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DepressionESSENCENCT04157816

Digital Training for Non-Specialist Health Workers to Deliver a Brief Psychological Treatment for Depression

A study testing Face-to-Face Training, Digital Training and Coaching Support in people with Depression and Mental Disorder, run by Harvard Medical School (HMS and HSDM) at 1 site in India.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The purpose of this 3-arm randomized controlled trial is to compare two forms of digital training (i.e., low-intensity and high-intensity) with traditional face-to-face training of non-specialist health workers to deliver an evidence-based brief psychological treatment for depression called the Healthy Activity… Read more about this study

Who is it for?
Ages 18 years and olderHealthy volunteers can take part
Conditions the study is for
Depression, Mental Disorder, Psychological
What is being tested?
Face-to-Face Training, Digital Training and Coaching Support
Could I receive a placebo?
No, everyone receives an active treatment
How many people
340 participants
Where
1 siteIndia
Study dates
20 Nov 2019to 20 Jun 2021
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • Healthy volunteers accepted
  • Adult, Older adult

Who may be able to join

  • Adult (age ≥18 years)
  • Non-specialist health worker
  • Minimum education level 8th Standard
  • Willingness to complete training to deliver HAP
  • Willingness to stay in the study area during the trial period

Who cannot join

  • Significant speech, sight, or hearing impairment
  • Illiterate/ who cannot read and write
  • Prior participation in the formative research and pilot testing (during the development of the training programs)

Trial locations and contacts

1 site in 1 country.

India1 site
  • Sangath

    Bhopal, Madhya Pradesh, 462016

Other trials in India

About this study

Official title: Digital Compared to Conventional Training for Non-Specialist Health Workers to Deliver a Brief Psychological Treatment for Depression in Primary Care in India: A Three-Arm Randomized Controlled Trial

The purpose of this 3-arm randomized controlled trial is to compare two forms of digital training (i.e., low-intensity and high-intensity) with traditional face-to-face training of non-specialist health workers to deliver an evidence-based brief psychological treatment for depression called the Healthy Activity Program (HAP) in primary care settings in India. This study will evaluate a low-intensity digital training program (DGT) compared with traditional face-to-face training (F2F) on change in competence outcomes and cost-effectiveness. This study will also evaluate a high-intensity digital training program with the addition of individualized coaching support (DGT+) compared with traditional F2F on change in competence outcomes and cost-effectiveness.

Read the detailed description

Few individuals living with depression in India have access to adequate treatment in primary care settings. Task-sharing, which involves building capacity of frontline non-specialist health workers to deliver evidence-based treatment for common mental disorders such as depression, is an effective approach for bridging these gaps in available care. This emphasizes the need for novel approaches to scale up training efforts and to support the development of a skilled and competent workforce capable of delivering high quality treatment for depression in primary care settings. Therefore, the purpose of this study is to compare two forms of digital training (i.e., low-intensity and high-intensity) with traditional face-to-face training of non-specialist health workers to deliver an evidence-based brief psychological treatment for depression called the Healthy Activity Program (HAP) in primary care settings in India. This trial uses a 3-arm randomized controlled design. This study will evaluate a low-intensity digital training (DGT) compared with traditional face-to-face training (F2F) on change in competence outcomes and cost-effectiveness; and evaluate a high-intensity digital training with the addition of individualized coaching support (DGT+) compared with traditional F2F on change in competence outcomes and cost-effectiveness. In this trial, a total of 336 non-specialist health workers will be recruited from community health centers in Sehore District of Madhya Pradesh, a large and predominantly rural state situated in central India. This trial will generate knowledge on the most effective and cost-effective approaches to address the critical knowledge gap regarding the training of non-specialist health workers to deliver an evidence-based brief psychological treatment for depression in a low-resource setting. The findings from this trial will inform broader efforts to develop a mental health workforce necessary for scaling up brief psychological therapies for common mental disorders.

