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Increasing use of mental health services in remote areas using mobile technology: a pre-post evaluation of the SMART Mental Health project in rural India
Open accessAbstract
BACKGROUND: About 25% of the Indian population experience common mental disorders (CMD) but only 15-25% of them receive any mental health care. Stigma, lack of adequate mental health professionals and mental health services account for this treatment gap, which is worse in rural areas. Our project evaluated task shifting and mobile-technology based electronic decision support systems to enhance the ability of primary care health workers to provide evidence-based mental health care for stress, depression, and suicidal risk in 30 remote villages in the state of Andhra Pradesh, India. METHODS: The Systematic Medical Appraisal Referral and Treatment (SMART) Mental Health project between May 2014 and April 2016 trained lay village health workers (Accredited Social Health Activists - ASHAs) and primary care doctors to screen, diagnose and manage individuals with common mental disorders using an electronic decision support system. An anti-stigma campaign using multi-media approaches was conducted across the villages at the outset of the project. A pre-post evaluation using mixed methods assessed the change in mental health service utilization by screen positive individuals. This paper reports on the quantitative aspects of that evaluation. RESULTS: Training was imparted to 21 ASHAs and 2 primary care doctors. 5007 of 5167 eligible individuals were screened, and 238 were identified as being positive for common mental disorders and referred to the primary care doctors for further management. Out of them, 2 (0.8%) had previously utilized mental health services. During the intervention period, 30 (12.6%) visited the primary care doctor for further diagnosis and treatment, as advised. There was a significant reduction in the depression and anxiety scores between start and end of the intervention among those who had screened positive at the beginning. Stigma and mental health awareness in the broader community improved during the project. CONCLUSIONS: The intervention led to individuals being screened for common mental disorders by village health workers and increase in mental health service use by those referred to the primary care doctor. The model was deemed feasible and acceptable. The effectiveness of the intervention needs to be demonstrated using more robust randomized controlled trials, while addressing the issues identified that will facilitate scale up.
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“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 [28]
In the citing paper
“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 [28]
In the citing paper
“This mobile decision support system was developed for use on basic Android devices, and used an OpenMRS platform allowing community health workers and primary care doctors to share clinical data securely using the cloud-based servers.28”
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 [28]
In the citing paper
“During this time, over 5000 patients were screened for common mental disorders of which 238 were identified as being positive and were referred to the primary care doctors for treatment.”
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 [28]
In the citing paper
“Pre-recorded messages were also sent to individuals who screened positive to promote adherence and continuation of care as recommended by the community health workers and primary care doctors.”
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 [28]
In the citing paper
“and a reduction in anxiety measured using the 7-item Generalized Anxiety Disorder (GAD-7) questionnaire (adjusted mean difference in GAD-7, −1.3; SE = 0.4; P = 0.004).28”
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 [28]
In the citing paper
“The SMART program supported with mobile technology was considered both feasible and acceptable for use in this rural setting.”
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 [28]
In the citing paper
“At 3-months follow up, there was a reduction in depression measured using the PHQ-9 (adjusted mean difference in PHQ-9, −3.6; SE = 0.6; P < 0.001)”
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 [28]
In the citing paper
“As part of the program, 21 community health workers and two primary care doctors were trained over a two-year period across 30 villages.”
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 [28]
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“…delivery by lay health worker Cultural and Linguistic Competence of care providers Integrated care LGBTQIA+population [37 ,47,48] Competency [6, 39,51,52] Digital Mental Health Interventions Integration of mental health care with primary care Task shifting and training primary care health workers…”
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“…most prominent in somatic health care (Norwegian Centre for E-health Research, 2023; University of Agder, 2023; van Gemert-Pijnen et al., 2013; Zulman et al., 2015); however, new technology is also being used in mental health care (Areán et al., 2016; Biagianti et al., 2017; Maulik et al., 2017).”
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Luitel, N. P. (2023) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2023.69.pr1
(2024) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2024.35.pr5
(2024) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2024.35.pr6
(2024) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2024.35.pr3
Metadata
- Authors
- Maulik, P. K., Kallakuri, S., Devarapalli, S., Vadlamani, V. K., Jha, V., & 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
- Journal of Global Health
- Published
- 2017-03-18
- Volume
- 7
- Issue
- 1
- Pages
- 010408-010408
- ISSN
- 2047-2978 (ISSN-L)
- 2047-2986
- PMC
- PMC5370210
- OpenAlex
- W2603376457
- Cited by
- 125
- References
- 35
- Citations by year
- 2026: 7 · 2025: 14 · 2024: 14 · 2023: 20 · 2022: 11 · 2021: 32 · 2020: 10 · 2019: 9 · 2018: 7 · 2017: 1
- FWCI
- 10.57
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Journal of Global Health (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- UNSWorks (UNSW Sydney) (submittedVersion, cc-by-nc-nd)
- Spiral (Imperial College London) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › 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
- mental health service utilization, common mental disorders, task shifting, electronic decision support, mobile health, Accredited Social Health Activists, primary care, mental health screening, mental health stigma, anti-stigma campaigns, depression, anxiety, suicide risk, rural India, Andhra Pradesh
- MeSH terms
- Adult, Anxiety, Awareness, Mental Disorders, Community Health Workers, Depression, Female, Humans, India, Male, Mass Screening, Mental Health Services, Middle Aged, Primary Health Care, Referral and Consultation, Rural Population, Outcome Assessment, Health Care, Social Stigma, Mobile Applications
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