title: The Systematic Medical Appraisal, Referral and Treatment (SMART) Mental Health Project: Development and Testing of Electronic Decision Support System and Formative Research to Understand Perceptions about Mental Health in Rural India.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  The findings assisted with refining the intervention prior to large-scale implementation and evaluation.
authors.affiliation: The George Institute for Global Health, New Delhi, India.|The George Institute for Global Health, Oxford University, Oxford, United Kingdom.
authors.forename: Pallab K
authors.initials: PK
authors.lastname: Maulik
authors.affiliation: The George Institute for Global Health, New Delhi, India.
authors.forename: Abha
authors.initials: A
authors.lastname: Tewari
authors.affiliation: The George Institute for Global Health, New Delhi, India.
authors.forename: Siddhardha
authors.initials: S
authors.lastname: Devarapalli
authors.affiliation: The George Institute for Global Health, New Delhi, India.
authors.forename: Sudha
authors.initials: S
authors.lastname: Kallakuri
authors.affiliation: The George Institute for Global Health, Sydney, Australia.|Department of Medicine, University of Sydney, Sydney, Australia.
authors.forename: Anushka
authors.initials: A
authors.lastname: Patel
mesh_terms: D000328:Adult; D000368:Aged; D001294:Attitude to Health; D003150:Community Health Workers / Q000193:education*; D003469:Culture; D020000:Decision Support Systems, Clinical; D005260:Female; D017144:Focus Groups; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D008603:Mental Health; D008605:Mental Health Services; D008875:Middle Aged; D063731:Mobile Applications; D012111:Residence Characteristics; D012424:Rural Population; D057545:Social Stigma; D055815:Young Adult