Bioethical Considerations in Deploying Mobile Mental Health Apps in LMIC Settings: Insights from the MITHRA Pilot Study in Rural India

Abstract

In India, untreated depression among women contributes significantly to morbidity and mortality, underscoring an urgent need for accessible and ethical mental health interventions. A pilot randomized controlled trial was conducted to assess the MITHRA app (Multiuser Interactive Health Response Application), tailored for depression screening and treatment among women participating in self-help groups (SHGs) in rural India in the state of Karnataka. The present study, carried out at the end of that trial, explored the ethical considerations associated with such mobile tools. Specifically, we assessed how technological proficiency and privacy concerns influence app use among rural Indian women. Focus‑group discussions with SHG members addressed connectivity, accessibility, technological competence, informed consent, privacy, and gender‑specific interactions; transcripts were coded to identify recurring patterns. Participants preferred a hybrid care model that combined mobile app use with human interactions, exhibited diverse technological proficiency yet uncertainty about mental‑health apps, and revealed gaps in understanding privacy policies. In collectivist cultural contexts such as rural India, autonomy and informed consent were often expressed through family and community relationships rather than individual decision-making alone. These findings highlight the need to tailor mobile mental‑health solutions to individual preferences, enhance transparency around data use and integrate ethical, technological and socio‑cultural considerations to improve accessibility and acceptability in rural settings.