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Tugnawat D, Singh A, Anand A, Bondre A, Chandke D, Dhurve P, Joshi U, Khan A, Muke S, Negi B, Nikhare K, Rathore D, Ramaswamy R, Haney JR, Sen Y, Sharma K, Shrivastava R, Verma N, Vishwakarma R, Vishwakarma D, Vorapanya V, Patel V, Bhan A, Naslund JA. ESSENCE: An Implementation Research Program to Scale Up Depression Care in Rural Communities. Psychiatr Serv 2024; 75:167-177. [PMID: 37904491 DOI: 10.1176/appi.ps.202100223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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. NEXT STEPS 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.
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Affiliation(s)
- Deepak Tugnawat
- 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)
| | - Abhishek Singh
- 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)
| | - Aditya Anand
- 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)
| | - Ameya Bondre
- 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)
| | - Dinesh Chandke
- 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)
| | - Pooja Dhurve
- 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)
| | - Udita Joshi
- 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)
| | - Azaz Khan
- 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)
| | - Shital Muke
- 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)
| | - Babita Negi
- 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)
| | - Kalyani Nikhare
- 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)
| | - Dharmendra Rathore
- 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)
| | - Rohit Ramaswamy
- 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)
| | - Juliana Restivo Haney
- 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)
| | - Yogendra Sen
- 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)
| | - Kamlesh Sharma
- 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)
| | - Ritu Shrivastava
- 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)
| | - Narendra Verma
- 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)
| | - Ram Vishwakarma
- 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)
| | - Deepali Vishwakarma
- 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)
| | - Vorapat Vorapanya
- 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)
| | - Vikram Patel
- 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)
| | - Anant Bhan
- 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)
| | - John A Naslund
- 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)
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Shrivastava R, Singh A, Khan A, Choubey S, Haney JR, Karyotaki E, Tugnawat D, Bhan A, Naslund JA. Stress Alleviation Methods for community-Based Health ActiVists (SAMBHAV): Development of a digital program for stress reduction for community health workers in rural India. SSM - MENTAL HEALTH 2023; 4:100230. [PMID: 38188869 PMCID: PMC10769151 DOI: 10.1016/j.ssmmh.2023.100230] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024] Open
Abstract
Background Community health workers (CHWs) face high levels of stress (both professional and personal) and risk of burnout, highlighting the need for efforts to promote their mental health and well-being. This study seeks to develop a digital stress reduction program for CHWs in rural India. Methods A stepwise design process was employed to adapt and digitize the evidence-based World Health Organization's Self-Help Plus (SH+) intervention for addressing psychological distress among CHWs in Madhya Pradesh, India. This involved participatory design workshops with CHWs to ensure that the digital stress reduction intervention would be relevant for their needs and the local culture and context. Small groups of CHWs reviewed the adapted program content, allowing the research team to make refinements such as simplifying language, tailoring content to the local setting, and ensuring that program materials are both interesting and relevant. Simultaneously, the research team digitized the content, leveraging a combination of video and graphical content, and uploaded it to the Sangath Learning Management System, a digital platform accessible on a smartphone app. Results In total, 18 CHWs contributed to the adaptation of the SH+ content and digital intervention development. Participants commented on finding some terms difficult to follow and recommended simplifying the language and providing detailed explanations. Participants offered positive feedback on the adapted content, expressing that they found the examples covered in the material both relatable and relevant to their own personal experiences at home and in the workplace. By combining participants' insights and comments with feedback from content experts, it was possible to finalize a digital Hindi version of the SH+ intervention for CHWs in rural India. Conclusions This study is timely given the continued detrimental impacts of the COVID-19 pandemic, and offers a promising and potentially scalable digital program to alleviate psychological distress among frontline health workers.
