Information processing by community health nurses using mobile health (mHealth) tools for early identification of suicide and depression risks in Fiji Islands

Vimla Lodhia Patel, Mariel Halpern, Vijayalakshmi Nagaraj, Odille Chang, Sriram Iyengar, William May

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Objectives High rates of depression and suicide and a lack of trained psychiatrists have emerged as significant concerns in the low-income and middle-income countries (LMICs) such as the Pacific Island Countries (PICs). Readily available smartphones were leveraged with community health nurses (CHNs) in task-sharing for early identification of suicide and depression risks in Fiji Islands, the largest of PICs. This investigation examines how CHNs can efficiently and effectively process patient information about depression and suicide risk for making diagnostic and management decisions without compromising safety. The research is driven by the theoretical framework of text comprehension (knowledge representation and interpretation) and decision-making. Methods Mobile health (mHealth) Application for Suicide Risk and Depression Assessment (ASRaDA) was designed to include culturally useful clinical guidelines for these disorders. A representative sample of 48 CHNs was recruited and presented with two clinical cases (depression and suicide) in a simulated setting under three conditions: No support, paper-based and mobile-based culturally valid guideline support. Data were collected as the nurses read through the scenarios, 'thinking aloud', before summarising, diagnoses and follow-up recommendations. Transcribed audiotapes were analysed using formal qualitative discourse analysis methods for diagnostic accuracy, comprehension of clinical problems and reasoning patterns. Results Using guidelines on ASRaDA, the CHNs took less time to process patient information with more accurate diagnostic and therapeutic decisions for depression and suicide risk than with paper-based or no guideline conditions. A change in reasoning pattern for nurses' information processing was observed with decision support. Discussion Although these results are shown in a mental health setting in Fiji, there are reasons to believe they are generalisable beyond mental health and other lower-to-middle income countries. Conclusions Culturally appropriate clinical guidelines on mHealth supports efficient information processing for quick and accurate decisions and a positive shift in reasoning behaviour by the nurses. However, translating complex qualitative patient information into quantitative scores could generate conceptual errors. These results are valid in simulated conditions.

Original languageEnglish (US)
Article numbere100342
JournalBMJ Health and Care Informatics
Issue number1
StatePublished - Nov 15 2021


  • BMJ health informatics
  • information science
  • medical informatics
  • smartphone

ASJC Scopus subject areas

  • Computer Science Applications
  • Health Informatics
  • Health Information Management


Dive into the research topics of 'Information processing by community health nurses using mobile health (mHealth) tools for early identification of suicide and depression risks in Fiji Islands'. Together they form a unique fingerprint.

Cite this