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Cited by 79Digital Mental Health InterventionsMobile Health and mHealth ApplicationsMental Health Treatment and Access

Is India ready for mental health apps (MHApps)? A quantitative-qualitative exploration of caregivers’ perspective on smartphone-based solutions for managing severe mental illnesses in low resource settings

Open access
Sinha Deb, Koushik, Tuli, Anupriya, Sood, Mamta, Chadda, Rakesh, Verma, Rohit, Kumar, Saurabh, Ganesh, Ragul, Singh, Pushpendra·2018·PLOS ONE
DOI 10.1371/journal.pone.0203353PMC PMC6145572
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Abstract

BACKGROUND: Mobile application based delivery of psycho-social interventions may help reduce the treatment gap for severe mental illnesses (SMIs) and decrease the burden on caregivers. Apps developed in high income settings show effectiveness, but they suffer from lack of applicability in low resource scenarios due to the difference in technology penetration, affordability, and acceptance. OBJECTIVE: This study aimed to understand health technology usage, perceived needs, and acceptability of app based interventions in patients with SMIs to improve illness management and reduce caregiver burden. METHODS: The study was conducted in inpatient and outpatient settings of a tertiary care center in North India. A cross-sectional survey assessed smartphone and health app usage. Further, three focus group discussions evaluated the needs and apprehensions in using apps in management of SMIs. RESULTS: A total of 176 participants including 88 patients and 88 caregivers completed the survey. Smartphone ownership was similar to the national average (30%) in both caregivers (38.6%) and in patients (31.8%). Although subjects regularly used a third party app, health app usage was very low. Cost, unfamiliarity, and language were significant barriers to adoption. The focus group discussions provided insight into the various apprehensions of caregivers in using and in allowing patients to use smartphones and such apps. Caregivers wanted mobile apps for accessing information regarding services and resources available for people with SMI, and they felt such apps can be helpful if they could automate some of their routine caregiving activities. However, the significant difficulty was perceived in regards to the cost of the device, language of the medium, and unfamiliarity in using technology. Apprehensions that SMI patients might misuse technology, or damage the device were also prevalent. CONCLUSIONS: The study systematically looks into the scope, design considerations and limitations of implementing a mobile technology based intervention for low resource settings. With only one-third of the patients and caregivers having access to smartphones and internet, parallel outreach strategies like IVRS should be actively considered while designing interventions. The difficulty of understanding and searching in a non-native language needs to be addressed. Hand holding of caregivers and frequent encouragement from treating doctors might significantly help in technology adoption and in surmounting the apprehensions related to using technology. To make the solution acceptable and useful to the already over-burdened caregivers, developers need to work closely with patients' family members and follow a ground-up collaborative approach to app development. The scope of delivering mental health services through technology is immense in resource constrained settings like India, provided we, researchers, appreciate and accept the fact that in the varied landscape of a divergent economic, educational, and cultural milieu, a single solution will never suffice for all, and intervention modality matching with end user capacity will be of paramount importance in determining the success of the endeavor.

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  • Participants found Otis' short and varied content delivery engaging, congruent with other studies assessing content delivery and user experience.

    “Finally, participants found that Otis’ short and varied content delivery (text, videos, audio, and GIFs) was engaging, which is congruent with other studies assessing the effects of content delivery on overall user experience [56].”

    From A Cognitive Behavioral Therapy Chatbot (Otis) for Health Anxiety Management: Mixed Methods Pilot Study (2022) · cites this paper as [56]

    The Results (Findings from the focus group discussions; page unavailable) report that most participants preferred audiovisual health information because reading text was difficult for many patients. This supports the relevance of delivery format to users’ preferences, but the paper does not assess whether short, varied content improves engagement or overall user experience. (LLM, conf=0.83)

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  • Some participants prefer audio or video options in addition to text-only information.

    “Other factors related to the modality through which content was delivered, with some participants preferring to have audio or video options in addition to text-only information [144]”

    From Barriers to and facilitators of user engagement with digital mental health interventions: Systematic review (2021) · cites this paper as [144]

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Authors
Sinha Deb, K., Tuli, A., Sood, M., Chadda, R., Verma, R., Kumar, S., Ganesh, R., & Singh, P.
Affiliations
  • Indraprastha Institute of Information Technology Delhi (IN)
  • All India Institute of Medical Sciences (IN)
Corresponding author
Singh, Pushpendra
ORCID
Venue
PLOS ONE
Publisher
Public Library of Science (PLoS)
Published
2018-09-19
Volume
13
Issue
9
Pages
e0203353
ISSN
1932-6203 (ISSN-L)
DOI
10.1371/journal.pone.0203353
PMC
PMC6145572
OpenAlex
W2889995635
Cited by
79
References
64
Citations by year
2026: 2 · 2025: 10 · 2024: 18 · 2023: 11 · 2022: 10 · 2021: 6 · 2020: 16 · 2019: 6
FWCI
8.83
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS ONE (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (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)
  • Greater South Information System
Funders
All-India Institute of Medical Sciences
Topics
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
  • Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
Keywords
mental health apps, severe mental illness, caregiver burden, smartphone adoption, resource-limited settings, technology acceptance, barriers to app use, language barriers, interactive voice response, India, treatment gap, access to mental health care
MeSH terms
Smartphone, Adolescent, Adult, Mental Disorders, Female, Health Resources, Humans, India, Male, Mental Health, Mental Health Services, Middle Aged, Surveys and Questionnaires, Caregivers, Focus Groups, Telemedicine, Young Adult, Mobile Applications

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