A qualitative exploration of perceived needs and barriers of individuals with schizophrenia, caregivers and clinicians in using mental health applications in Madhya Pradesh, India

Ameya P Bondre, Ritu Shrivastava, Harikeerthan Raghuram, Deepak Tugnawat, Azaz Khan, Snehil Gupta, Mohit Kumar, Urvakhsh Meherwan Mehta, Matcheri Keshavan, Tanvi Lakhtakia, Prabhat Kumar Chand, Jagadisha Thirthalli, Vikram Patel, John Torous, Abhijit R Rozatkar, John A Naslund, Anant Bhan, Ameya P Bondre, Ritu Shrivastava, Harikeerthan Raghuram, Deepak Tugnawat, Azaz Khan, Snehil Gupta, Mohit Kumar, Urvakhsh Meherwan Mehta, Matcheri Keshavan, Tanvi Lakhtakia, Prabhat Kumar Chand, Jagadisha Thirthalli, Vikram Patel, John Torous, Abhijit R Rozatkar, John A Naslund, Anant Bhan

Abstract

Introduction: About 3.5 million people are living with schizophrenia in India, with most failing to receive minimally adequate care. Digital mental health applications could potentially decrease this treatment gap; however, these applications should be tailored to meet the needs and overcoming barriers of its end-users to ensure their adoption and sustained usage. Few studies in India have explored the perspectives of target stakeholders to understand how digital tools could be viable for supporting care. Therefore, this study explores the perceived needs and barriers of patients with schizophrenia, caregivers and clinicians in using digital mental health applications.

Methods: Focus group discussions (FGDs) were conducted with patients having schizophrenia attending outpatient clinics at a government tertiary hospital, and their caregivers, and mental health clinicians in Bhopal, Madhya Pradesh, India. FGDs were audio-recorded and coded. Framework analysis was employed to guide the analysis, involving deductive and inductive generation of themes, data triangulation and comparison of perspectives between participant groups.

Results: Six FGDs were conducted with individuals with schizophrenia (n ​= ​11), their caregivers (n ​= ​14), and mental health clinicians (n ​= ​19). Four a priori themes were established: a) Prior experiences with health applications; b) Content of a mental health application; c) Involvement of caregivers in mental health application usage and d) Supporting doctors' work through mental health applications. Additionally, two themes were generated inductively: a) Qualities of a mental health application and b) Data privacy and confidentiality.

Conclusion: Exploration of stakeholder perspectives on the content, features, and uses of mental health applications is crucial to yield initial insights about the use of these digital programs in India. This study generated a multitude of suggestions on app functionality and components, which can guide ongoing efforts to develop and deliver digital mental health applications for patients living with schizophrenia in low-resource settings, with limited access to mental health services.

Keywords: Digital health; Global mental health; LMIC; Low-resource setting; Mental health; Qualitative; Schizophrenia; Smartphone application; mHealth.

Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

© 2022 The Authors.

Figures

Fig. A.1
Fig. A.1
Themes and Subthemes for Analysis. Note: Deductive themes were based on the FGD guide and inductive themes emerged in the course of data analysis. Taken together, they provided perspectives on needs and barriers in using mental health applications among patients, caregivers and clinicians.

