Can Mobile Health Improve Depression Treatment Access and Adherence Among Rural Indian Women? A Qualitative Study
Introduction: Low rates of follow up with mental health treatments, and medication non-adherence are common among patients with Major Depressive Disorder (MDD), more so in low-middle income countries (LMIC). While mobile mental health has the potential to address this problem in resource-poor settings, the feasibility and acceptability of its use in rural women is unknown. We aimed to explore barriers to access and adherence to mental health treatment, and the feasibility of using mobile health to address these barriers among women with MDD in rural south India. Methods: Six focus groups were conducted among women with MDD (n=69) seeking care at a rural community health center in South India. Discussion centered on barriers to mental health treatment access and adherence and attitudes toward use of technology in addressing these barriers. We transcribed the discussions and analyzed them using qualitative analysis software. Results: Reasons for non-adherence were: transcultural explanatory model of illness; structural, financial and social barriers to access, and medication side-effects. Women were unenthusiastic about mobile health solutions due to illiteracy, lack of family support, unfamiliarity with use of mobile devices, lack of access to mobile phones and preference for in-person clinical consultation. Conclusions: This qualitative study examines the acceptability of mobile-mental health as a strategy to address barriers to depression treatment access and adherence among women in a rural setting. There are several barriers to adoption of mobile mental health technology in LMIC. It is important to address these barriers before implementing mobile health based solutions.