Sivakumar Thanapal, Thirthalli Jagadisha, Kumar C Naveen, Basavarajappa Chethan
Psychiatric Rehabilitation Services, Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
Indian J Psychol Med. 2020 Dec;42(6 Suppl):S73-S79. doi: 10.1177/0253717620971203. Epub 2020 Dec 7.
Task shifting has been recommended as a strategy to reach out to persons with mental illness and bridge the treatment gap. There is a need to explore task-shifting using existing health staff like Accredited Social Health Activists (ASHAs).
ASHAs are involved in ongoing community-based rehabilitation (CBR) program run with a public-private partnership over the last 5 years at Jagaluru Taluk (an administrative block) in Davanagere district (Karnataka, India). This article aims to summarize a randomized controlled trial (RCT) to examine whether CBR delivered by ASHAs is more effective than treatment as usual (TAU) control group in reducing disability associated with severe mental illness (SMI).
A group of proactive ASHAs is already working with us for a follow-up of persons with SMI. For the study, we would allocate areas that are currently not being covered proactively by ASHAs randomly in a 1:1 ratio via computer-generated randomization list to receive either ASHAs delivered CBR arm or TAU control group. A sample size of about 100 in each arm is enough to identify an effect size of 0.5 in total IDEAS score between the intervention and control arms with a power of 90% and an alpha of 0.05. We use the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) statement to describe the methods of the trial.
The study has been approved by the institute ethics committee and registered with CTRI (CTRI/2019/08/020585 dated 6th August 2019). The recruitment of subjects is ongoing. The patients will be followed up for 1 year and assessed. The trial is funded by the Indian Council of Medical Research, Government of India.
The results of the study will be helpful from a public health perspective in delivering cost-effective and replicable CBR for persons with SMI through ASHAs. If the model turns successful, this could be expanded throughout the state/country. This would go a long way in bridging the huge treatment gap.
任务转移已被推荐为一种接触精神疾病患者并弥合治疗差距的策略。有必要探索利用现有卫生工作人员，如经认证的社会健康活动家（ASHAs）来进行任务转移。
在过去五年中，ASHAs参与了在印度卡纳塔克邦达瓦纳吉里区贾加卢鲁乡（一个行政区）通过公私伙伴关系开展的社区康复（CBR）项目。本文旨在总结一项随机对照试验（RCT），以检验ASHAs提供的CBR在减少与严重精神疾病（SMI）相关的残疾方面是否比常规治疗（TAU）对照组更有效。
一组积极主动的ASHAs已与我们合作对SMI患者进行随访。对于本研究，我们将通过计算机生成的随机化列表以1:1的比例随机分配目前ASHAs未主动覆盖的区域，使其接受ASHAs提供的CBR组或TAU对照组。每组约100人的样本量足以在干预组和对照组之间识别出总IDEAS评分中效应大小为0.5，检验效能为90%且α为0.05。我们使用SPIRIT（标准方案项目：干预试验建议）声明来描述试验方法。
该研究已获得研究所伦理委员会批准，并在CTRI注册（CTRI/2019/08/020585，日期为2019年8月6日）。受试者招募正在进行中。患者将接受为期1年的随访并进行评估。该试验由印度政府医学研究理事会资助。
从公共卫生角度来看，该研究结果将有助于通过ASHAs为SMI患者提供具有成本效益且可复制的CBR。如果该模式成功，可在整个邦/国家推广。这将在很大程度上弥合巨大的治疗差距。
