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

Abstract

Background Despite significant advancements in healthcare technology, digital health solutions – especially those for serious mental illnesses – continue to fall short of their potential across both clinical practice and efficacy. The utility and impact of medicine, including digital medicine, hinges on relationships, trust, and engagement, particularly in the field of mental health. This paper details results from Phase 1 of a two-part study that seeks to engage people with schizophrenia, their family members, and clinicians in co-designing a digital mental health platform for use across different cultures and contexts in the United States and India. Methods Each site interviewed a mix of clinicians, patients, and their family members in focus groups (n = 20) of two to six participants. Open-ended questions and discussions inquired about their own smartphone use and, after a demonstration of the mindLAMP platform, specific feedback on the app's utility, design, and functionality. Results Our results based on thematic analysis indicate three common themes: increased use and interest in technology during coronavirus disease 2019 (COVID-19), concerns over how data are used and shared, and a desire for concurrent human interaction to support app engagement. Conclusion People with schizophrenia, their family members, and clinicians are open to integrating technology into treatment to better understand their condition and help inform treatment. However, app engagement is dependent on technology that is complementary – not substitutive – of therapeutic care from a clinician.

TreadWill: Development and pragmatic randomized controlled trial of an unguided, computerized cognitive behavioral therapy intervention in a lower middle-income country

“…Our study establishes TreadWill as a potential population-level intervention. This is among the largest studies conducted in India on digital mental health (Kanuri et al, 2020;Mehrotra et al, 2018;Rodriguez-Villa et al, 2021;Srivastava et al, 2020). Our study is also the first fully online trial conducted in India and provides a template for conducting online trials for other mental health conditions in the country.…”

Schizophrenia Assessment, Referral and Awareness Training for Health Auxiliaries (SARATHA): Protocol for a Mixed-Methods Pilot Study in Rural India

“…Sangath is now leading the National Institute of Mental Health (NIMH) funded ESSENCE (Enabling translation of Science to Service to Enhance Depression Care) project, supported by a Memorandum of Understanding with the National Health Systems Resource Centre (NHSRC), Government of India and Department of Public Health and Family Welfare, Government of Madhya Pradesh, a major component of which seeks to leverage digital technology for building capacity of community health workers in treating common mental disorders in primary care settings [ 30 ]. More recently, Sangath has been collaborating with Beth Israel Deaconess Medical Center and Harvard Medical School in the United States, and AIIMS Bhopal and NIMHANS in India to support an effort aimed at leveraging smartphone technology for digital phenotyping in patients with schizophrenia as part of the SHARP (Smartphone Health Assessment for Relapse Prevention) project [ 31 , 32 , 33 , 34 , 35 ]. The SARATHA project builds on these prior and ongoing efforts, and involves recruiting community health workers from primary healthcare facilities in the Sehore district who are already enrolled in other ongoing training activities [ 30 ].…”

Time to Have Effective Regulation of the Mental Health Apps Market: Maximize Gains and Minimize Harms

“…In a recent study exploring the views of general people and health professionals in India about using MHapps, both the groups expressed concern about their data safety and privacy. 24 Furthermore, the policy of linking the unique identity number (i.e., Aadhaar) with digital health records as a mandatory requirement to avail benefits under a government program for tuberculosis and Acquired Immunodeficiency Syndrome (AIDS) resulted in a significant proportion of beneficiaries to drop-out, possibly because of the fear of unintended breach of privacy and sharing of sensitive health-related information and subsequent discrimination. 25 Both these health conditions are considered highly stigmatizing, like mental illness, in Indian society.…”

“…The limited available literature qualitatively exploring the transcultural differences in uptake and response to mobile-delivered digital mental health interventions in the Indian context points out some encouraging similarities and important differences from the western context. 24 , 26 The majority had a positive response toward the use of MHapps for a multitude of things, such as seeking reliable information related to the mental health disorder symptoms, its treatment, and practical aspects (e.g., help in accessing local resources, such as ambulance or legal services); self-monitoring of symptoms; or providing reminders for taking medications and doing daily routine activities (e.g., self-care-related tasks). However, most of the Indian users endorsed the use of MHapps as complementary and not substitutive to direct therapeutic care provided by mental health professionals.…”