References

    1. Acocella I. The focus groups in social research: Advantages and disadvantages. Quality and Quantity. 2012;46:1125–1136. doi: 10.1007/s11135-011-9600-4.
    1. Aggarwal N.K. Applying mobile technologies to mental health service delivery in South Asia. Asian Journal Of Psychiatry. 2012;5:225–230. doi: 10.1016/j.ajp.2011.12.009.
    1. Balamurugan G., Radhakrishnan G., Vijayarani M. Models and roles in national mental health programme. Indian Journal Of Psychiatry Nursing. 2019;16:52–54. doi: 10.4103/IOPN.IOPN_18_19.
    1. Ben-Zeev D., Kaiser S.M., Brenner C.J., Begale M., Duffecy J., Mohr D.C. Development and usability testing of FOCUS: A smartphone system for self-management of schizophrenia. Psychiatric Rehabilitation Journal. 2013;36:289–296.
    1. Berry N., Bucci S., Lobban F. Use of the internet and mobile phones for self-management of severe mental health problems: Qualitative study of staff views. JMIR Mental Health. 2017;4:e52. doi: 10.2196/mental.8311.
    1. Bucci S., Berry N., Morris R., Berry K., Haddock G., Lewis S., Edge D. “They are not hard-to-reach clients. We have just got hard-to-reach services.” staff views of digital health tools in specialist mental health services. Frontiers in Psychiatry. 2019;10:1–14. doi: 10.3389/fpsyt.2019.00344.
    1. Carter H., Araya R., Anjur K., Deng D., Naslund J.A. The emergence of digital mental health in low-income and middle-income countries: A review of recent advances and implications for the treatment and prevention of mental disorders. Journal of Psychiatric Research. 2021;133:223–246. doi: 10.1016/j.jpsychires.2020.12.016.
    1. Chakrabarti S. Research on family caregiving for mental illness in India and its impact on clinical practice: Are we doing enough to help families? Indian Journal of Social Psychiatry. 2016;32:19–24. doi: 10.4103/0971-9962.176762.
    1. Chancellor S., Birnbaum M.L., Caine E.D., Silenzio V.M.B., De Choudhury M. Proceedings of the conference on fairness, accountability, and transparency. 2019. A taxonomy of ethical tensions in inferring mental health states from social media; pp. 79–88.
    1. Chang L.W., Njie-Carr V., Kalenge S., Kelly J.F., Bollinger R.C., Alamo-Talisuna S. Perceptions and acceptability of mHealth interventions for improving patient care at a community-based HIV/AIDS clinic in Uganda: A mixed methods study. AIDS Care. 2013;25:874–880. doi: 10.1080/09540121.2013.774315.
    1. Gagnon M.P., Ngangue P., Payne-Gagnon J., Desmartis M. m-Health adoption by healthcare professionals: a systematic review. Journal of the American Medical Informatics Association. 2015;23:212–220. doi: 10.1093/jamia/ocv052.
    1. GBD 2017 Disease and injury incidence and prevalence collaborators, global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: A systematic analysis for the global burden of Disease study 2017. The Lancet. 2018;392:1789–1858. doi: 10.1016/S0140-6736(18)32279-7.
    1. Gonsalves P.P., Hodgson E.S., Bhat B., Sharma R., Jambhale A., Michelson D., Patel V. App-based guided problem-solving intervention for adolescent mental health: A pilot cohort study in Indian schools. Evidence-Based Mental Health. 2021;24:11–18. doi: 10.1136/ebmental-2020-300194.
    1. Hahn R.A., Inhorn M.C. Oxford University Press; Oxford: 2009. Anthropology and public health: Bridging differences in culture and society.
    1. Hoffman L., Wisniewski H., Hays R., Henson P., Vaidyam A., Hendel V., Keshavan M., Torous J. Digital opportunities for outcomes in recovery services (DOORS): A pragmatic hands-on group Approach toward increasing digital health and smartphone competencies, autonomy, relatedness, and alliance for those with serious mental illness. Journal of Psychiatric Practice. 2020;26:80–88. doi: 10.1097/PRA.0000000000000450.
    1. Irwin T.E., Nordstrom S.K., Pyra M. O326 Acceptability of mobile phone technology for tracking cervical cancer in rural Guatemala. International Journal of Gynecology & Obstetrics. 2012;119:S375–S376. doi: 10.1016/S0020-7292(12)60756-5.
    1. Joshi A., Rane M., Roy D., Emmadi N., Srinivasan P., Kumarasamy N., Pujari S., Solomon D., Rodrigues R., Saple D.G., Sen K., Veldeman E., Rutten R. Proceedings of the SIGCHI conference on human factors in computing systems. CHI’14. ACM; New York, NY, USA: 2014. Supporting treatment of people living with HIV/AIDS in resource limited settings with IVRs; pp. 1595–1604.
