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. 2024 Oct 22:11:e90.
doi: 10.1017/gmh.2024.95. eCollection 2024.

Comparing implementation strategies for training and supervising nonspecialists in Group Problem Management Plus: A hybrid effectiveness-implementation trial in Colombia

M Claire Greene  1 , Diany Castellar  2 , Manaswi Sangraula  3 , Natalia Camargo  4 , Jennifer Diaz  4 , Valeria Meriño  2 , Lucy Miller-Suchet  1 , Ana Maria Chamorro Coneo  4 , Marcela Venegas  5 , Maria Cristobal  6 , David Chávez  7 , Brandon Kohrt  8 , Peter Ventevogel  9 , Miguel Uribe  10 , Marilyn DeLuca  11 , James Shultz  12 , Zelde Espinel  12 , Leslie Snider  13 , Lisa Marsch  14 , Sara Romero  15 , Monica Ferrer  16 , Abel Guerrero Gonzalez  17 , Camilo Ramirez  5 , Ana Maria Trejos Herrera  4 , Matthew Schojan  6 , Annie G Bonz  6 , Adam Brown  3
Affiliations

Comparing implementation strategies for training and supervising nonspecialists in Group Problem Management Plus: A hybrid effectiveness-implementation trial in Colombia

M Claire Greene et al. Glob Ment Health (Camb). .

Abstract

Migrants and refugees face elevated risks for mental health problems but have limited access to services. This study compared two strategies for training and supervising nonspecialists to deliver a scalable psychological intervention, Group Problem Management Plus (gPM+), in northern Colombia. Adult women who reported elevated psychological distress and functional impairment were randomized to receive gPM+ delivered by nonspecialists who received training and supervision by: 1) a psychologist (specialized technical support); or 2) a nonspecialist who had been trained as a trainer/supervisor (nonspecialized technical support). We examined effectiveness and implementation outcomes using a mixed-methods approach. Thirteen nonspecialists were trained as gPM+ facilitators and three were trained-as-trainers. We enrolled 128 women to participate in gPM+ across the two conditions. Intervention attendance was higher in the specialized technical support condition. The nonspecialized technical support condition demonstrated higher fidelity to gPM+ and lower cost of implementation. Other indicators of effectiveness, adoption and implementation were comparable between the two implementation strategies. These results suggest it is feasible to implement mental health interventions, like gPM+, using lower-resource, community-embedded task sharing models, while maintaining safety and fidelity. Further evidence from fully powered trials is needed to make definitive conclusions about the relative cost of these implementation strategies.

Keywords: Colombia; Group PM+; migrants; refugees; task sharing.

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Conflict of interest statement

P.V. is a staff member of the United Nations. The views expressed in this manuscript are those of the authors and do not necessarily reflect the view of the United Nations. The remaining authors have no other competing interests to declare.

Figures

Figure 1.
Figure 1.
Participant flow diagram.
Figure 2.
Figure 2.
Change in participant outcomes over calendar time.
Figure 3.
Figure 3.
Change in participant outcomes over exposure time.
See this image and copyright information in PMC

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