Table 3 Summary of themes from the Perception of providers about use of the mental health gap action program intervention guide and Apps in Nigerian primary care settings

Current Practice

• Apps used for purposes other than clinical consultation and decision making

• Expectations of staff–mandate, need to be accessible and use guidance

• Workload

• Systematic exclusion of some staff-

Low cadre, older, have no smartphone

• Patients’ expectation of staff to not use phone in consultation

• Paper record of clinical activities

• Paper guidance/mhGAP-IG not embedded

‘I was the focal person for my LGA (Local Government area). App was used to send reports on immunization which involved the number of children immunized and the number of vaccines used…’(Interview, Female, Nurse)

‘Mostly we don’t have time to use it during work hours; that is the fact.’(Focus group participant, Female, CHEW)

….’though Community Health Extension Workers were excluded from the project.’(Interview, Female, Nurse)

‘The only thing that Patients don’t like is for you to be making calls during consultations. They don’t like it at all.’(Focus group participant, Male, CHO)

‘…. like the mh-GAP book given to us, I cannot remember the last time I opened it….’(Interview, Female, Nurse)

Future Practice

• Smartphone guidance preferred to paper-

Sees many benefits

• Training

• Patient’s expectation of staff to explain process

• Embedded practice-

E.g., Staff exclusion as above, interest

‘To me, putting it (mhGAP-IG) on the electronic (platforms) is better in the sense that it will make it easy for people to go through it (e-mhGAP-IG) at any time of the day’(Interview, Female, Nurse)

‘The only thing that can solve that problem is there will be training, there must be a training on that aspect before applying it…’(Interview, Female, Nurse)

‘You know, before you start with the patient, you can explain to them that once they see you doing things on the phone, they should not think you are not listening to them. It is actually for their good. You tell them that answers to some of the questions they ask, may be found on the device on your hand as the health worker.’(Interview, Female, CHO)

Design features

• Features to encourage utility

‘Supervision too can be there when there is a checklist there. And anytime you want to supervise, that one will give you the clue of what and what you are looking for like the time we were asked to go for the supervision after the training of SPECTRA (Another programme)’(Focus group participant, Female, Nurse)

‘Video of somebody depressed but has overcome it [depression] can be of help, by letting them [service users] see it [recovery story] that they [service users] can come out of that problem [depression] if they [service users] cooperate with us [providers], and also true life experience can help, that will serve as client expert interview…’(Interview, Female, Nurse)

‘….just like the NURI (another programme)App, the checklist [of signs and symptoms] should be there…’(Focus group participant, Female, Nurse)

‘Like all those core signs can be there (in the App), the other signs can be there (in the App) and even the managements can be there too and if possible…’(Interview, Female, Nurse)