    1. Kannisto K.A., Adams C.E., Koivunen M., Katajisto J., Välimäki M. Feedback on SMS reminders to encourage adherence among patients taking antipsychotic medication: A cross-sectional survey nested within a randomised trial. BMJ Open. 2015;5 doi: 10.1136/bmjopen-2015-008574.
    1. Kennedy J.L., Altar C.A., Taylor D.L., Degtiar I., Hornberger J.C. The social and economic burden of treatment-resistant schizophrenia: A systematic literature review. International Clinical Psychopharmacology. 2014;29:63–76.
    1. Kermode M., Bowen K., Arole S., Joag K., Jorm A.F. Community beliefs about treatments and outcomes of mental disorders: A mental health literacy survey in a rural area of Maharashtra, India. Public Health. 2009;123:476–483. doi: 10.1016/j.puhe.2009.06.004.
    1. Kishore J., Gupta A., Jiloha R., Bantman P. Myths, beliefs and perceptions about mental disorders and health-seeking behavior in Delhi, India. Indian Journal of Psychiatry. 2011;53:324–329. 10.4103/0019-5545.91906 PMID: 22303041.
    1. Kleine-Budde K., Touil E., Moock J., Bramesfeld A., Kawohl W., Rössler W. Cost of illness for bipolar disorder: A systematic review of the economic burden. Bipolar Disorders. 2014;16:337–353.
    1. Kokane A., Pakhare A., Gururaj G., Varghese M., Benegal V., Rao G.N., Arvind B., Shukla M., Mitra A., Yadav K., Chatterji R., Ray S., Singh A.R. Mental health issues in Madhya Pradesh: Insights from national mental health survey of India 2016. Healthcare (Basel) 2019;7:1–12. doi: 10.3390/healthcare7020053. PMID: 30935112; PMCID: PMC6627290.
    1. Krueger R.A. Sage publications; New York: 2014. Focus groups: A practical guide for applied research.
    1. Lahariya C. Strengthen mental health services for universal health coverage in India. Journal of Postgraduate Medicine. 2018;64:7–9. 10.4103%2Fjpgm.JPGM_185_17.
    1. Larsen M.E., Huckvale K., Nicholas J., Torous J., Birrell L., Li E., Reda B. Using science to sell apps: Evaluation of mental health app store quality claims. NPJ Digit Med. 2019;2:1–6. doi: 10.1038/s41746-019-0093-1.
    1. Leggatt M. Families and mental health workers: The need for partnership. World Psychiatry. 2002;1:52–54. PMID: 16946824.
    1. Lund C., Tomlinson M., De Silva M., Fekadu A., Shidhaye R., Jordans M., Petersen I., Bhana A., Kigozi F., Prince M., Thornicroft G., Hanlon C., Kakuma R., McDaid D., Saxena S., Chisholm D., Raja S., KippenWood S., Honikman S., Fairall L., Patel V. PRIME: A programme to reduce the treatment gap for mental disorders in five low- and middle-income countries. PLoS Medicine. 2012;9:1–6. doi: 10.1371/journal.pmed.1001359.
    1. Mahmud N., Rodriguez J., Nesbit J. A text message-based intervention to bridge the healthcare communication gap in the rural developing world. Technology and Health Care. 2010;18:137–144. doi: 10.3233/THC-2010-0576.
    1. McCurdie T., Taneva S., Casselman M., Yeung M., McDaniel C., Ho W., Cafazzo J. mHealth consumer apps: the case for user-centered design. Biomedical Instrumentation & Technology. 2012;49–56 doi: 10.2345/0899-8205-46.s2.49.
    1. Merchant R., Torous J., Rodriguez-Villa E., Naslund J.A. Digital technology for management of severe mental disorders in low-income and middle-income countries. Current Opinion in Psychiatry. 2020;33:501–507. doi: 10.1097/YCO.0000000000000626.
    1. Ministry of home Affairs. Government of India; 2011. Available from:
    1. Mueser K.T., Deavers F., Penn D.L., Cassisi J.E. Psychosocial treatments for schizophrenia. Annual Review of Clinical Psychology. 2013;9:465–497.
    1. Muke S.S., Tugnawat D., Joshi U., Anand A., Khan A., Shrivastava R., Singh A., Restivo J.L., Bhan A., Patel V., Naslund J.A. Digital training for non-specialist health workers to deliver a brief psychological treatment for depression in primary care in India: Findings from a randomized pilot study. International Journal of Environmental Research and Public Health. 2020;17:6368. doi: 10.3390/ijerph17176368.
    1. Naslund J.A., Marsch L.A., McHugo G.J., Bartels S.J. Emerging mHealth and eHealth interventions for serious mental illness: A review of the literature. Journal of Mental Health. 2015;24:321–332. doi: 10.3109/09638237.2015.1019054.