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Affiliation(s)
| | | | | | | | | | - Eirini Karyotaki
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | | | - John A. Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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Perret S, Alon N, Carpenter-Song E, Myrick K, Thompson K, Li S, Sharma K, Torous J. Standardising the role of a digital navigator in behavioural health: a systematic review. Lancet Digit Health 2023; 5:e925-e932. [PMID: 38000876 DOI: 10.1016/s2589-7500(23)00152-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 07/26/2023] [Accepted: 07/28/2023] [Indexed: 11/26/2023]
Abstract
As the number and availability of digital mental health tools increases, patients and clinicians see benefit only when these tools are engaging and well integrated into care. Digital navigators-ie, members of health-care teams who are dedicated to supporting patient use of digital resources-offer one solution and continue to be piloted in behavioural health; however, little is known about the core features of this position. The aims of this systematic review were to assess how digital navigators are implemented in behavioural health, and to provide a standardised definition of this position. In January, 2023, we conducted a systematic literature search resulting in 48 articles included in this systematic review. Results showed high heterogeneity between four attributes of digital navigators: training specifications, educational background, frequency of communication, and method of communication with patients. Reported effect sizes for depression and anxiety were medium to large, but could not be synthesised due to study heterogeneity and small study sample size. This systematic review was registered with PROSPERO (CRD42023391696). Results suggest that digital navigator support can probably increase access to, engagement with, and clinical integration of digital health technology, with standards for training and defined responsibilities now emerging.
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Affiliation(s)
- Sarah Perret
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Noy Alon
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Keris Myrick
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Kennedy Thompson
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Sunnie Li
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Karuna Sharma
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - John Torous
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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Mathur S, Weiss HA, Neuman M, Leurent B, Field AP, Shetty T, J. JE, Nair P, Mathews R, Malik K, Michelson D, Patel V. Developing knowledge-based psychotherapeutic competencies in non-specialist providers: A pre-post study with a nested randomised controlled trial of a coach-supported versus self-guided digital training course for a problem-solving psychological intervention in India. Glob Ment Health (Camb) 2023; 10:e87. [PMID: 38161749 PMCID: PMC10755375 DOI: 10.1017/gmh.2023.81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 11/14/2023] [Accepted: 11/17/2023] [Indexed: 01/03/2024] Open
Abstract
We evaluated a digital learning programme for non-specialists to develop knowledge-based competencies in a problem-solving intervention for adolescents to examine the overall impact of training on knowledge-based competencies among learners; and to compare the effects of two training conditions (self-guided digital training with or without coaching) in a nested parallel, two-arm, individually randomised controlled trial. Eligible participants were 18 or older; fluent in Hindi or English; able to access digital training; and had no prior experience of delivering structured psychotherapies. 277 participants were enrolled from 31 March 2022 to 19 June 2022 of which 230 (83%) completed the study. There was a significant increase in competency score from pre-training (Mean = 7.01, SD = 3.29) to post-training (Mean = 8.88, SD = 3.80), 6 weeks after the pre-training assessment. Knowledge competency scores showed larger increase among participants randomised to the coaching arm (AMD = 1.09, 95% CI 0.26-1.92, p = 0.01) with an effect size (d) of 0.33 (95% CI 0.08-0.58). More participants completed training in the coaching arm (n = 96, 69.6%) compared to the self-guided training arm (n = 56, 40.3%). In conclusion, a coach-supported remote digital training intervention is associated with enhanced participation by learners and increased psychotherapeutic knowledge competencies.
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Affiliation(s)
| | - Helen A. Weiss
- Medical Research Council International Statistics and Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Melissa Neuman
- Medical Research Council International Statistics and Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Baptiste Leurent
- Department of Statistical Science, University College London, London, UK
| | - Andy P. Field
- School of Psychology, University of Sussex, Brighton, UK
| | | | | | | | | | - Kanika Malik
- Jindal School of Psychology and Counselling, O.P. Jindal Global University, Sonipat, India
| | - Daniel Michelson
- School of Psychology, University of Sussex, Brighton, UK
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Luitel NP, Pudasaini K, Pokhrel P, Lamichhane B, Gautam K, Adhikari S, Makhmud A, Taylor Salisbury T, Votruba N, Green E, Chowdhary N, Jordans MJ, Kohrt BA, Dua T, Thornicroft G, Carswell K. Development and functioning of the mobile app-based mh-GAP intervention guide in detection and treatment of people with mental health conditions in primary healthcare settings in Nepal. Glob Ment Health (Camb) 2023; 10:e90. [PMID: 38161752 PMCID: PMC10755379 DOI: 10.1017/gmh.2023.69] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 09/12/2023] [Accepted: 10/26/2023] [Indexed: 01/03/2024] Open
Abstract
This paper describes the development process of a mobile app-based version of the World Health Organization mental health Gap Action Programme Intervention Guide, testing of the app prototypes, and its functionality in the assessment and management of people with mental health conditions in Nepal. Health workers' perception of feasibility and acceptability of using mobile technology in mental health care was assessed during the inspiration phase (N = 43); the ideation phase involved the creation of prototypes; and prototype testing was conducted over multiple rounds with 15 healthcare providers. The app provides provisional diagnoses and treatment options based on reported symptoms. Participants found the app prototype useful in reminding them of the process of assessment and management of mental disorders. Some challenges were noted, these included a slow app prototype with multiple technical problems, including difficulty in navigating 'yes'/'no' options, and there were challenges reviewing detailed symptoms of a particular disorder using a "more information" icon. The initial feasibility work suggests that if the technical issues are addressed, the e-mhGAP warrants further research to understand if it is a useful method in improving the detection of people with mental health conditions and initiation of evidence-based treatment in primary healthcare facilities.
