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Table 1 Sample quotes from interviewees regarding use of mobile health Community Informant Detection Tool (mCIDT)

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

Theme Description Quote
Perceived benefits Reduced travel burden for FCHVs when using mobile phone SMS for mCIDT We don't have to go to the hospital time and again to ask about a patient. We don't have to ask the health worker. Previously we had to walk for 1 or 2 h to reach the health institution but we can know about them if we send the message from our home. We can also find if the patient has gone for the treatment or not through messages.” – FCHV in FGD
We got to know whether the patient went to hospital or not within a week after we had sent message despite the distance of patient's location. Otherwise, we need to go to the hospital to know if the patient went there or not. Now it is easy for us to go to patient’s home twice and ask about not going to the hospital.”— FCHV in FGD
“FCHVS are engaged in other programs such as Vitamin A distribution, visiting the pregnant and recent mothers and were very busy in these activities due to which they had neglected mental health initially. But later when they were oriented about the mobile, they had a sense that they should work on this otherwise.”—FCHV in FGD
Feasibility Lack of feasibility for implementing mCIDT because FCHVs are overburdened “Because recently what we have been doing is the government has been mobilizing the FCHVs and we can see that FCHVs has been mobilized a lot. Because they have been engaging in programs related to maternal health, related to child health, and population statistics. And they have also been providing services regarding distribution of hygiene issues and home infestations so they’re quite busy so many times we have seen that they have not been referring the cases using CIDT due to the fact that they’re over-engaged and they have not been provided basic salary. Due to this fact I think if we can use other people, like teachers, or local clubs, or mothers’ groups I think there are a lot of mothers’ groups in the community, if we can mobilize them, we can better provide coverage to a large number of people. The FCHVs are overly busy with their schedule so if we can ease the burden of FCHVs on part and shift it to people to mothers group, teachers, and local leaders who have recently been elected, I think that can cause a huge impact and we might be getting a large number of referrals.”— KII with Mental Health Expert
Lack of perceived need Some FCHVs did not see mental health care as a need for their communities “There aren’t many cases in my ward. I cannot register anyone who doesn’t have problem.”— FCHV in FGD
Stigma Inability to use mCIDT because of mental health stigma “When people hear the word manasik (mental), they feel different. They don't want to engage at all. May be because of such stigma in the community, the FCHVs might have had problems.”— KII with Government Health Official
Perceived difficulty of mental health care Reluctance to work with mental health patients because of perceived difficulties It’s difficult to work with manasik samasya (mental problems) It's easy to work on other areas but for mental problems, it's quite difficult.”—FCHV in FGD
Privacy concerns Reluctance to use mobile phones for mental health information We need to create public awareness. Some patient has feeling that their illness is recorded in the phone and that information will be given to someone else.”—FCHV in FGD
Low technological literacy Inability to use SMS function on mobile phones “Some of the FCHVs were finding it difficult to use the mobile phones and using the menu key.” –KII with Mental Health CIDT Trainer
Another challenge would be difficulty in typing. We don't know how to type messages here. If it had been hand written, we could have written down some according to our capability but it is difficult to type it in the mobile.”—FCHV in FGD
Supervision needs Recommendation from FCHVs for more regular supervision when introducing technology “You taught them today, and when you call them after a month, they will get embarrassed if they are not able to do it. They might think that you'll scold them if they can't do it. Because of that fear, they will learn by whatever way they can e.g. by asking children, or looking at books, and come. But, if you leave as it is, then they might not care about it. Even if you don't scold later, if you keep following up with them from time to time, they might feel that they will be embarrassed, which will urge them to learn. I think the monthly supervision will be very beneficial.”— FCHV in FGD