Can Mobile Health Improve Depression Treatment Access and Adherence Among Rural Indian Women? A Qualitative Study
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Can Mobile Health Improve Depression Treatment Access and Adherence Among Rural Indian Women? A Qualitative Study A. Bhat1 • B. Ramakrishna Goud2 • J. R. Pradeep3 • G. Jayaram4 • R. Radhakrishnan5,6 • K. Srinivasan3,7
Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Major Depressive Disorder (MDD) is associated with low rates of treatment and medication non-adherence, more so in low- and middle-income countries (LMICs). Mobile mental health (mHealth) interventions offer promise as a tool to address these problems. However, the feasibility and acceptability of mHealth interventions among rural women in LMICs is unknown. We examined barriers to accessing mental health treatment, reasons for non-adherence, and attitudes towards mHealth solutions among women with MDD in rural south India. Six focus groups were conducted among women with MDD (n = 69) who had been in treatment at a rural community health center. The discussion was transcribed and analyzed using a modified grounded-theory approach. Women perceived limited autonomy within their family structure, and experienced financial and systemic barriers as contributing to poor treatment access and non-adherence. Illiteracy, limited personal access to mobile phones, and preference for in-person clinical consultation were identified as barriers to use of mHealth. This is the first qualitative study, to our knowledge, that examines attitude towards mHealth among women R. Radhakrishnan and K. Srinivasan are shared last-authorship. & A. Bhat [email protected] 1
Department of Psychiatry and Behavioral Sciences, University of Washington, NE Pacific Street, 1959, Seattle, WA 98052, USA
2
Department of Community Health, St John’s Medical College, Bengaluru, India
3
Department of Psychiatry, St John’s Medical College Hospital, Bengaluru, India
4
Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA
5
Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
6
Yale Institute for Global Health, Yale University, New Haven, CT, USA
7
Division of Mental Health and Neurosciences, St Johns Research Institute, Bengaluru, India
123
Cult Med Psychiatry
with MDD in a rural setting in India. The study identified contextual barriers that will be important to address before implementing mHealth interventions. Keywords Mobile mental health Depression Non-adherence Global mental health Qualitative study
Introduction Depressive disorders are the second-leading cause of disability worldwide (Ferrari et al. 2013) and contribute to mortality associated with suicide and cardiovascular disease (Ferrari et al. 2013; Whiteford and Baxter 2013). About three-quarters of the global burden of neuropsychiatric disorders is in low- and middle-income countries (LMICs), yet most patients (76–85%) in these countries receive no treatment (World Health Organization 2010). In India, according to the National Mental Health Survey (Gururaj et al. 2016), the treatment gap for mental health problems (defi
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