The Systematic Medical Appraisal, Referral and Treatment (SMART) Mental Health Project: development and testing of electronic decision support system and formative research to understand perceptions about mental health in rural India
Open accessAbstract
INTRODUCTION: Common mental disorders (CMD) such as depression, suicidal risk and emotional/medically unexplained complaints affect a large number of people in India, but few receive appropriate care. Key reasons for this include few trained mental health professionals and stigma associated with mental health. A potential approach to address poor access to care is by training village healthcare workers in providing basic mental health care, and harnessing India's vast mobile network to support such workers using mobile-based applications. We propose an intervention to implement such an approach that incorporates the use of mobile-based electronic decision support systems (EDSS) to provide mental health services for CMD, combined with a community-based anti-stigma campaign. This will be implemented and evaluated across 42 villages in Andhra Pradesh, a south Indian state. This paper discusses the development and testing of the EDSS, and the formative research that informed the anti-stigma campaign. MATERIALS AND METHODS: The development of the EDSS used an iterative process that was validated against clinical diagnosis. A mixed methods approach tested the user acceptability of the EDSS. Focus group discussions and in-depth interviews provided community-level perceptions about mental health. This study involved 3 villages and one primary health centre. RESULTS: The EDSS application was found to be acceptable, but some modifications were needed. The community lacked adequate knowledge about CMD and its treatment and there was stigma associated with mental illness. Faith and traditional healers were considered to be important mental health service providers. DISCUSSION: A number of barriers and facilitators were identified in implementing the intervention analysed in a framework using Andersen's behavioural model of health services use. CONCLUSION: The findings assisted with refining the intervention prior to large-scale implementation and evaluation.
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In SMART, community health workers called Accredited Social Health Activists and primary care doctors were trained to screen, diagnose, and manage common mental disorders using an electronic decision support system.
“In this project, community health workers referred to as Accredited Social Health Activists (ASHAs) and primary care doctors were trained to screen, diagnose and manage common mental disorders using an electronic decision support system.28,29”
From Digital Technology for Building Capacity of Nonspecialist Health Workers for Task Sharing and Scaling Up Mental Health Care Globally (2019) · cites this paper as [29]
The SMART Mental Health project in Andhra Pradesh, India, used task-sharing and mobile technology to support primary care health workers in providing evidence-based mental health care in remote villages.
“The Systematic Medical Appraisal Referral and Treatment (SMART) Mental Health project involved task-sharing and use of mobile technology to support primary care health workers in providing evidence-based mental health care in remote villages in Andhra Pradesh, India.”
From Digital Technology for Building Capacity of Nonspecialist Health Workers for Task Sharing and Scaling Up Mental Health Care Globally (2019) · cites this paper as [29]
In SMART, individuals increased their use of mental health services following screening and referral to primary care doctors.
“A key finding was that individuals increased their use of mental health services following screening and referral to the primary care doctor.31”
From Digital Technology for Building Capacity of Nonspecialist Health Workers for Task Sharing and Scaling Up Mental Health Care Globally (2019) · cites this paper as [31]
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- Authors
- Maulik, P. K., Tewari, A., Devarapalli, S., Kallakuri, S., & Patel, A.
- Affiliations
- The George Institute for Global Health (GB)
- George Institute for Global Health (IN)
- The University of Sydney (AU)
- Corresponding author
- Maulik, Pallab K
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2016-10-12
- Volume
- 11
- Issue
- 10
- Pages
- e0164404
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC5061375
- OpenAlex
- W2530046471
- Cited by
- 58
- References
- 21
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 1 · 2023: 2 · 2022: 10 · 2021: 17 · 2020: 6 · 2019: 7 · 2018: 5 · 2017: 3 · 2016: 1
- FWCI
- 8.37
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- The Sydney eScholarship Repository (The University of Sydney) (submittedVersion, cc-by)
- UNSWorks (University of New South Wales, Sydney, Australia) (submittedVersion, cc-by)
- Funders
- Wellcome Trust/Department of Biotechnology India Alliance Fellowship (IA/I/13/1/500879)
- Grand Challenges Canada (0524-01-10)
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Physical Sciences › Computer Science › Information Systems › ICT in Developing Communities
- Keywords
- decision support system, common mental disorders, mental health stigma, mobile health, community mental health services, anti-stigma campaigns, user acceptance, faith healers, Andersen Behavioral Model, rural mental health services, Andhra Pradesh
- MeSH terms
- Adult, Aged, Attitude to Health, Mental Disorders, Community Health Workers, Culture, Female, Humans, India, Male, Mental Health, Mental Health Services, Middle Aged, Residence Characteristics, Rural Population, Focus Groups, Decision Support Systems, Clinical, Young Adult, Social Stigma, Mobile Applications
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