Globally, mental health problems are a growing public health concern. Resources and services for mental disorders are disproportionately low compared to disease burden. In order to bridge treatment gaps, The Systematic Medical Appraisal, Referral and Treatment (SMART) Mental Health Project was implemented across 12 villages in West Godavari district of the southern Indian state of Andhra Pradesh. This paper reports findings from a process evaluation of feasibility and acceptability of the intervention that focused on a mental health services delivery model to screen, diagnose and manage common mental disorders (CMDs). A mixed methods evaluation was undertaken using quantitative service usage analytics, and qualitative data from in-depth interviews and focus group discussions were conducted with stakeholders including primary care physicians, community health workers, field staff and community members. Barriers to and facilitators of intervention implementation were identified. Andersen’s Behavioral Model for Health Services Use was the conceptual framework used to guide the process evaluation and interpretation of data. In all, 41 Accredited Social Health Activists (ASHAs) and 6 primary health centre (PHC) doctors were trained in mental health symptoms and its management. ASHAs followed up 98.7% of screen positive cases, and 81.2% of these were clinically diagnosed and treated by the PHC doctors. The key facilitators of implementation were adequate training and supervision of field staff, ASHAs and doctors, use of electronic decision support, incorporation of a door-to-door campaign and use of culturally tailored dramas/videos to raise awareness about CMDs, and organising health camps at the village level facilitating delivery of intervention activities. Barriers to implementation included travel distance to receive care, limited knowledge about mental health, high level of stigma related to mental health issues, and poor mobile network signals and connectivity in the villages. Lack of familiarity with and access to mobile phones, especially among women, to accessing health related messages as part of the intervention. The evaluation not only provides a context to the interventions delivered, but also allowed an understanding of possible factors that need to be addressed to make the programme scalable and of benefit to policy makers.

中文翻译：

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SMART心理健康项目：过程评估，以了解在印度农村地区实施多层面干预的障碍和促进者

在全球范围内，精神健康问题日益成为公共卫生关注的焦点。与疾病负担相比，精神障碍的资源和服务低得多。为了弥合治疗差距，在印度南部安得拉邦西戈达瓦里地区的12个村庄中实施了系统的医疗评估，推荐和治疗（SMART）心理健康项目。本文报告了对干预措施的可行性和可接受性进行过程评估的结果，该评估结果着重于筛查，诊断和管理常见精神障碍（CMD）的心理健康服务提供模型。使用定量服务使用情况分析进行了混合方法评估，并与包括初级保健医生在内的利益相关者进行了深入访谈和焦点小组讨论的定性数据 社区卫生工作者，现场工作人员和社区成员。确定了干预实施的障碍和促进者。Andersen的《卫生服务使用行为模型》是用于指导过程评估和数据解释的概念框架。总共对41名获得认可的社会卫生活动家（ASHA）和6名初级卫生中心（PHC）的医生进行了心理健康症状及其管理方面的培训。ASHA随访了98.7％的筛查阳性病例，其中81.2％由PHC医生进行了临床诊断和治疗。实施的主要推动者是对现场工作人员，ASHA和医生进行充分的培训和监督，使用电子决策支持，开展门到门运动以及使用文化定制的话剧/录像以提高对CMD的认识，在村庄一级组织卫生营，以促进开展干预活动。实施的障碍包括获得医疗服务的旅行距离，对心理健康的了解有限，与心理健康问题有关的污名化程度高以及村庄中移动网络信号和连接性差。作为干预措施的一部分，尤其是在女性中间，人们对移动电话缺乏了解和使用，因此无法获得与健康相关的消息。评估不仅为所采取的干预措施提供了背景，而且还使他们了解了可能需要解决的因素，以使该计划具有可扩展性，并使决策者受益。关于心理健康的知识有限，与心理健康问题有关的污名化程度高以及村庄中移动网络信号和连接性差。作为干预措施的一部分，人们缺乏对手机的了解和使用，特别是在女性中，他们缺乏获取与健康相关的消息的能力。评估不仅为所采取的干预措施提供了背景，而且还使他们了解了可能需要解决的因素，以使该计划具有可扩展性，并使决策者受益。关于心理健康的知识有限，与心理健康问题有关的污名化程度高以及村庄中移动网络信号和连接性差。作为干预措施的一部分，人们缺乏对手机的了解和使用，特别是在女性中，他们缺乏获取与健康相关的消息的能力。评估不仅为所采取的干预措施提供了背景，而且还使他们了解了可能需要解决的因素，以使该计划具有可扩展性，并使决策者受益。