Table 4.

Enhancements made to the electronic decision support system.

Issues that needed amendments	Solutions for the problems/issues
Daily monitoring of data at the field level and comparison of data across sites, localities, and users was very difficult. Monitoring of clinical data of patients was also difficult	Development of descriptive analytics at the database level while implementing the SMHa trial was done to ease monitoring of data. There were many enhancements made at that level, in terms of representing real-time data from different aspects of the study. This included identification of mental health service use, the burden of different mental health conditions, and comparison of different conditions, among other factors. These analytics could be viewed by comparisons made across regions, gender, and age groups. These were represented through pictorial modes such as graphs and pie charts (see Figure 7 for examples)
Monitoring an individual’s mental health status over time was not possible	Analytics were developed to track the PHQ9b and GAD7c scores of an individual in the different phases of the study. Data captured periodically during monitoring could be viewed as graphs and charts based on the longitudinal data at the backend using analytics.
The performance of ASHAsd could not be tracked well	There were enhancements made to the ASHA app, which tracked the performance of each ASHA and provided data about the numbers of screenings and follow-ups performed, including the time taken for each. Random audio recordings of their interactions were also captured to ensure quality checks.
As the database is encrypted and stored in a password-protected, secure location, it is hard to gain access to data by reverse engineering or decoding	The app is protected with multifactor authentication using a password and lock pin as an enhancement to the existing setup.
User interface and functioning of the app were not clear	Several changes were made to the user interface, including a change of font size, color, and creating different section headers using attractive symbols/pictures, for better user experience
Enabling online training during COVID-19	Some of the training materials were embedded in the mobile apps to enable easier access for trainees using virtual modes during COVID-19.
Real-time monitoring of the activities of field staff was required to ensure increased data quality	Random audio recording of interaction of field staff with study participants or high-risk individuals was enabled. The time taken for each screening was also made available at the database level for these audio recordings. This helped the implementation team to monitor data collection and quality.
Merging of two apps, namely household listing and participant screening, into one app	This merger made it possible for simultaneous data collection for both listing and screening, which saved time for both the participant and field staff and reduced multiple visits to the same household for data collection.

^aSMH: Systematic Medical Appraisal and Referral Treatment Mental Health.

^bPHQ9: Patient Health Questionnaire-9.

^cGAD7: Generalized Anxiety Disorder-7.

^dASHA: Accredited Social Health Activist.