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Using Technology to Scale-up Training and Supervision of Community Health Workers in the Psychosocial Management of Perinatal Depression: A Non-Inferiority, Randomized Controlled Trial

Citation

Rahman, Atif; Akhtar, Parveen; Hamdani, Syed Usman; Atif, Najia; Nazir, Huma; Uddin, Iftikhar; Nisar, Anum; Huma, Zille; Maselko, Joanna; & Sikander, Siham, et al. (2019). Using Technology to Scale-up Training and Supervision of Community Health Workers in the Psychosocial Management of Perinatal Depression: A Non-Inferiority, Randomized Controlled Trial. Global Mental Health, 6, e8. PMCID: PMC6533850

Abstract

Background: The Thinking Healthy Programme (THP) is an evidence-based psychological intervention endorsed by the World Health Organization, tailored for non-specialist health workers in low- and middle-income countries. However, training and supervision of large numbers of health workers is a major challenge for the scale-up of THP. We developed a 'Technology-Assisted Cascaded Training and Supervision system' (TACTS) for THP consisting of a training application and cascaded supervision delivered from a distance.
Methods: A single-blind, non-inferiority, randomized controlled trial was conducted in District Swat, a post-conflict area of North Pakistan. Eighty community health workers (called Lady Health Workers or LHWs) were randomly assigned to either TACTS or conventional face-to-face training and supervision by a specialist. Competence of LHWs in delivering THP post-training was assessed by independent observers rating a therapeutic session using a standardized measure, the 'Enhancing Assessment of Common Therapeutic factors' (ENACT), immediately post-training and after 3 months. ENACT uses a Likert scale to score an observed interaction on 18 dimensions, with a total score of 54, and a higher score indicating greater competence.
Results: Results indicated no significant differences between health workers trained using TACTS and supervised from distance v. those trained and supervised by a specialist face-to-face (mean ENACT score M = 24.97, s.d. = 5.95 v. M = 27.27, s.d. = 5.60, p = 0.079, 95% CI 4.87-0.27) and at 3 months follow-up assessment (M = 44.48, s.d. = 3.97 v. M = 43.63, s.d. = 6.34, p = 0.53, CI -1.88 to 3.59).
Conclusions: TACTS can provide a promising tool for training and supervision of front-line workers in areas where there is a shortage of specialist trainers and supervisors.

URL

http://dx.doi.org/10.1017/gmh.2019.7

Reference Type

Journal Article

Year Published

2019

Journal Title

Global Mental Health

Author(s)

Rahman, Atif
Akhtar, Parveen
Hamdani, Syed Usman
Atif, Najia
Nazir, Huma
Uddin, Iftikhar
Nisar, Anum
Huma, Zille
Maselko, Joanna
Sikander, Siham
Zafar, Shamsa

PMCID

PMC6533850