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Affiliation(s)
- Nagendra P. Luitel
- Center for Global Mental Health Equity, Department of Psychiatry and Behavioral Health, George Washington University, Washington, DC, USA
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Nepal
| | - Kriti Pudasaini
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Nepal
| | - Pooja Pokhrel
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Nepal
| | - Bishnu Lamichhane
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Nepal
| | - Kamal Gautam
- Center for Global Mental Health Equity, Department of Psychiatry and Behavioral Health, George Washington University, Washington, DC, USA
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Nepal
| | - Sandarba Adhikari
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Nepal
| | - Akerke Makhmud
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychology, Psychiatry & Neuroscience, King’s College London, London, UK
| | - Tatiana Taylor Salisbury
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychology, Psychiatry & Neuroscience, King’s College London, London, UK
| | - Nicole Votruba
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychology, Psychiatry & Neuroscience, King’s College London, London, UK
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford, UK
- The George Institute for Global Health UK, Imperial College London, London, UK
| | - Eric Green
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Neerja Chowdhary
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Mark J.D. Jordans
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Nepal
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychology, Psychiatry & Neuroscience, King’s College London, London, UK
| | - Brandon A. Kohrt
- Center for Global Mental Health Equity, Department of Psychiatry and Behavioral Health, George Washington University, Washington, DC, USA
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Nepal
| | - Tarun Dua
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Graham Thornicroft
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychology, Psychiatry & Neuroscience, King’s College London, London, UK
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychology, Psychiatry & Neuroscience, King’s College London, London, UK
| | - Kenneth Carswell
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
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Alon N, Perret S, Torous J. Working towards a ready to implement digital literacy program. Mhealth 2023; 9:32. [PMID: 38023777 PMCID: PMC10643183 DOI: 10.21037/mhealth-23-13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 08/17/2023] [Indexed: 12/01/2023] Open
Abstract
Background As healthcare continues to expand online and digital care offerings multiply, the importance of digital inclusion and equity is now better recognized. Yet despite impressive regional grassroots efforts, today there remain few readily deployable programs designed to support patient digital literacy. Methods Digital Outreach for Obtaining Resources and Skills (DOORs) is one such digital literacy program that has evolved over the last 5 years to meet the rising demand. Through community partnerships, the DOORs curriculum and delivery has been updated to make the program more accessible and applicable as Coronavirus Disease 2019 (COVID-19) changes healthcare. Participants' experience in the most updated iteration of DOORS was assessed through surveys and semi-structured interviews. Results Improvements to DOORs include an updated DOORs curriculum, updated facilitator manual, an online platform with a learning management system, standardized training, patient-facing educational handouts, consolidation of all DOORs materials into a single package that is ready to be shared with other groups, implementation of a single-session intervention model, and Spanish translation. Participants reported improved confidence on 72% of the digital skills assessed. Thematic analysis resulted in three themes: awareness of divide, patient-centered design, and expanded skills and confidence. Conclusions Combined, these changes and participant outcomes better position DOORS to meet the rising need for digital literacy and offers a scalable model for teams across the world.
