Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel).
Psychiatr Serv. 2024 Feb 1;75(2):167-177. doi: 10.1176/appi.ps.202100223. Epub 2023 Oct 31.
Task sharing may involve training nonspecialist health workers (NSHWs) to deliver brief mental health interventions. This approach is promising for reducing the global mental health treatment gap. However, capacity is limited for training large cadres of frontline workers in low- and middle-income countries, hindering uptake of these interventions at scale.
The ESSENCE (enabling translation of science to service to enhance depression care) project in Madhya Pradesh, India, aims to address these challenges through two sequential randomized controlled trials. First, a training trial will evaluate the effectiveness and cost-effectiveness of digital training, compared with conventional face-to-face training, in achieving clinical competency of NSHWs in delivering an intervention for depression. This initial trial will be followed by an implementation trial aimed at evaluating the effectiveness of a remote enhanced implementation support, compared with routine implementation support, in addressing barriers to delivery of depression care in primary care facilities.
This project involved developing and pilot testing a scalable smartphone-based program for training NSHWs to deliver a brief psychological intervention for depression screening. This initial research guided a randomized trial of a digital training approach with NSHWs to evaluate the effectiveness of this approach. This trial will be followed by a cluster-randomized trial to evaluate the effectiveness of remote implementation support in ensuring efficient delivery of depression care in primary care facilities.
Findings from these trials may inform sustainable training and implementation support models to integrate depression care into primary care for scale-up in resource-constrained settings.
任务分担可能涉及培训非专业卫生工作者（NSHW）提供简短的心理健康干预措施。这种方法有望减少全球精神卫生治疗差距。然而，在中低收入国家培训大量的一线工作人员的能力有限，这阻碍了这些干预措施的大规模采用。
印度中央邦的 ESSENCE（促进科学转化为服务以加强抑郁症护理）项目旨在通过两项序贯随机对照试验来应对这些挑战。首先，一项培训试验将评估数字培训与传统面对面培训在实现非专业卫生工作者提供抑郁症干预措施的临床能力方面的有效性和成本效益。这项初步试验将随后进行一项实施试验，旨在评估远程强化实施支持与常规实施支持相比，在解决初级保健设施提供抑郁症护理方面的障碍方面的有效性。
该项目涉及开发和试点测试一种可扩展的基于智能手机的程序，用于培训非专业卫生工作者提供简短的心理干预措施进行抑郁症筛查。这项初步研究为针对非专业卫生工作者的数字培训方法进行了一项随机试验，以评估该方法的有效性。该试验将随后进行一项集群随机试验，以评估远程实施支持在确保初级保健设施中有效提供抑郁症护理方面的有效性。
这些试验的结果可能为在资源有限的环境中纳入初级保健中的抑郁症护理提供可持续的培训和实施支持模型提供信息。
