Strengthening Community-based Preventive Psychiatry-related Interventional Research in India by Employing SWOT Analysis

Discussion

We faced challenges in limited public transport to reach remote areas for fieldwork, limited budgetary allocation to cover private travel expenses to the community, and mobilizing participants for the research, who were often not formally educated and had difficulty identifying their MH needs. Our concerns was echoed in an other literature in this area from India, focusing on medical undergraduates’ CBMHR. ¹ The above challenges were compounded by inadequate engagement of community health officers, either because of parallel commitments that limit their support for the research or because of hesitancy to provide any help, as also evidenced in the literature from Asia.^2,5

Additionally, we experienced systemic barriers like health infrastructural constraints, for example, a lack of private space to conduct assessments, well-lit & ventilated rooms, furniture, internet connectivity, and unavailability of prompt stationery facilities for Information, Education, and Communication activities as and when needed in the health facility.

Cultural factors such as service users’ limited interest in discussing MH issues, prioritizing socio-cultural or household events over MH assessment or interventions, cultural beliefs not promoting or supporting MH-related help-seeking, and undervaluation of promotive and preventive services, particularly when community members perceive common MH issues (depression, anxiety, stress) as a part of their daily hassles. We also observed the potential service users’ dependency on their partner/family, particularly in females. Additionally, a pervasive reliance on pharmacological treatment, so-called “pills” for the perceived MH issues, vis-à-vis psychosocial interventions or counseling, was observed, which would merely be perceived as some casual conversation. These issues reflect logistic issues with frequently accessing the MH services, poor MH literacy among the individuals with MH issues and key decision makers of the family, and community members’ lack of psychological mindedness to undergo non-pharmacological interventions.

Therefore, to better understand the situation, we undertook a comprehensive SWOT analysis, an effective yet underutilized tool in CMHR.^3,6 This framework enabled us to critically evaluate our position and develop targeted strategies to enhance appeal, acceptability, and smooth implementation of our research work, including MH assessment and intervention delivery (Table 1).

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Table 1.

SWOT Analysis Field Challenges in Conducting Community-based Mental Health Research.

Strength	Weakness
1. A motivated team, ready to undertake challenges and overcome obstacles. 2. Strong collaboration, mutual support, and understanding among research team members. 3. The inherent strength of the community in terms of family/social support required for mental health intervention, their close ties with the community health workers, and openness to medical help (at least for some of them) can be harnessed.	1. Lack of regular commute facilities for field visits, including connecting to community members’ doorsteps/health & wellness centers. 2. Lack of prior exposure to community-based research or prior networks in the community.
Opportunities	Threats
1. To understand the socio-cultural aspects of the potential participants, identify their MH issues, and design tailored interventions. 2. Availability of support for some of the health staff and the key community personnel. 3. Informing future researchers on CBMHR and preventive psychiatry. 4. Career growth and skill advancement for the research team. 5. Incorporation of a user-informed and user-driven perspective for project implementation. 6. Developing problem-solving skills during crises and emergencies.	1. Lack of awareness in the community about mental health issues. 2. Community members’ constraints in help-seeking, which could prevent their regular visits to health facilities for availing services, thereby affecting their research participation, even if they have the will to do so, such as  a. logistic issues, poor support from family members for help-seeking,  b. poor literacy, and parallel competing commitments (house task, farm work, etc.). 3. Potential participants may not be willing to receive treatment for their MH issues, including visiting health centers (PHC, AAM) for treatment. 4. The research staff’s motivation may fade away, considering potentially poor uptake of the services by the community members and lack of consistent support of health workers.

CBMHR, Community-based Mental Health Research; MH, Mental Health; PHC, Primary health center; AAM, Ayushman Arogya Mandir (formerly health and wellness center).

Conducting a SWOT analysis provided us with valuable insights into the local population’s prevalent health issues, socio-cultural and educational characteristics, the availability of current MH services, and how the research can be carried out effectively. The insights included:

Ensuring regular community visits (twice a week) to engage stakeholders, provide consistent services, and conduct research activities.

Conclusion

The SWOT analysis demonstrated the need for consistent community engagement, culturally and linguistically appropriate intervention designs, and the involvement of local health workers, community stakeholders, and family members. Our work can guide future CBMHR efforts.