Being tested
Face-to-Face Training, Digital Training, Coaching Support
Keywords
health worker training, non-specialist health worker, community health worker, task sharing, common mental disorders, low-resource setting, primary care, global mental health, digital technology, mobile health
Medical subject headings
Depression, Mental Disorders

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Face-to-Face TrainingOther

    This intervention is a traditional classroom-based (face-to-face) training program for non-specialist health workers offering instruction for the delivery of the Healthy Activity Program (HAP) in primary care settings. HAP is an evidence-based brief psychological treatment for depression. The classroom instruction follows the HAP manuals and is facilitated by an experienced counselor with certification as a Master Trainer, meaning that they have significant experience delivering HAP to patients with depression in clinical settings and also training other health workers in the delivery HAP. The total duration of classroom instruction is 6 days.

  • Digital TrainingOther

    This 4-week digital training program for non-specialist health workers is accessed through a smart phone app and offers instruction in the delivery of the Healthy Activity Program (HAP) in primary care settings. HAP is an evidence-based brief psychological treatment for depression. The digital training covers the same content as the Face-to-Face training. The course includes 16 modules with video lectures, role-play videos, graphics, slide presentations, quizzes, and assessment questions. Participants also receive low-intensity support to enhance their learning experience and sustain engagement, including: 1) access to an automated 'Help Line' that participants can call any time with questions about the program; 2) weekly automated messages sent through the mobile app to encourage participants; and 3) automated messages and phone calls to participants who show prolonged periods of inactivity in the mobile app to offer technical support and help them complete the training program.

  • Coaching SupportOther

    Individualized remote coaching is a form of high-intensity support that will be used to help sustain participant engagement in the digital training program and promote success in progressing through the course. Each week, a Coach will phone participants and offer encouragement and support related to the course. The phone call will last no more than 60 minutes. The Coach will be someone who has successfully completed the course, and therefore can offer first hand knowledge of the content. During the coaching session, the coach will review the participants' progress through the course, offer praise and encouragement, discuss any challenges or questions related to the course content, and review the participants' goals and plans for the upcoming week. Each participant will receive a maximum of 4 remote coaching sessions (1 per week over the 4-week training program).

Study groups in NCT04157816
Study groupRoleWhat they receive
Digital Training (DGT)ExperimentalParticipants allocated to this arm receive a low-intensity digital program accessible by smart phone app for training non-specialist health workers to deliver an evidence-based brief psychological treatment for depression, called the Healthy Activity Program (HAP), in primary care settings in India.
Receives: Other: Digital Training
Digital Training with Coaching Support (DGT+)ExperimentalParticipants allocated to this arm receive a high-intensity digital program accessible by smart phone app augmented with weekly telephone coaching support for training non-specialist health workers to deliver an evidence-based brief psychological treatment for depression, called the Healthy Activity Program (HAP), in primary care settings in India.
Receives: Other: Digital Training; Other: Coaching Support
Face-to-Face TrainingActive comparatorParticipants allocated to this arm receive a traditional classroom-based (face-to-face) program hosted in community settings for training non-specialist health workers to deliver an evidence-based brief psychological treatment for depression, called the Healthy Activity Program (HAP), in primary care settings in India.
Receives: Other: Face-to-Face Training

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Change in Competency

    26-item multiple choice exam to assess the competency of the non-specialist health workers in delivering the Healthy Activity Program (HAP) after training. The measure consists of clinical vignettes followed by multiple-choice questions focused predominantly on assessing applied knowledge. Scores on the measure range from 0 to 26, with higher scores indicating higher levels of competency for delivering HAP. There are three different equivalent versions of this 26-item measure, and each participant will be assessed randomly with one of these at each of the two time points, ensuring that the same test is not used twice.To assess change in competency between two time points, this measure will be collected at baseline and at up to 8 weeks.

    Measured: Change from Baseline to up to 8 weeks.

Secondary outcomes (1)
  1. Change in Mental Health Knowledge, Attitude, and Behavior

    13-item self-report questionnaire uses a 5-point Likert scale to ascertain non-specialist health workers' knowledge, attitudes, and behavior about different aspects of mental health. Scores range from 13 to 65, with higher scores indicating greater knowledge and better attitudes and behaviors towards persons living with a mental illness. Lower scores on this measure suggest lower levels of knowledge and greater stigma towards mental illness. This is important to measure because completion of the training program may contribute to improvements in knowledge, attitudes and behaviors about mental health. To assess change in mental health knowledge, attitudes, and behavior between two time points, this measure will be collected at baseline and at up to 8 weeks.

    Measured: Change from Baseline to up to 8 weeks.

