mag. 2017;6(1):104–10. sourceNot checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Psychiatric case conferences were found to be effective and were appreciated by trained health care workers.

“Although, the psychiatric case conferences were found to be effective and were also appreciated by the trained health care workers [37], this approach requires physical presence of both mental health specialists and primary health care workers.”

• cites [37] Luitel NP, Breuer E, Adhikari A, Kohrt BA, Lund C, Komproe IH, Jordans MJD. Process evaluation of a district mental healthcare plan in Nepal: a mixed-methods case study. BJPsych Open. 2020;6(4):e77. sourceNot checked yet

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May combine two claims.

In the authors' recent study among the same health care workers in Chitwan, detection rates of depression and alcohol use disorder in primary care increased significantly (15.5 points for depression and 58.9 points for AUD) after introduction of mhGAP-based training, but reduced substantially (10.2 points increase for depression and 12.1 points for AUD) 2 years after training.

“In our recent study among the same health care workers in Chitwan, the detection rates of depression and alcohol use disorder in primary care increased significantly (i.e.15.5 points for depression and 58.9 points for AUD) after the introduction of the mhGAP-based training; however, the rates reduced substantially (i.e. 10.2 points increase for depression and 12.1 points for AUD) 2 years after the”

• cites [36] Jordans MJD, Luitel NP, Kohrt BA, Rathod SD, Garman EC, De Silva M, Komproe IH, Patel V, Lund C. Community-, facility-, and individual-level outcomes of a district mental healthcare plan in a low-resource setting in Nepal: a population-based evaluation. PLoS Med. 2019;16(2):e1002748. sourceNot checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

A systematic review on the feasibility and effectiveness of m-Health strategies for frontline health workers in LMICs reported that if adequate training is provided to frontline workers, they can easily learn the technology for improving the services they provide.

“A systematic review on the feasibility and effectiveness of m-Health strategies for frontline health workers in LMICs reported that if adequate training is provided to the frontline workers, they can easily learn the technology for improving the services they provide [45].”

• cites [45] Agarwal S, Perry HB, Long LA, Labrique AB. Evidence on feasibility and effective use of mHealth strategies by frontline health workers in developing countries: systematic review. Trop Med Int Health TM & IH. 2015;20(8):1003–14. sourceNot checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

A pilot programme in rural Nepal reported that community health workers can collect health surveillance data accurately using mobile technology if they are trained adequately.

“A pilot programme in rural Nepal which tested the feasibility of using mobile phones for collecting health surveillance data reported that community health workers can collect health surveillance data accurately using mobile technology if they are trained adequately [31].”

• cites [31] Meyers DJ, Filkins M, Bangura AH, Sharma R, Baruwal A, Pande S, Halliday S, Schwarz D, Schwarz RK, Maru SRD. Management challenges in mHealth: failures of a mobile community health worker surveillance programme in rural Nepal. BMJ Innov. 2017;3(1):19–25. sourceNot checked yet

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May combine two claims.

The study was conducted in two districts, Chitwan and Ramechhap, and therefore the results may not be generalizable to all health workers in Nepal.

“First, the study was conducted in two districts namely Chitwan and Ramechhap; therefore, the results may not be generalizable to all health workers in Nepal.”

Probably not a substantial claim: may not pass S3 (load-bearing).

About half of the study population in the US national survey had concerns about privacy and security of their medical records.

“About half of the study population in the US national survey had concerns about privacy and security of their medical records [50].”

• cites [50] Patel V, Hughes P, Barker W, Moon L. Trends in individuals’ perceptions regarding privacy and security of medical records and exchange of health information: 2012–2014. ONC Data Brief, no. 33. Washington: Office of the National Coordinator for Health Information Technology; 2016.Not checked yet

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Classified as probably not a substantial claim.

The key features and functions suggested by health workers (suggestive diagnosis and treatment options, patients' data recording system, messaging, and offline functions) are instrumental to inform the design of the app.

“The key features and functions suggested by the health workers in the mobile app-based clinical guides, i.e. suggestive diagnosis and treatment options, patients’ data recording system, messaging, and offline functions, are instrumental to inform the design of the app.”

May combine two claims.

The mhGAP-IG based district mental health care plan was effective in improving treatment coverage, accurate detection of mental disorders, initiation of minimally adequate treatment in primary care, and positive clinical outcomes in Nepal.

“The mhGAP-IG based district mental health care plan was also effective in improving treatment coverage, accurate detection of mental disorders and initiation of minimally adequate treatment in primary care, and positive clinical outcomes in Nepal [36].”