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Affiliation(s)
- Noy Alon
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Sarah Perret
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - John Torous
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Tyagi V, Khan A, Siddiqui S, Kakra Abhilashi M, Dhurve P, Tugnawat D, Bhan A, Naslund JA. Development of a Digital Program for Training Community Health Workers in the Detection and Referral of Schizophrenia in Rural India. Psychiatr Q 2023; 94:141-163. [PMID: 36988785 PMCID: PMC10052309 DOI: 10.1007/s11126-023-10019-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/12/2023] [Indexed: 03/30/2023]
Abstract
This study aimed to develop and assess the acceptability of a digital program for training community health workers (CHWs) in the detection and referral of patients with schizophrenia in community settings in rural India. An iterative design process was employed. First, evidence-based content from existing community programs for schizophrenia care was incorporated into the curriculum, and reviewed by experts to ensure clinical utility and fidelity of the adapted content. Second, CHWs provided feedback on the appropriateness of language, content, and an initial prototype of the digital training program to ensure relevance for the local context. Focus group discussions were then used to understand the acceptability of the digital training prototype and to inform modifications to the design and layout. Qualitative data was analysed using a rapid thematic analysis approach based on predetermined topics pertaining to acceptability of the training content and digital platform. Development of the initial prototype involved content review by 13 subject matter experts with clinical expertise or experience accessing and receiving mental health services, and engagement of 23 CHWs, of which 11 provided feedback for contextualization of the training content and 12 participated in focus group discussions on the acceptability of the prototype. Additionally, 2 service-users with lived experience of schizophrenia contributed to initial testing of the digital training prototype and offered feedback in a focus group discussion. During contextualization of the training content, key feedback pertained to simplifying the language and presentation of the content by removing technical terms and including interactive content and images to enhance interest and engagement with the digital training. During prototype testing, CHWs shared their familiarity with similar symptoms but were unaware of schizophrenia as a treatable illness. They shared that training can help them identify symptoms of schizophrenia and connect patients with specialized care. They were also able to understand misconceptions and discrimination towards people with schizophrenia, and how to address these challenges by supporting others and spreading awareness in their communities. Participants also appreciated the digital training, as it could save them time and could be incorporated within their routine work. This study shows the acceptability of leveraging digital technology for building capacity of CHWs to support early detection and referral of schizophrenia in community settings in rural India. These findings can inform the subsequent evaluation of this digital training program to determine its impact on enhancing the knowledge and skills of CHWs.
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Affiliation(s)
| | | | | | | | | | | | | | - John A Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA, USA.
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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; 94:33-47. [PMID: 36536268 DOI: 10.1007/s11126-022-10007-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/12/2022] [Indexed: 12/24/2022]
Abstract
Efforts to reduce the global burden of common mental disorders have focused on scaling up evidence-based training programs for non-specialist providers to deliver brief psychological interventions. To evaluate these provider training programs, appropriate and scalable assessments of competency need to be developed alongside them. We followed a systematic approach for the cultural adaptation and translation into Hindi of a valid, English, multiple-choice applied knowledge measure to assess non-specialists' competence to deliver a brief psychological intervention for depression in rural India. We then explored the relationship between the performance of 30 non-specialist providers on the same written measure compared with a structured performance-based measure consisting of two role-plays. The results of the multiple-choice assessment had an overall mean score of 37.40 (SD = 11.31) compared to the mean scores of role-play A (the easier role-play) of 43.25 (SD = 14.50) and role-play B (the more difficult role-play) of 43.25 (SD = 13.00). Role-play performance-based measures and written applied knowledge measures represent different approaches with unique strengths and challenges to measuring competence. Scaling up training programs requires the development of scalable methods for competency assessment. Exploring the relationship between these two measures, our team found no apparent differences between the two modes of assessment. Continued comparison of these approaches is needed to determine the consistency of outcomes across the two formats and to link the scores on these measures with clinical performance as reflected by the quality of care and patient outcomes.Trial Registration: ClinicalTrials.gov Identifier: NCT04157816; 8th November 2019.
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Affiliation(s)
| | - Juliana Restivo Haney
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Ave, 02115, Boston, MA, USA
| | | | - Daisy R Singla
- Campbell Family Mental Health Research Institute, Center of Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Lunenfeld Tanenbaum Research Institute, Sinai Health, Toronto, Canada
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Ave, 02115, Boston, MA, USA
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Zafra Cooper
- Department of Psychiatry, Yale School of Medicine, New Haven, USA
| | - John A Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Ave, 02115, Boston, MA, USA.
