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      Mobile Mental Health in Women’s Community-Based Organizations: Protocol for a Pilot Randomized Controlled Trial

      , MD, MPH 1 , , , MD, MSc, MBA 2 , , BAMS, MPH 3 , , MBBS, MD 2 , 3 , , BDS, MBA 3 , , MBBS, ADB, MBA 3 , , MD, MPH 1 , 4 , , MBBS, MD 3 , , MBBS, MD 2 , 3
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      JMIR Research Protocols
      JMIR Publications
      mobile mental health, women, community-based, depression, rural, stepped care

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          Of every 10 women in rural India, 1 suffers from a common mental disorder such as depression, and untreated depression is associated with significant morbidity and mortality. Several factors lead to a large treatment gap, specifically for women in rural India, including stigma, lack of provider mental health workforce, and travel times. There is an urgent need to improve the rates of detection and treatment of depression among women in rural India without overburdening the scarce mental health resources.


          We propose to develop, test, and deploy a mental health app, MITHRA (Multiuser Interactive Health Response Application), for depression screening and brief intervention, designed for use in women’s self-help groups (SHGs) in rural India.


          We will use focus groups with SHG members and community health workers to guide the initial development of the app, followed by iterative modification based on input from a participatory design group consisting of proposed end users of the app (SHG members). The final version of the app will then be deployed for testing in a pilot cluster randomized trial, with 3 SHGs randomized to receive the app and 3 to receive enhanced care as usual.


          This study was funded in June 2021. As of September 2022, we have completed both focus groups, 1 participatory design group, and app development.


          Delivering app-based depression screening and treatment in community settings such as SHGs can address stigma and transportation-related barriers to access to depression care and overcome cultural and contextual barriers to mobile health use. It can also address the mental health workforce shortage. If we find that the MITHRA approach is feasible, we will test the implementation and effectiveness of MITHRA in multiple SHGs across India in a larger randomized controlled trial. This approach of leveraging community-based organizations to improve the reach of depression screening and treatment is applicable in rural and underserved areas across the globe.

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          Most cited references44

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          Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010

          The Lancet, 382(9904), 1575-1586
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            Acceptability of healthcare interventions: an overview of reviews and development of a theoretical framework

            Background It is increasingly acknowledged that ‘acceptability’ should be considered when designing, evaluating and implementing healthcare interventions. However, the published literature offers little guidance on how to define or assess acceptability. The purpose of this study was to develop a multi-construct theoretical framework of acceptability of healthcare interventions that can be applied to assess prospective (i.e. anticipated) and retrospective (i.e. experienced) acceptability from the perspective of intervention delivers and recipients. Methods Two methods were used to select the component constructs of acceptability. 1) An overview of reviews was conducted to identify systematic reviews that claim to define, theorise or measure acceptability of healthcare interventions. 2) Principles of inductive and deductive reasoning were applied to theorise the concept of acceptability and develop a theoretical framework. Steps included (1) defining acceptability; (2) describing its properties and scope and (3) identifying component constructs and empirical indicators. Results From the 43 reviews included in the overview, none explicitly theorised or defined acceptability. Measures used to assess acceptability focused on behaviour (e.g. dropout rates) (23 reviews), affect (i.e. feelings) (5 reviews), cognition (i.e. perceptions) (7 reviews) or a combination of these (8 reviews). From the methods described above we propose a definition: Acceptability is a multi-faceted construct that reflects the extent to which people delivering or receiving a healthcare intervention consider it to be appropriate, based on anticipated or experienced cognitive and emotional responses to the intervention. The theoretical framework of acceptability (TFA) consists of seven component constructs: affective attitude, burden, perceived effectiveness, ethicality, intervention coherence, opportunity costs, and self-efficacy. Conclusion Despite frequent claims that healthcare interventions have assessed acceptability, it is evident that acceptability research could be more robust. The proposed definition of acceptability and the TFA can inform assessment tools and evaluations of the acceptability of new or existing interventions. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2031-8) contains supplementary material, which is available to authorized users.
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              An Empirical Evaluation of the System Usability Scale


                Author and article information

                JMIR Res Protoc
                JMIR Res Protoc
                JMIR Research Protocols
                JMIR Publications (Toronto, Canada )
                8 February 2023
                : 12
                : e42919
                [1 ] Department of Psychiatry and Behavioral Sciences University of Washington Seattle, WA United States
                [2 ] St John’s Medical College Bengaluru India
                [3 ] St John's Research Institute Bengaluru India
                [4 ] Department of Global Health University of Washington Seattle, WA United States
                Author notes
                Corresponding Author: Amritha Bhat amritha@ 123456uw.edu
                Author information
                ©Amritha Bhat, B Ramakrishna Goud, Bharat Kalidindi, Johnson Pradeep Ruben, Dhinagaran Devadass, Abijeet Waghmare, Pamela Y Collins, Tony Raj, Krishnamachari Srinivasan. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 08.02.2023.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Research Protocols, is properly cited. The complete bibliographic information, a link to the original publication on https://www.researchprotocols.org, as well as this copyright and license information must be included.

                : 23 September 2022
                : 6 December 2022
                : 19 December 2022
                : 20 December 2022

                mobile mental health,women,community-based,depression,rural,stepped care


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