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. 2024 Dec 6:12:1439997.
doi: 10.3389/fpubh.2024.1439997. eCollection 2024.

Development of a remote implementation support strategy to enhance integration of depression treatment into primary care settings in rural India

Gloria A Pedersen  1 , Juliana Restivo Haney  1   2 , Abhishek Singh  3 , Shivangi Choubey  3 , Ameya Bondre  3 , Vorapat Vorapanya  4 , Anant Bhan  3 , Deepak Tugnawat  3 , Vikram Patel  1   5 , John A Naslund  1 , Rohit Ramaswamy  4   6
Affiliations

Development of a remote implementation support strategy to enhance integration of depression treatment into primary care settings in rural India

Gloria A Pedersen et al. Front Public Health. .

Abstract

Introduction: Contextually responsive implementation support strategies are needed to enhance the integration of mental health services into primary health care. Technical assistance is widely used as a core "capacity building" strategy, primarily for increasing the motivation and capacity of individuals (e.g., frontline workers) to adopt evidence-based interventions in healthcare settings. This article documents the systematic design of a technical assistance strategy for supporting primary care staff (e.g., nurses) in integrating depression care, from screening to treatment, aligned with a non-communicable disease program across seven health facilities in the Sehore District of Madhya Pradesh, India.

Methods: We conducted a mapping exercise of local health facilities with dedicated staff and a literature review to inform the development of the technical assistance strategy.

Results: Reporting guidelines guided the structure of the strategy protocol. The evidence-supported strategy, called Remote Coaching Support, is tailored to the local setting. It uses quality improvement methods like the Plan-Do-Act-Study cycle and training materials to help coaches deliver support remotely via video/phone-based calls and WhatsApp messaging with the overall goal of increasing uptake and fidelity of depression screening and referral among primary care staff in alignment with an existing non-communicable diseases program.

Conclusion: The development of Remote Coaching Support involved iterative improvements through team meetings and practice-training feedback, though limitations exist due to a lack of systematic implementation standards, especially in this setting. This strategy will be tested in increasing scales to refine its application, with effectiveness and acceptability results to be evaluated in a randomized control trial.

Keywords: depression; global health; implementation science; mental health; primary care.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Diagram of the proposed “Remote Coaching Support” process.
Figure 2
Figure 2
Decision flow chart to guide coaches in offering support during fortnightly calls.
See this image and copyright information in PMC

References

    1. India State-Level Disease Burden Initiative Mental Disorders Collaborators . The burden of mental disorders across the states of India: the global burden of disease study 1990–2017. Lancet Psychiatry. (2020) 7:148–61. doi: 10.1016/S2215-0366(19)30475-4 - DOI - PMC - PubMed
    1. Arvind BA, Gururaj G, Loganathan S, Amudhan S, Varghese M, Benegal V, et al. Prevalence and socioeconomic impact of depressive disorders in India: multisite population-based cross-sectional study. BMJ Open. (2019) 9:e027250. doi: 10.1136/bmjopen-2018-027250, PMID: - DOI - PMC - PubMed
    1. Wagenaar BH, Hammett WH, Jackson C, Atkins DL, Belus JM, Kemp CG. Implementation outcomes and strategies for depression interventions in low-and middle-income countries: a systematic review. Glob Ment Health. (2020) 7:e7. doi: 10.1017/gmh.2020.1, PMID: - DOI - PMC - PubMed
    1. Whitfield J, Owens S, Bhat A, Felker B, Jewell T, Chwastiak L. Successful ingredients of effective collaborative care programs in low-and middle-income countries: a rapid review. Glob Ment Health. (2023) 10:e11. doi: 10.1017/gmh.2022.60 - DOI - PMC - PubMed
    1. van Ginneken N, Chin WY, Lim YC, Ussif A, Singh R, Shahmalak U, et al. Primary-level worker interventions for the care of people living with mental disorders and distress in low-and middle-income countries. Cochrane Database Syst Rev. (2021) 8:Cd009149. doi: 10.1002/14651858.CD009149.pub3, PMID: - DOI - PMC - PubMed

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