The effectiveness of Technology-assisted Cascade Training and Supervision of community health workers in delivering the Thinking Healthy Program for perinatal depression in a post-conflict area of Pakistan - study protocol for a randomized controlled trial

被引:18
作者
Zafar, Shamsa [1 ,2 ]
Sikander, Siham [1 ]
Hamdani, Syed Usman [1 ]
Atif, Najia [1 ]
Akhtar, Parveen [1 ]
Nazir, Huma [1 ]
Maselko, Joanna [3 ]
Rahman, Atif [4 ]
机构
[1] Human Dev Res Fdn, Islamabad, Pakistan
[2] Hlth Serv Acad, Islamabad, Pakistan
[3] Duke Univ, Islamabad, Pakistan
[4] Univ Liverpool, Inst Psychol Hlth & Soc, Manchester, Lancs, England
关键词
Thinking Healthy Program; Conflict settings; Community health workers; Technology-assisted Cascade Training and Supervision; Psychosocial intervention; Perinatal depression; Low and middle income countries; MENTAL-HEALTH; MATERNAL DEPRESSION; SCALING-UP; LOW-INCOME; DISORDERS; COUNTRIES; BEHAVIOR; GROWTH; RISK; WAR;
D O I
10.1186/s13063-016-1308-2
中图分类号
R-3 [医学研究方法]; R3 [基础医学];
学科分类号
1001 ;
摘要
Background: Rates of perinatal depression in low and middle income countries are reported to be very high. Perinatal depression not only has profound impact on women's health, disability and functioning, it is associated with poor child health outcomes such as pre-term birth, under-nutrition and stunting, which ultimately have an adverse trans-generational impact. There is strong evidence in the medical literature that perinatal depression can be effectively managed with psychological treatments delivered by non-specialists. Our previous research in Pakistan led to the development of a successful perinatal depression intervention, the Thinking Healthy Program (THP). The THP is a psychological treatment delivered by community health workers. The burden of perinatal depression can be reduced through scale-up of this proven intervention; however, training of health workers at scale is a major barrier. To enhance access to such interventions there is a need to look at technological solutions to training and supervision. Methods/design: This is a non-inferiority, single-blinded randomized controlled trial. Eighty community health workers called Lady Health Workers (LHWs) working in a post-conflict rural area in Pakistan (Swat) will be recruited through the LHW program. LHWs will be randomly allocated to Technology-assisted Cascade Training and Supervision (TACTS) or to specialist-delivered training (40 in each group). The TACTS group will receive training in THP through LHW supervisors using a tablet-based training package, whereas the comparison group will receive training directly from mental health specialists. Our hypothesis is that both groups will achieve equal competence. Primary outcome measure will be competence of health workers at delivering THP using a modified ENhancing Assessment of Common Therapeutic factors (ENACT) rating scale immediately post training and after 3 months of supervision. Independent assessors will be blinded to the LHW allocation status. Discussion: Women living in post-conflict areas are at higher risk of depression compared to the general population. Implementation of evidence-based interventions for depression in such situations is a challenge because health systems are weak and human resources are scarce. The key innovation to be tested in this trial is a Technology-assisted Cascade Training and Supervision system to assist scale-up of the THP.
引用
收藏
页数:8
相关论文
共 26 条
  • [1] [Anonymous], IDENTIFYING TREATING
  • [2] Analysis and interpretation of cost data in randomised controlled trials: review of published studies
    Barber, JA
    Thompson, SG
    [J]. BRITISH MEDICAL JOURNAL, 1998, 317 (7167) : 1195 - 1200
  • [3] Bile KM, 2009, LANCET, V374, P23
  • [4] Global Mental Health 4 Scale up of services for mental health in low-income and middle-income countries
    Eaton, Julian
    McCay, Layla
    Semrau, Maya
    Chatterjee, Sudipto
    Baingana, Florence
    Araya, Ricardo
    Ntulo, Christina
    Thornicroft, Graham
    Saxena, Shekhar
    [J]. LANCET, 2011, 378 (9802) : 1592 - 1603
  • [5] Representing uncertainty: The role of cost-effectiveness acceptability curves
    Fenwick, E
    Claxton, K
    Sculpher, M
    [J]. HEALTH ECONOMICS, 2001, 10 (08) : 779 - 787
  • [6] Prevalence and determinants of common perinatal mental disorders in women in low- and lower-middle-income countries: a systematic review
    Fisher, Jane
    de Mello, Meena Cabral
    Patel, Vikram
    Rahman, Atif
    Thach Tran
    Holton, Sara
    Holmes, Wendy
    [J]. BULLETIN OF THE WORLD HEALTH ORGANIZATION, 2012, 90 (02) : 139 - 149
  • [7] A Meta-analysis of Depression During Pregnancy and the Risk of Preterm Birth, Low Birth Weight, and Intrauterine Growth Restriction
    Grote, Nancy K.
    Bridge, Jeffrey A.
    Gavin, Amelia R.
    Melville, Jennifer L.
    Iyengar, Satish
    Katon, Wayne J.
    [J]. ARCHIVES OF GENERAL PSYCHIATRY, 2010, 67 (10) : 1012 - 1024
  • [8] Model for Service Delivery for Developmental Disorders in Low-Income Countries
    Hamdani, Syed Usman
    Minhas, Fareed Aslam
    Iqbal, Zafar
    Rahman, Atif
    [J]. PEDIATRICS, 2015, 136 (06) : 1166 - 1172
  • [9] Therapist competence in global mental health: Development of the ENhancing Assessment of Common Therapeutic factors (ENACT) rating scale
    Kohrt, Brandon A.
    Jordans, Mark J. D.
    Rai, Sauharda
    Shrestha, Pragya
    Luitel, Nagendra P.
    Ramaiya, Megan K.
    Singla, Daisy R.
    Patel, Vikram
    [J]. BEHAVIOUR RESEARCH AND THERAPY, 2015, 69 : 11 - 21
  • [10] Scaling up in international health: what are the key issues?
    Mangham, Lindsay J.
    Hanson, Kara
    [J]. HEALTH POLICY AND PLANNING, 2010, 25 (02) : 85 - 96