    1. Nicholas J., Larsen M.E., Proudfoot J., Christensen H. Mobile apps for bipolar disorder: A systematic review of features and content quality. Journal of Medical Internet Research. 2015;17:e198. doi: 10.2196/jmir.4581.
    1. Patel V., Xiao S., Chen H., Hanna F., Jotheeswaran A.T., Luo D., Parikh R., Sharma E., Usmani S., Yu Y., Druss B.G. The magnitude of and health system responses to the mental health treatment gap in adults in India and China. The Lancet. 2016;388:3074–3084. doi: 10.1016/S0140-6736(16)00160-4.
    1. QSR International . 1999. NVivo qualitative data analysis software. [Software]. Version 12.
    1. Rathod S., Pinninti N., Irfan M., Gorczynski P., Rathod P., Gega L., Naeem F. Mental health service provision in low-and middle-income countries. Health Services. 2017;10:1–7. doi: 10.1177/1178632917694350.
    1. Ritchie J., Lewis J., Nicholls C.M., Ormston R. 2nd ed. Sage publications; London: 2003. Qualitative research practice: A guide for social science students and researchers.
    1. Robotham D., Satkunanathan S., Doughty L., Wykes T. Do we still have a digital divide in mental health? A five-year survey follow-up. Journal of Medical Internet Research. 2016;18:e309. doi: 10.2196/jmir.6511.
    1. Rodriguez-Villa E., Mehta U.M., Naslund J., Tugnawat D., Gupta S., Thirtalli J., Bhan A., Patel V., Chand P.K., Rozatkar A., Keshavan M., Torous J. Smartphone health assessment for relapse prevention (SHARP): A digital solution toward global mental health. British Journal of Psychiatry Open. 2021;7:1–7. doi: 10.1192/bjo.2020.142.
    1. Rodriguez-Villa E., Rozatkar A.R., Kumar M., Patel V., Bondre A., Naik S.S., Dutt S., Mehta U.M., Nagendra S., Tugnawat D., Shrivastava R., Raghuram H., Khan A., Naslund J.A., Gupta S., Bhan A., Thirthalli J., Chand P.K., Lakhtakia T., Kesavan M., Torous J. Cross cultural and global uses of a digital mental health app: Results of focus groups with clinicians, patients and family members in India and the United States. Global Mental Health. 2021;8:1–10. doi: 10.1017/gmh.2021.28.
    1. Sagar R., Dandona R., Gururaj G., Dhaliwal R.S., Singh A., Ferrari A., Dua T., Ganguli A., Varghese M., Chakma J.K., Kumar G.A. The burden of mental disorders across the states of India: The global burden of Disease study 1990–2017. The Lancet Psychiatry. 2020;7:148–161. doi: 10.1016/S2215-0366(19)30475-4.
    1. Saunders B., Sim J., Kingstone T., Baker S., Waterfield J., Bartlam B., Burroughs H., Jinks C. Saturation in qualitative research: Exploring its conceptualization and operationalization. Quality and Quantity. 2008;52:1893–1907. doi: 10.1007/s11135-017-0574-8.
    1. Shidhaye R., Lyngdoh T., Murhar V., Samudre S., Krafft T. Predictors, help-seeking behaviour and treatment coverage for depression in adults in Sehore district, India. British Journal of Psychiatry Open. 2017;3:212–222. doi: 10.1192/bjpo.bp.116.004648.
    1. Sinclair C., Holloway K., Riley G., Auret K. Online mental health resources in rural Australia: Clinician perceptions of acceptability. Journal of Medical Internet Research. 2013;15:e193. doi: 10.2196/jmir.2772.
    1. Sinha D.K., Tuli A., Sood M., Chadda R., Verma R., Kumar S., Ganesh R., Singh P. 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. PLoS One. 2018;13 doi: 10.1371/journal.pone.0203353.
    1. Somaiya M., Grover S., Chakrabarti S., Avasthi A. Comparative study of cost of care of outpatients with bipolar disorder and schizophrenia. Asian Journal Of Psychiatry. 2014;12:125–133.
    1. Srivastava K., Chatterjee K., Bhat P.S. Mental health awareness: The Indian scenario. Industrial Psychiatry Journal. 2016;25:131–134.
    1. Telecom Regulatory Authority of India . 2016. Highlights of telecom subscription data as on 31st may. 2016.
    1. Toefy Y., Skinner D., Thomsen S. “Please Don’t Send Us Spam!” A participative, theory-based methodology for developing an mHealth intervention. JMIR MHealth UHealth. 2016;4:e100.
    1. Valaitis R.K., O’Mara L.M. Public health nurses’ perceptions of mobile computing in a school program. Computers, Informatics, Nursing. 2005;23:153–160. doi: 10.1097/00024665-200505000-00011.
    1. World Health Organization . 1992. The ICD-10 classification of mental and behavioural disorders: Clinical descriptions and diagnostic guidelines.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir