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

doi:10.1016/j.ssmmh.2022.100063

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

SSM Ment Health. 2022 Dec:2:100063. doi: 10.1016/j.ssmmh.2022.100063.

Authors

Ameya P Bondre¹, Ritu Shrivastava¹, Harikeerthan Raghuram¹, Deepak Tugnawat¹, Azaz Khan¹, Snehil Gupta², Mohit Kumar², Urvakhsh Meherwan Mehta³, Matcheri Keshavan⁴, Tanvi Lakhtakia⁴, Prabhat Kumar Chand³, Jagadisha Thirthalli³, Vikram Patel⁵, John Torous⁴, Abhijit R Rozatkar², John A Naslund⁵, Anant Bhan¹

Affiliations

¹ Sangath, 120 Deepak Society, Chuna Bhatti, Bhopal, Madhya Pradesh, 462016, India.
² All India Institute of Medical Sciences (AIIMS), Saket Nagar, Bagh Swaniya, Bhopal, Madhya Pradesh, 462020, India.
³ National Institute of Mental Health and Neurosciences, Hosur Road, Lakkasandra, Wilson Garden, Bengaluru, Karnataka, 560029, India.
⁴ Division of Digital Psychiatry, Beth Israel Deaconess Medical Center (BIDMC), 330 Brookline Ave, Boston, MA, 02215, United States.
⁵ Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, United States.

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.