Mental Health on a Shoestring? Assessing Awareness and Acceptance of Digital Phenotyping in Dhaka's Korail Slum: A Qualitative Study (Preprint)

BACKGROUND                         Digital phenotyping (DP), the process of using data from digital devices, like smartphones and wearable technology to understand and monitor people's behaviour, health, and daily activities, has shown significant promise in mental health care within high-income countries (HICs). However, its application in lower and middle-income countries (LMICs) is limited, particularly among impoverished populations such as slum residents.                                                                       OBJECTIVE                         This study investigates the awareness, knowledge, acceptance, and implementation of DP, including willingness to share data, and concerns regarding privacy and data security, among residents of Dhaka's Korail slum, one of Bangladesh's largest and most densely populated informal settlements.                                                                       METHODS                         We conducted eight focus group discussions (FGDs) with 38 participants with individuals diagnosed with serious mental disorders (SMDs) and their caregivers. The FGDs also included a section explaining what DP is.                                                                       RESULTS                         There was a general lack of awareness about DP among the participants. Most had no prior knowledge of DP, but after receiving an explanation, they acknowledged its potential applications and benefits. Participants recognized the utility of DP for health monitoring, particularly in managing mental health conditions. They expressed their interest in sharing data, if the content of their activities was not accessed. Despite these perceived benefits, significant concerns about privacy and data security emerged. Participants expressed fears about the potential misuse of their personal information, with some feeling resigned to the idea of already being constantly monitored. This highlights a critical barrier to the adoption of DP tools: the need for robust data protection measures and transparent communication to build trust among users. Participants stressed the need for DP to reflect local customs and practices.                                                                       CONCLUSIONS                         To implement DP effectively in LMICs, educational initiatives are necessary to raise awareness and understanding of the technology. Additionally, robust data protection measures must be in place, and clear communication about these measures can help alleviate fears and build trust. DP tools should be adapted to fit the cultural context of the target population, possibly involving modifications to the types of data collected or the way data is interpreted. In conclusion, while DP holds potential to improve mental health care in underserved communities, addressing barriers related to awareness, privacy, culture and usability is crucial. Focusing on educational initiatives, robust data protection, cultural adaptation, user-friendly design, and community engagement, DP can become a valuable tool in bridging the mental health care gap in LMICs.