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted8 Nov 2019
  2. Study start20 Nov 2019
  3. Primary completion20 Jun 2021
  4. Study completion20 Jun 2021

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Health services research
Allocation
Randomised
Intervention model
Parallel groups
Model description
This study employs a 3-arm parallel randomized controlled trial design. Participants are randomly allocated to one of three training interventions: 1) low-intensity digital training (DGT); 2) high-intensity digital training with additional coaching support (DGT+); and 3) traditional face-to-face training (F2F).
Masking
Double blind
Who is masked
Investigator, Outcomes assessor
Enrolment
340 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04157816
Sponsor's protocol ID
U19MH113211-03
Acronym
ESSENCE
Status last verified
Aug 2021
First submitted
3 Nov 2019
Last updated
18 Aug 2021
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: Individual participant data (IPD) from this trial will be shared with the scientific community according to the National Institute of Mental Health (NIMH) Data Archive Data Sharing terms and conditions. Data will have all direct or indirect identifiable information removed before being submitted to the NIMH Data Archive (NDA). After the trial, the investigators will send de-identified information from participants to NDA. Researchers can access this de-identified data by submitting a request to NIMH. Data sharing with NDA offers no direct benefit to participants, though the information provided to NDA may help researchers around the world treat future mental health challenges so that they have better outcomes. Study participants can choose not to have their de-identified data shared with NDA. These details about data sharing with NDA are described in the participant consent form, and additional information is available at the NDA website.

Publications

  • Patel V, Weobong B, Weiss HA, Anand A, Bhat B, Katti B, Dimidjian S, Araya R, Hollon SD, King M, Vijayakumar L, Park AL, McDaid D, Wilson T, Velleman R, Kirkwood BR, Fairburn CG. The Healthy Activity Program (HAP), a lay counsellor-delivered brief psychological treatment for severe depression, in primary care in India: a randomised controlled trial. Lancet. 2017 Jan 14;389(10065):176-185. doi: 10.1016/S0140-6736(16)31589-6. Epub 2016 Dec 15.

    PubMed 27988143
  • Muke SS, Shrivastava RD, Mitchell L, Khan A, Murhar V, Tugnawat D, Shidhaye R, Patel V, Naslund JA. Acceptability and feasibility of digital technology for training community health workers to deliver brief psychological treatment for depression in rural India. Asian J Psychiatr. 2019 Oct;45:99-106. doi: 10.1016/j.ajp.2019.09.006. Epub 2019 Sep 7.

    PubMed 31557716
  • Muke SS, Tugnawat D, Joshi U, Anand A, Khan A, Shrivastava R, Singh A, Restivo JL, Bhan A, Patel V, Naslund JA. Digital Training for Non-Specialist Health Workers to Deliver a Brief Psychological Treatment for Depression in Primary Care in India: Findings from a Randomized Pilot Study. Int J Environ Res Public Health. 2020 Sep 1;17(17):6368. doi: 10.3390/ijerph17176368.

    PubMed 32883018
  • Naslund JA, Tugnawat D, Anand A, Cooper Z, Dimidjian S, Fairburn CG, Hollon SD, Joshi U, Khan A, Lu C, Mitchell LM, Muke S, Nadkarni A, Ramaswamy R, Restivo JL, Shrivastava R, Singh A, Singla DR, Spiegelman D, Bhan A, Patel V. 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.

    PubMed 33421650
  • Joshi U, Haney JR, Sequeira M, Singla DR, Patel V, Bhan A, Cooper Z, Naslund JA. Adaptation and translation of a scalable measure for assessing health worker competence to deliver a brief psychological intervention: A case study from central India of its comparison to a performance-based measure. Psychiatr Q. 2023 Mar;94(1):33-47. doi: 10.1007/s11126-022-10007-6. Epub 2022 Dec 20.

    PubMed 36536268

Questions about this trial

What is this clinical trial studying?

A study testing Face-to-Face Training, Digital Training and Coaching Support in people with Depression and Mental Disorder, run by Harvard Medical School (HMS and HSDM) at 1 site in India.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 3 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 18 Aug 2021. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in India. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Change in Competency (time frame: Change from Baseline to up to 8 weeks.). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04157816, which also lists 5 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 18 Aug 2021.

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