Examining Mental Health Apps Potential in Providing Equitable Access to Care in the Global North and Global South: A Scoping Review
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Promising, ongoing research on online mental health interventions or mental health applications (MHAPPs) has presented the global mental health care community with a potential solution to fill in the gaps in access to mental health care. Many of the MHAPPs have focused on conditions of depression and anxiety. Yet, it remains unclear whether such interventions can address the access to care gap in an equitable manner by reaching the diverse communities both in the global North and global South. The countries of Canada and United States were chosen as exemplars for the global North and China and India as exemplars for the global South. Using Arksey and O’Malley’s methodical framework, a scoping review was conducted on academic and grey literature published since 2015. Under critical social paradigm, the synthesis of review studies employed the social determinants of health lens along with role of macro forces like neoliberalism and collectivism-individualism. The results reveal that MHAPPs for depression and anxiety have been shown to be efficacious in studies both in the global North and global South, though few of the efficacious apps have been made freely available. Further, the guided-online interventions in the global North and global South are also found to facilitate program adherence, especially in rural settings. However, the review reveals that several barriers exist in the global South to make online interventions widely available and accessible. The identified barriers include mental health stigma and discrimination, financial and social challenges, difficulties in using the technology-based applications, and cultural barriers to ‘self-management’. In conclusion, this review has identified the potential of MHAPPs in broad settings; however, there is a need to design these programs by incorporating the social determinants of health framework to better address the structural barriers to access care. Policy makers should be cautious in steadily implementing MHAPPs in disadvantaged communities, as broader policies are needed to address the logistical capabilities of accessing online mental care. Further studies on MHAPPS are also needed with a bottom-up approach to adapt to various cultural context and reach marginalized communities. Given the specific focus of the presented review on Canada and United States as global North and China and India as global South, the findings need to be interpreted carefully. Further work by including additional geographic regions is needed to advance the scholarly understanding.
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