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9
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Black CJ, Berent JM, Joshi U, Khan A, Chamlagai L, Shrivastava R, Gautam B, Negeye A, Iftin AN, Ali H, Desrosiers A, Bhan A, Bhattacharya S, Naslund JA, Betancourt TS. Applying Human-Centered Design in Global Mental Health to Improve Reach Among Underserved Populations in the United States and India. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:GHSP-D-22-00312. [PMID: 36853639 PMCID: PMC9972370 DOI: 10.9745/ghsp-d-22-00312] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 01/24/2023] [Indexed: 03/01/2023]
Abstract
INTRODUCTION Human-centered design (HCD) refers to a diverse suite of interactive processes that engage end users in the development of a desired outcome. We showcase how 2 global mental health research teams applied HCD to develop mobile health tools, each directed at reducing treatment gaps in underserved populations. CASE STUDY 1: Refugees face higher risks for mental health problems, yet these communities face structural and cultural barriers that reduce access to and use of services. To address these challenges, the Research Program on Children and Adversity at the Boston College School of Social Work, in partnership with resettled refugee communities in the northeastern United States, used codesign methodology to digitally adapt delivery of the Family Strengthening Intervention for Refugees-a program designed to improve mental health and family functioning among resettled families. We describe how codesign methods support the development of more feasible, acceptable, and sustainable interventions. CASE STUDY 2: Sangath, an NGO in India focused on mental health services research, in partnership with Harvard Medical School, designed and evaluated a digital training program for community health workers to deliver an evidence-based, brief psychological treatment for depression as part of primary care in Madhya Pradesh, India. We describe how HCD was applied to program development and discuss our approach to scaling up training and capacity-building to deliver evidence-based treatment for depression in primary care. IMPLICATIONS HCD involves a variety of techniques that can be flexibly adapted to engage end users in the conceptualization, implementation, scale-up, and sustainment of global mental health interventions. Community solutions generated using HCD offer important benefits for key stakeholders. We encourage widespread adoption of HCD within global mental health policy, research, and practice, especially for addressing mental health disparities with underserved populations.
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Affiliation(s)
- Candace J. Black
- Research Program on Children and Adversity, School of Social Work, Boston College, Boston, MA, USA.,Correspondence to Candace J. Black ()
| | - Jenna M. Berent
- Research Program on Children and Adversity, School of Social Work, Boston College, Boston, MA, USA
| | - Udita Joshi
- Bangalore Hospice Trust – Karunashraya Institute for Palliative Care Education and Research, Bangalore, India.,Sangath, Bhopal, India
| | | | - Lila Chamlagai
- Community member from the resettled Bhutanese community, Springfield, MA, USA
| | | | - Bhuwan Gautam
- Research Program on Children and Adversity, School of Social Work, Boston College, Boston, MA, USA.,Community member from the resettled Bhutanese community, Springfield, MA, USA
| | - Abdikadir Negeye
- Community member from the resettled Somali Bantu community, Lewiston, ME, USA
| | - Abdi Nor Iftin
- Community member from the resettled Somali Bantu community, Lewiston, ME, USA
| | - Halimo Ali
- Community member from the resettled Somali Bantu community, Lewiston, ME, USA
| | - Alethea Desrosiers
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | | | | | - John A. Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Cambridge, MA, USA
| | - Theresa S. Betancourt
- Research Program on Children and Adversity, School of Social Work, Boston College, Boston, MA, USA
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Scaling up person-centered psychosocial interventions: Global mental Health’s next challenge. SSM - MENTAL HEALTH 2022. [DOI: 10.1016/j.ssmmh.2022.100072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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11
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Naslund JA, Tyagi V, Khan A, Siddiqui S, Kakra Abhilashi M, Dhurve P, Mehta UM, Rozatkar A, Bhatia U, Vartak A, Torous J, Tugnawat D, Bhan A. Schizophrenia Assessment, Referral and Awareness Training for Health Auxiliaries (SARATHA): Protocol for a Mixed-Methods Pilot Study in Rural India. