Process evaluation of the systematic medical appraisal, referral and treatment (SMART) mental health project in rural India

作者：Abha Tewari, Sudha Kallakuri, Siddhardha Devarapalli, Vivekanand Jha, Anushka Patel, Pallab K Maulik · 发表于：BMC Psychiatry · 年份：2017 · DOI：10.1186/s12888-017-1525-6 · 被引用次数：72 · 研究领域：Mental Health Treatment and Access、Digital Mental Health Interventions、Healthcare Systems and Reforms

BACKGROUND: Availability of basic mental health services is limited in rural areas of India. Health system and individual level factors such as lack of mental health professionals and infrastructure, poor awareness about mental health, stigma related to help seeking, are responsible for poor awareness and use of mental health services. We implemented a mental health services delivery model that leveraged technology and task sharing to facilitate identification and treatment of common mental disorders (CMDs) such as stress, depression, anxiety and suicide risk in rural areas of the state of Andhra Pradesh, India. The intervention was delivered by lay village health workers (Accredited Social Health Activists - ASHAs) and primary care doctors. An anti-stigma campaign was implemented prior to this activity. This paper reports the process evaluation of the intervention using mixed methods. METHODS: A mixed methods pre-post evaluation assessed the intervention using quantitative service usage analytics from the server, and qualitative interviews with different stakeholders. Barriers and facilitators in implementing the intervention were identified. RESULTS: Health service use increased significantly at post-intervention, ASHAs could followup 78.6% of those who had screened positive, and 78.6% of the 1243 Interactive Voice Response System calls made, were successful. Most respondents were aware of the intervention. They indicated that knowledge received through the intervention emp...