Development, evaluation, and implementation of a tablet device-based depression screening and management tool for rural womens self-help groups

Depression is a critical public health issue among women in rural India, with diagnosis and treatment rates being very low. The paper summarizes the development of MITHRA, a user-centred mobile app for depression screening and treatment among women in self-help groups (SHGs) of rural India. The predevelopment phase involved situation analysis and forming participatory design groups of prospective users. The app development phase used an Agile approach for flexibility and rapid adaptation. The post-development phase involved user acceptance testing, training on app usage, data synchronization, accuracy testing and usability evaluation. The study found that only 25% of the women in the participatory design group were digitally literate, despite 63% smartphone ownership. On assessing the cellular connectivity, the average download speed across the eight study sites was 9.81 Mbps, and the average upload speed was 4.6 Mbps. The user tests showed improvement in the task success rate between user testing session 1 and session 2 for all the tested tasks. The app successfully passed user acceptance testing (UAT) and data accuracy testing, demonstrating its readiness for deployment. Heuristic evaluation identified 52 violations with a mean score of 2.3, indicating minor usability issues to be addressed. This description of app development underscores the potential of mHealth apps in addressing mental health issues in underrepresented populations. What is already known on this topicDepression bears a high burden in rural India, particularly among women. Despite high prevalence, diagnosis and treatment rates remain low due to limited resources and stigma. Additionally, lack of awareness contributes to the problem, as many individuals in rural communities may not recognise depression as a treatable condition. Moreover, the scarcity of mental health specialists exacerbates the situation, especially in underserved rural areas. What this study addsThis study underscores the importance of a human-centred app development processes, utilizing a participatory design group approach that places users at the core of every development phase. This study uniquely involved no-to-low literate women and poor digital literacy from rural India as the primary users. By integrating these users before, during, and after the app development phase, the study ensured that the app was intuitive and accessible, specifically catering to the needs of this demographic. The apps design and functionality were directly influenced by the users, enhancing its effectiveness during mental health interventions. This approach improved usability, demonstrating the profound impact of inclusive and user-focused development practices. How this study might affect research, practice or policyThe results from this study reveal that incorporating human-centred design through a participatory approach--where a group of women from the same rural community actively contributed to an app development--leads to the development of an app that is well accepted by the target population. These findings represent a significant advancement in healthcare technology, emphasizing the importance of user engagement and cultural relevance in creating effective solutions. As researchers, policymakers, and practitioners consider these results, they may reshape methodologies, policies, and clinical practices to prioritize user-centric approaches and enhance overall healthcare outcomes. This study also highlights a potential alternative, accessible treatment option for rural communities, partially addressing the mental health workforce shortage.