Digital Training for Non-Specialist Health Workers to Deliver a Brief Psychological Treatment for Depression
- Conditions
- DepressionPsychologicalMental Disorder
- Interventions
- Other: Digital TrainingOther: Face-to-Face TrainingOther: Coaching Support
- Registration Number
- NCT04157816
- Lead Sponsor
- Harvard Medical School (HMS and HSDM)
- Brief Summary
The purpose of this 3-arm randomized controlled trial is to compare two forms of digital training (i.e., low-intensity and high-intensity) with traditional face-to-face training of non-specialist health workers to deliver an evidence-based brief psychological treatment for depression called the Healthy Activity Program (HAP) in primary care settings in India. This study will evaluate a low-intensity digital training program (DGT) compared with traditional face-to-face training (F2F) on change in competence outcomes and cost-effectiveness. This study will also evaluate a high-intensity digital training program with the addition of individualized coaching support (DGT+) compared with traditional F2F on change in competence outcomes and cost-effectiveness.
- Detailed Description
Few individuals living with depression in India have access to adequate treatment in primary care settings. Task-sharing, which involves building capacity of frontline non-specialist health workers to deliver evidence-based treatment for common mental disorders such as depression, is an effective approach for bridging these gaps in available care. This emphasizes the need for novel approaches to scale up training efforts and to support the development of a skilled and competent workforce capable of delivering high quality treatment for depression in primary care settings. Therefore, the purpose of this study is to compare two forms of digital training (i.e., low-intensity and high-intensity) with traditional face-to-face training of non-specialist health workers to deliver an evidence-based brief psychological treatment for depression called the Healthy Activity Program (HAP) in primary care settings in India. This trial uses a 3-arm randomized controlled design. This study will evaluate a low-intensity digital training (DGT) compared with traditional face-to-face training (F2F) on change in competence outcomes and cost-effectiveness; and evaluate a high-intensity digital training with the addition of individualized coaching support (DGT+) compared with traditional F2F on change in competence outcomes and cost-effectiveness. In this trial, a total of 336 non-specialist health workers will be recruited from community health centers in Sehore District of Madhya Pradesh, a large and predominantly rural state situated in central India. This trial will generate knowledge on the most effective and cost-effective approaches to address the critical knowledge gap regarding the training of non-specialist health workers to deliver an evidence-based brief psychological treatment for depression in a low-resource setting. The findings from this trial will inform broader efforts to develop a mental health workforce necessary for scaling up brief psychological therapies for common mental disorders.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 340
- Adult (age ≥18 years)
- Non-specialist health worker
- Minimum education level 8th Standard
- Willingness to complete training to deliver HAP
- Willingness to stay in the study area during the trial period
- Significant speech, sight, or hearing impairment
- Illiterate/ who cannot read and write
- Prior participation in the formative research and pilot testing (during the development of the training programs)
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Digital Training with Coaching Support (DGT+) Digital Training Participants allocated to this arm receive a high-intensity digital program accessible by smart phone app augmented with weekly telephone coaching support for training non-specialist health workers to deliver an evidence-based brief psychological treatment for depression, called the Healthy Activity Program (HAP), in primary care settings in India. Digital Training (DGT) Digital Training Participants allocated to this arm receive a low-intensity digital program accessible by smart phone app for training non-specialist health workers to deliver an evidence-based brief psychological treatment for depression, called the Healthy Activity Program (HAP), in primary care settings in India. Digital Training with Coaching Support (DGT+) Coaching Support Participants allocated to this arm receive a high-intensity digital program accessible by smart phone app augmented with weekly telephone coaching support for training non-specialist health workers to deliver an evidence-based brief psychological treatment for depression, called the Healthy Activity Program (HAP), in primary care settings in India. Face-to-Face Training Face-to-Face Training Participants allocated to this arm receive a traditional classroom-based (face-to-face) program hosted in community settings for training non-specialist health workers to deliver an evidence-based brief psychological treatment for depression, called the Healthy Activity Program (HAP), in primary care settings in India.
- Primary Outcome Measures
Name Time Method Change in Competency Change from Baseline to up to 8 weeks. 26-item multiple choice exam to assess the competency of the non-specialist health workers in delivering the Healthy Activity Program (HAP) after training. The measure consists of clinical vignettes followed by multiple-choice questions focused predominantly on assessing applied knowledge. Scores on the measure range from 0 to 26, with higher scores indicating higher levels of competency for delivering HAP. There are three different equivalent versions of this 26-item measure, and each participant will be assessed randomly with one of these at each of the two time points, ensuring that the same test is not used twice.To assess change in competency between two time points, this measure will be collected at baseline and at up to 8 weeks.
- Secondary Outcome Measures
Name Time Method Change in Mental Health Knowledge, Attitude, and Behavior Change from Baseline to up to 8 weeks. 13-item self-report questionnaire uses a 5-point Likert scale to ascertain non-specialist health workers' knowledge, attitudes, and behavior about different aspects of mental health. Scores range from 13 to 65, with higher scores indicating greater knowledge and better attitudes and behaviors towards persons living with a mental illness. Lower scores on this measure suggest lower levels of knowledge and greater stigma towards mental illness. This is important to measure because completion of the training program may contribute to improvements in knowledge, attitudes and behaviors about mental health. To assess change in mental health knowledge, attitudes, and behavior between two time points, this measure will be collected at baseline and at up to 8 weeks.
Trial Locations
- Locations (1)
Sangath
🇮🇳Bhopal, Madhya Pradesh, India