Abstract
BackgroundIn recent years, a significant change has taken place in the health care delivery systems due to the availability of smartphones and mobile software applications. The use of mobile technology can help to reduce a number of barriers for mental health care such as providers’ workload, lack of qualified personnel, geographical and attitudinal barriers to seek treatment. This study assessed the perception of Nepali primary healthcare workers about the feasibility, acceptability, and benefits of using a mobile app-based clinical guideline for mental health care.MethodA qualitative study was conducted in two districts Chitwan and Ramechhap of Nepal with purposively selected medical officers (n = 8) and prescribing primary healthcare workers (n = 35) who were trained in the World Health Organization mental health Gap Action Program Intervention Guide. Semi-structured interviews and focus group discussions were conducted in Nepali, audio recorded, transcribed and translated into English for data analysis. Data were analysed manually using a thematic analysis approach.ResultsThe majority of the healthcare workers and medical officers reported a high level of interest, motivation and positive attitudes towards the mobile app-based clinical guidelines for detection and treatment of people with mental disorders in primary care. They respondents suggested that several features and functions should be included in the app: suggestive diagnosis and treatment options; clinical data recording system; sending messages to patients to promote follow-up visits; allow offline functions; minimal typing options and content to be available in Nepali language. The study participants reported that the app could help in bringing uniformity in diagnosis and management of mental disorders across all health facilities, enabling remote supervision, helping verification of health workers’ diagnosis and treatment; and increasing patients’ trust in the treatment. Lack of reliable internet connection in health facilities, possibility of distracting interaction between patient and provider, and confidentiality were the key factors potentially hindering the use of the app.ConclusionThe suggested functions and features as well as the potential risk factors highlighted by the health workers, will be considered when further developing the mobile app-based clinical guidelines, training modality and materials, and the supervision system.
Highlights
In recent years, a significant change has taken place in the health care delivery systems due to the availability of smartphones and mobile software applications
They respondents suggested that several features and functions should be included in the app: suggestive diagnosis and treatment options; clinical data recording system; sending messages to patients to promote follow-up visits; allow offline functions; minimal typing options and content to be available in Nepali language
The suggested functions and features as well as the potential risk factors highlighted by the health workers, will be considered when further developing the mobile app-based clinical guidelines, training modality and materials, and the supervision system
Summary
A significant change has taken place in the health care delivery systems due to the availability of smartphones and mobile software applications. Despite the availability of effective treatments for mental illness, there is a huge gap between the number of individuals who need mental health care, and those who receive treatment. The recent World Health Organization (WHO) World Mental Health Survey initiative reported that 86.3% of people with anxiety, mood or substance disorders in low or middle-income countries (LMICs) received no treatment in the past 12 months [1]. A recent study conducted in 21 countries found that only 1-in-27 people living with major depressive disorder in LMICs receives minimally adequate treatment [3]. In 2008, WHO launched the mental health Gap Action Programme (mhGAP) [13], and the Intervention Guides (IG) in 2010, with the aim of providing evidence-based guidance to primary health care workers for detection and treatment of MNS disorders in primary care [14]. Due to the scarcity of mental health specialists in many LMICs, this approach alone may not be adequate to close the substantial mental health treatment gap [17]
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