• cites [36] Jordans MJD, Luitel NP, Kohrt BA, Rathod SD, Garman EC, De Silva M, Komproe IH, Patel V, Lund C. Community-, facility-, and individual-level outcomes of a district mental healthcare plan in a low-resource setting in Nepal: a population-based evaluation. PLoS Med. 2019;16(2):e1002748. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

A study in Ethiopia reported that health care providers who did not have previous exposure to smartphones and electronic devices were able to use the phones effectively in day-to-day maternal health care service delivery.

“Similarly, a study conducted to assess the feasibility of using smartphones in maternal health care in Ethiopia reported that the health care providers who did not have previous exposure to smart phones and electronic devices were able to use the phones effectively in day-to-day maternal health care service delivery [48].”

• cites [48] Medhanyie AA, Little A, Yebyo H, Spigt M, Tadesse K, Blanco R, Dinant GJ. Health workers’ experiences, barriers, preferences and motivating factors in using mHealth forms in Ethiopia. Hum Resour Health. 2015;13:2. sourceNot checked yet

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May combine two claims.

The study was conducted with prescribing health workers (health assistants, auxiliary health workers and medical officers), and therefore the results may not represent the opinions of non-prescribing health workers (e.g., nurse and auxiliary nurse midwives).

“Second, the study was conducted with prescribing health workers (i.e. health assistants, auxiliary health workers and medical officers); therefore, the results may not represent the opinions of non-prescribing health workers (e.g. nurse and auxiliary nurse midwives).”

Probably not a substantial claim: may not pass S3 (load-bearing).

A study in rural India reported limited familiarity of health care providers with digital technology as a key challenge for delivering depression care.

“For example, a study conducted to assess the acceptability and feasibility of using digital technology in mental health care in rural India also reported limited familiarity of health care providers’ with digital technology as a key challenge for delivering depression care [46].”

• cites [46] Muke SS, Shrivastava RD, Mitchell L, Khan A, Murhar V, Tugnawat D, Shidhaye R, Patel V, Naslund JA. Acceptability and feasibility of digital technology for training community health workers to deliver brief psychological treatment for depression in rural India. Asian J Psychiatr. 2019;45:99–106. sourceNot checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

A separate study reported that 50% of patients expressed concerns regarding privacy issues, and 40% felt uncomfortable about providing their personal information to clinicians.

“Similar results have also been reported in a separate study where 50% patients expressed concerns regarding privacy issues, and 40% felt uncomfortable about providing their personal information to clinicians [51].”

• cites [51] Dragovic M, Davison S, Morgan VA, Chiu VW, Richards N, Vatskalis T. Validated, easy to use and free’: top three requests for mobile device applications (‘apps’) from mental health consumers and clinicians. Adv Mental Health. 2018. https://doi.org/10.1080/18387357.2018.1557014. sourceNot checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

The first version of mhGAP-IG has already been used in more than 100 countries.

“The mobile app-based clinical guideline, which is currently being developed, is based on the second version of the mhGAP-IG [22], the first version has already been used in more than 100 countries [52].”

• cites [52] Keynejad R, Dua T, Barbui C, Thornicroft G. WHO Mental Health Gap Action Programme (mhGAP) Intervention Guide: a systematic review of evidence from low and middle-income countries. Evid Based Mental Health 2017; 21:ebmental-2017. sourceNot checked yet

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Classified as probably not a substantial claim. May combine two claims.

Collection of patients' socio-demographic and clinical data can be used by a mental health specialist or clinical mentoring and supervision of trained health workers remotely.

“One of the features in the app-based clinical guide suggested by the health care workers is collection of patients’ socio-demographic and clinical data which can also be used by a mental health specialist or clinical mentoring and supervision of the trained health workers remotely.”

Probably not a substantial claim: may not pass S3 (load-bearing).

If the mobile app includes a feature of sending reminders to patients for follow-up visits, this could help to minimize the high dropout rate in mental health care.

“Finally, as suggested by health care workers, if the mobile app could include a feature of sending reminders to patients for follow-up visits, this could help to minimize the high dropout rate in mental health care [37].”

• cites [37] Luitel NP, Breuer E, Adhikari A, Kohrt BA, Lund C, Komproe IH, Jordans MJD. Process evaluation of a district mental healthcare plan in Nepal: a mixed-methods case study. BJPsych Open. 2020;6(4):e77. sourceNot checked yet

  Not checked in the free run.