Digital training for non-specialist health workers to deliver a brief psychological treatment for depression in India: Protocol for a three-arm randomized controlled trial

John A Naslund; Deepak Tugnawat; Aditya Anand; Zafra Cooper; Sona Dimidjian; Christopher G Fairburn; Steven D Hollon; Udita Joshi; Azaz Khan; Chunling Lu; Lauren M Mitchell; Shital Muke; Abhijit Nadkarni; Rohit Ramaswamy; Juliana L Restivo; Ritu Shrivastava; Abhishek Singh; Daisy R Singla; Donna Spiegelman; Anant Bhan; Vikram Patel

doi:10.1016/j.cct.2021.106267

Digital training for non-specialist health workers to deliver a brief psychological treatment for depression in India: Protocol for a three-arm randomized controlled trial

Contemp Clin Trials. 2021 Mar:102:106267. doi: 10.1016/j.cct.2021.106267. Epub 2021 Jan 6.

Authors

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

Affiliations

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.

PMID: 33421650
DOI: 10.1016/j.cct.2021.106267

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.

Keywords: Community health workers; Depression; Digital health; Mental health; Task sharing; Training.

Publication types

Clinical Trial Protocol
Research Support, N.I.H., Extramural

MeSH terms

Depression* / therapy
Health Personnel
Health Workforce*
Humans
India
Primary Health Care
Randomized Controlled Trials as Topic
Treatment Outcome

Associated data

ClinicalTrials.gov/NCT04157816

Grants and funding

U19 MH113211/MH/NIMH NIH HHS/United States