John A Naslund1, Deepak Tugnawat2, Aditya Anand2, Zafra Cooper3, Sona Dimidjian4, Christopher G Fairburn5, Steven D Hollon6, Udita Joshi2, Azaz Khan2, Chunling Lu7, Lauren M Mitchell8, Shital Muke2, Abhijit Nadkarni9, Rohit Ramaswamy10, Juliana L Restivo11, Ritu Shrivastava2, Abhishek Singh2, Daisy R Singla12, Donna Spiegelman13, Anant Bhan2, Vikram Patel14. 1. Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA. Electronic address: John_Naslund@hms.harvard.edu. 2. Sangath, Bhopal, Madhya Pradesh, India. 3. Department of Psychiatry, Yale University School of Medicine, West Haven, CT, USA. 4. Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA. 5. Department of Psychiatry, University of Oxford, Oxford, UK. 6. Department of Psychology, Vanderbilt University, Nashville, TN, USA. 7. Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA. 8. Harvard Medical School, Boston, MA, USA. 9. Centre for Global Mental Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK; Sangath, Alto Porvorim, Goa, India. 10. Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. 11. Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA. 12. Department of Psychiatry, University of Toronto and Sinai Health System, Toronto, Canada. 13. Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA. 14. Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Abstract
BACKGROUND: Training non-specialist health workers (NSHWs) at scale is a major barrier to increasing the coverage of depression care in India. This trial will test the effectiveness of two forms of digital training compared to conventional face-to-face training in changing the competence of NSHWs to deliver a brief evidence-based psychological treatment for depression. METHODS: This protocol is for a three-arm, parallel group randomized controlled trial comparing three ways of training NSHWs to deliver the Healthy Activity Program (HAP), a brief manualized psychotherapy for depression, in primary care. The arms are: digital training (DGT); digital training combined with individualized coaching support (DGT+); and conventional face-to-face training (F2F). The target sample comprises N = 336 government contracted NSHWs in Madhya Pradesh, India. The primary outcome is change of competence to deliver HAP; secondary outcomes include cost-effectiveness of the training programs, change in participants' mental health knowledge, attitudes and behavior, and satisfaction with the training. Assessors blind to participant allocation status will collect outcomes pre- (baseline) and post- (endpoint) training to ascertain differences in outcomes between arms. Training program costs will be collected to calculate incremental costs of achieving one additional unit on the competency measure in the digital compared to face-to-face training programs. Health worker motivation, job satisfaction, and burnout will be collected as exploratory outcome variables. DISCUSSION: This trial will determine whether digital training is an effective, cost-effective, and scalable approach for building workforce capacity to deliver a brief evidence-based psychological treatment for depression in primary care in a low-resource setting. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04157816.
RCT Entities:
BACKGROUND: Training non-specialist health workers (NSHWs) at scale is a major barrier to increasing the coverage of depression care in India. This trial will test the effectiveness of two forms of digital training compared to conventional face-to-face training in changing the competence of NSHWs to deliver a brief evidence-based psychological treatment for depression. METHODS: This protocol is for a three-arm, parallel group randomized controlled trial comparing three ways of training NSHWs to deliver the Healthy Activity Program (HAP), a brief manualized psychotherapy for depression, in primary care. The arms are: digital training (DGT); digital training combined with individualized coaching support (DGT+); and conventional face-to-face training (F2F). The target sample comprises N = 336 government contracted NSHWs in Madhya Pradesh, India. The primary outcome is change of competence to deliver HAP; secondary outcomes include cost-effectiveness of the training programs, change in participants' mental health knowledge, attitudes and behavior, and satisfaction with the training. Assessors blind to participant allocation status will collect outcomes pre- (baseline) and post- (endpoint) training to ascertain differences in outcomes between arms. Training program costs will be collected to calculate incremental costs of achieving one additional unit on the competency measure in the digital compared to face-to-face training programs. Health worker motivation, job satisfaction, and burnout will be collected as exploratory outcome variables. DISCUSSION: This trial will determine whether digital training is an effective, cost-effective, and scalable approach for building workforce capacity to deliver a brief evidence-based psychological treatment for depression in primary care in a low-resource setting. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04157816.
Authors: John A Naslund; Jasmine Kalha; Juliana L Restivo; Ishmael Amarreh; Tamora Callands; Hongtu Chen; Carlos Gomez-Restrepo; Hesham M Hamoda; Arjun Kapoor; Sue Levkoff; Jones Masiye; Maria A Oquendo; Vikram Patel; Inge Petersen; Ozge Sensoy Bahar; Laura Shields-Zeeman; Fred M Ssewamala; Deepak Tugnawat; José Miguel Uribe-Restrepo; Lakshmi Vijayakumar; Bradley H Wagenaar; Milton L Wainberg; Larry Wissow; Haja Ramatulai Wurie; Chifundo Zimba; Soumitra Pathare Journal: Asian J Psychiatr Date: 2021-01-24