Digital Training for Non-Specialist Health Workers to Deliver a Brief Psychological Treatment for Depression in Primary Care in India: Findings from a Randomized Pilot Study

Shital S. Muke, Deepak Tugnawat, Udita Joshi, Aditya Anand, Azaz Khan, Ritu Shrivastava, Abhishek Singh, Juliana L. Restivo, Anant Bhan, Vikram Patel and John A. Naslund
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Shital S. Muke: Sangath, 120 Deepak Society, Chuna Bhatti, Kolar Road, Bhopal 462016, India
Deepak Tugnawat: Sangath, 120 Deepak Society, Chuna Bhatti, Kolar Road, Bhopal 462016, India
Udita Joshi: Sangath, 120 Deepak Society, Chuna Bhatti, Kolar Road, Bhopal 462016, India
Aditya Anand: Sangath, 120 Deepak Society, Chuna Bhatti, Kolar Road, Bhopal 462016, India
Azaz Khan: Sangath, 120 Deepak Society, Chuna Bhatti, Kolar Road, Bhopal 462016, India
Ritu Shrivastava: Sangath, 120 Deepak Society, Chuna Bhatti, Kolar Road, Bhopal 462016, India
Abhishek Singh: Sangath, 120 Deepak Society, Chuna Bhatti, Kolar Road, Bhopal 462016, India
Juliana L. Restivo: Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA
Anant Bhan: Sangath, 120 Deepak Society, Chuna Bhatti, Kolar Road, Bhopal 462016, India
Vikram Patel: Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA
John A. Naslund: Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA

IJERPH, 2020, vol. 17, issue 17, 1-22

Abstract: Introduction : Task sharing holds promise for scaling up depression care in countries such as India, yet requires training large numbers of non-specialist health workers. This pilot trial evaluated the feasibility and acceptability of a digital program for training non-specialist health workers to deliver a brief psychological treatment for depression. Methods : Participants were non-specialist health workers recruited from primary care facilities in Sehore, a rural district in Madhya Pradesh, India. A three-arm randomized controlled trial design was used, comparing digital training alone (DGT) to digital training with remote support (DGT+), and conventional face-to-face training. The primary outcome was the feasibility and acceptability of digital training programs. Preliminary effectiveness was explored as changes in competency outcomes, assessed using a self-reported measure covering the specific knowledge and skills required to deliver the brief psychological treatment for depression. Outcomes were collected at pre-training and post-training. Results : Of 42 non-specialist health workers randomized to the training programs, 36 including 10 (72%) in face-to-face, 12 (86%) in DGT, and 14 (100%) in DGT+ arms started the training. Among these participants, 27 (64%) completed the training, with 8 (57%) in face-to-face, 8 (57%) in DGT, and 11 (79%) in DGT+. The addition of remote telephone support appeared to improve completion rates for DGT+ participants. The competency outcome improved across all groups, with no significant between-group differences. However, face-to-face and DGT+ participants showed greater improvement compared to DGT alone. There were numerous technical challenges with the digital training program such as poor connectivity, smartphone app not loading, and difficulty navigating the course content—issues that were further emphasized in follow-up focus group discussions with participants. Feedback and recommendations collected from participants informed further modifications and refinements to the training programs in preparation for a forthcoming large-scale effectiveness trial. Conclusions : This study adds to mounting efforts aimed at leveraging digital technology to increase the availability of evidence-based mental health services in primary care settings in low-resource settings.

Keywords: depression; psychological treatment; task sharing; primary care; pilot study; non-specialist health worker; training; digital technology; mental health (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2020
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (3)

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