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Design and Development of a Digital Program for Training Non-specialist Health Workers to Deliver an Evidence-Based Psychological Treatment for Depression in Primary Care in India

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Abstract

Digital technologies hold promise for building capacity of non-specialist health workers towards scaling up depression care in low-resource settings. The purpose of this study was to describe the systematic approach to designing a digital program for training non-specialist health workers to deliver an evidence-based brief psychological treatment for depression, called the Healthy Activity Program, in primary care in rural India. The design and development of the training program involved 5 steps: (1) develop program blueprint, (2) create instructional content, (3) digitize content for a smartphone app, (4) develop a platform for uploading and hosting the digital content, and (5) user testing and refinements to ensure program functioning. This was followed by field testing and focus group discussions with non-specialist health workers recruited from primary care facilities in Madhya Pradesh, India, to inform further modifications and improvements to the digital training program. Training program development occurred over 12 months, and the final digital training consisted of 16 modules with videos, role-plays, and digital content tailored to the local culture and context. Focus group discussions with 19 non-specialist health workers generated three key action items and modifications to the digital training in response to participant feedback: (1) addressing technical challenges by making the digital content available offline, (2) account for low digital literacy by including a comprehensive orientation session about navigating the smartphone app, and (3) addition of remote coaching to support participants in completing the training. This study illustrates a step-wise approach to combine evidence-based content with iterative feedback from stakeholders to develop a digital training program tailored to the context in a low-resource setting. Further research is needed to validate this approach and to evaluate the effectiveness of the final modified digital training program while considering whether this approach can be adopted and replicated in other settings.

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Acknowledgements

We would like to thank the Ministry of Health and Family Welfare, Government of Madhya Pradesh and National Health Mission, Madhya Pradesh, India, and the National Health System Resource Center (NHSRC), Government of India, New Delhi, India, for facilitating the study. We gratefully acknowledge the contributions made by Sangath colleagues Medha Upadhye, Urvita Bhatia, and Miriam Sequeira for reviewing the scripts, and Deepali Vishwakarma, Pooja Dhurve, Dinesh Chandke, Narendra Verma, and Kamlesh Sharma for supporting the various phases of training program development activities. Also, we are grateful to our research participants—the non-specialist health workers who participated in the development and user testing activities without whom this intervention would not have been possible to finalize. We offer particular thanks to our scientific advisors, collaborators, researchers, and clinicians who have supported our efforts with the ESSENCE project, including Prof. Zafra Cooper, Prof. Christopher Fairburn, Prof. Steven Hollon, Dr. Chunling Lu, Dr. Lauren Mitchell, Dr. Abhijit Nadkarni, Prof. Rohit Ramaswamy, Dr. Daisy Singla, and Prof. Donna Spiegelman.

Funding

This study received financial support from the National Institute of Mental Health, USA.

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Authors and Affiliations

  1. Sangath, Bhopal, Madhya Pradesh, India

    Azaz Khan, Ritu Shrivastava, Deepak Tugnawat, Abhishek Singh, Vikram Patel & Anant Bhan

  2. Department of Psychology and Neuroscience, University of Colorado, Boulder, CO, USA

    Sona Dimidjian

  3. Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA

    Vikram Patel & John A. Naslund

  4. Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA

    Vikram Patel

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  1. Azaz Khan
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  2. Ritu Shrivastava
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  3. Deepak Tugnawat
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  4. Abhishek Singh
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  5. Sona Dimidjian
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  6. Vikram Patel
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  7. Anant Bhan
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  8. John A. Naslund
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Corresponding author

Correspondence to John A. Naslund.

Ethics declarations

All study procedures were approved by ethics review boards at Sangath, India, and Harvard Medical School, USA. Additional Health Ministry Screening Committee (HMSC) approval was obtained from its secretariat at the Indian Council of Medical Research (ICMR).

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The authors declare that they have no conflict of interest.

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Funding for this study was received from the National Institute of Mental Health (Grant number: 5U19MH113211). The funder had no role in the study design; collection, analysis, or interpretation of data; writing of the manuscript; or decision to submit the manuscript for publication.

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Khan, A., Shrivastava, R., Tugnawat, D. et al. Design and Development of a Digital Program for Training Non-specialist Health Workers to Deliver an Evidence-Based Psychological Treatment for Depression in Primary Care in India. J. technol. behav. sci. 5, 402–415 (2020). https://doi.org/10.1007/s41347-020-00154-7

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