The George Institute for Global Health, New Delhi, India.
The George Institute for Global Health, Oxford University, Oxford, United Kingdom.
PLoS One. 2016 Oct 12;11(10):e0164404. doi: 10.1371/journal.pone.0164404. eCollection 2016.
Common mental disorders (CMD) such as depression, suicidal risk and emotional/medically unexplained complaints affect a large number of people in India, but few receive appropriate care. Key reasons for this include few trained mental health professionals and stigma associated with mental health. A potential approach to address poor access to care is by training village healthcare workers in providing basic mental health care, and harnessing India's vast mobile network to support such workers using mobile-based applications. We propose an intervention to implement such an approach that incorporates the use of mobile-based electronic decision support systems (EDSS) to provide mental health services for CMD, combined with a community-based anti-stigma campaign. This will be implemented and evaluated across 42 villages in Andhra Pradesh, a south Indian state. This paper discusses the development and testing of the EDSS, and the formative research that informed the anti-stigma campaign.
The development of the EDSS used an iterative process that was validated against clinical diagnosis. A mixed methods approach tested the user acceptability of the EDSS. Focus group discussions and in-depth interviews provided community-level perceptions about mental health. This study involved 3 villages and one primary health centre.
The EDSS application was found to be acceptable, but some modifications were needed. The community lacked adequate knowledge about CMD and its treatment and there was stigma associated with mental illness. Faith and traditional healers were considered to be important mental health service providers.
A number of barriers and facilitators were identified in implementing the intervention analysed in a framework using Andersen's behavioural model of health services use.
The findings assisted with refining the intervention prior to large-scale implementation and evaluation.
常见的精神障碍（CMD），如抑郁、自杀风险和情绪/医学无法解释的抱怨，影响了印度的许多人，但很少有人得到适当的治疗。造成这种情况的主要原因包括心理健康专业人员数量有限，以及心理健康方面的污名化。解决医疗服务可及性差的一个潜在方法是培训乡村医疗工作者提供基本的精神卫生保健，并利用印度庞大的移动网络，通过基于移动的应用程序为这些工作者提供支持。我们提出了一项干预措施，以实施这种方法，包括使用基于移动的电子决策支持系统（EDSS）来提供 CMD 的精神卫生服务，同时开展基于社区的反污名运动。该干预措施将在安得拉邦的 42 个村庄实施和评估。本文讨论了 EDSS 的开发和测试，以及为反污名运动提供信息的形成性研究。
EDSS 的开发采用了一个迭代过程，该过程经过了临床诊断的验证。混合方法测试了 EDSS 的用户可接受性。焦点小组讨论和深入访谈提供了社区对心理健康的看法。本研究涉及 3 个村庄和一个初级保健中心。
EDSS 应用程序被认为是可以接受的，但需要进行一些修改。社区对 CMD 及其治疗缺乏足够的了解，而且存在与精神疾病相关的污名化。信仰和传统治疗师被认为是重要的精神卫生服务提供者。
在使用 Andersen 的卫生服务使用行为模型分析的框架中，确定了实施干预措施的若干障碍和促进因素。
这些发现有助于在大规模实施和评估之前完善干预措施。
