Lessons learned through piloting a community-based SMS referral system for common mental health disorders used by female community health volunteers in rural Nepal

Abstract

<jats:title>Abstract</jats:title> <jats:p>Objectives: The Community Informant Detection Tool (CIDT) is a paper-based proactive case detection strategy with evidence for improving help-seeking behavior by patients for mental health disorders. Key implementation barriers for the paper-based CIDT include delayed reporting of cases and lack of active follow up. We used mobile phones and structured short message system to improve timeliness of case reporting, follow up and case record keeping. Thirty-six lay health workers piloted this mobile CIDT (mCIDT) for three months in 2017 in rural Nepal.Results: Eight cases were identified by lay health workers using mCIDT, but only two of these cases engaged with health services post-referral. Accuracy with the mCIDT was considerably lower compared to the paper-based CIDT. Higher education levels of lay health workers was associated with greater mCIDT accuracy. Qualitative findings revealed new implementation challenges among cases not following through on referrals due to perceived lack of staff at health facilities, assumptions among lay health workers that all earthquake-related mental health needs had been met, and lack of financial incentives for use of mCIDT. Based on study findings, we present recommendations for introducing a new technology in low resource health systems.</jats:p>