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14936. [PMID: 36429654 PMCID: PMC9690971 DOI: 10.3390/ijerph192214936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/05/2022] [Accepted: 11/09/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Workforce shortages pose major obstacles to the timely detection and treatment of schizophrenia, particularly in low-income and middle-income countries. The SARATHA (Schizophrenia Assessment, Referral, and Awareness Training for Health Auxiliaries) project involves the systematic development, iterative refinement, and pilot testing of a digital program for training community health workers in the early detection and referral of schizophrenia in primary care settings in rural India. METHODS SARATHA is a three-phase study. Phase 1 involves consulting with experts and clinicians, and drawing from existing evidence to inform the development of a curriculum for training community health workers. Phase 2 consists of designing and digitizing the training content for delivery on a smartphone app. Design workshops and focus group discussions will be conducted to seek input from community health workers and service users living with schizophrenia to guide revisions and refinements to the program content. Lastly, Phase 3 entails piloting the training program with a target sample of 20 community health workers to assess feasibility and acceptability. Preliminary effectiveness will be explored, as measured by community health workers' changes in knowledge about schizophrenia and the program content after completing the training. DISCUSSION If successful, this digital training program will offer a potentially scalable approach for building capacity of frontline community health workers towards reducing delays in early detection of schizophrenia in primary care settings in rural India. This study can inform efforts to improve treatment outcomes for persons living with schizophrenia in low-resource settings.
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Affiliation(s)
- John A. Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA
| | | | | | - Saher Siddiqui
- Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | | | | | - Urvakhsh Meherwan Mehta
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru 560029, India
| | - Abhijit Rozatkar
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), Bhopal 462026, India
| | - Urvita Bhatia
- Department of Psychology, Health and Professional Development, Oxford Brookes University, Oxford OX3 0BP, UK
- Sangath, Porvorim 403501, India
| | - Anil Vartak
- Schizophrenia Awareness Association, Pune 411041, India
| | - John Torous
- Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
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12
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Innovations in Psychotherapy. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2022; 20:318-319. [PMID: 37205023 PMCID: PMC10172525 DOI: 10.1176/appi.focus.22020008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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13
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Patel V, Naslund JA, Wood S, Patel A, Chauvin JJ, Agrawal R, Bhan A, Joshi U, Amara M, Kohrt BA, Singla DR, G. Fairburn C. EMPOWER: Toward the Global Dissemination of Psychosocial Interventions. FOCUS 2022; 20:301-306. [PMID: 37021040 PMCID: PMC10071408 DOI: 10.1176/appi.focus.20220042] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Even before the COVID-19 pandemic, the needs for care of persons with mental illness remained largely unmet worldwide, testifying to the inadequacy of current approaches to mental health care and their unsuitability for the rising demand. One hurdle to improved access to quality care is the reliance on expensive specialist providers, particularly for the delivery of psychosocial interventions. This article describes EMPOWER, a not-for-profit program that builds on the clinical science demonstrating the effectiveness of brief psychosocial interventions for a range of psychiatric conditions; implementation science demonstrating the effectiveness of delivery of these interventions by non-specialist providers (NSPs); and pedagogical science demonstrating the effectiveness of digital approaches for training and quality assurance. The EMPOWER program leverages digital tools for training and supervising NSPs, designing competency-based curricula, assessing treatment-specific competencies, implementing measurement-based peer supervision for support and quality assurance, and evaluating impacts to enhance the effectiveness of the delivery system.
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Affiliation(s)
- Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School (V. Patel, Naslund, Wood, Chauvin, Amara) and Harvard T. H. Chan School of Public Health (V. Patel, A. Patel), Harvard University, Boston; Sangath, Bhopal, Madhya Pradesh, India (Bhan, Agrawal, Joshi); Division of Global Mental Health, George Washington University, Washington, DC (Kohrt); Centre for Complex Interventions, Centre for Addiction and Mental Health, and Department of Psychiatry, University of Toronto, Toronto (Singla)
| | - John A. Naslund
- Department of Global Health and Social Medicine, Harvard Medical School (V. Patel, Naslund, Wood, Chauvin, Amara) and Harvard T. H. Chan School of Public Health (V. Patel, A. Patel), Harvard University, Boston; Sangath, Bhopal, Madhya Pradesh, India (Bhan, Agrawal, Joshi); Division of Global Mental Health, George Washington University, Washington, DC (Kohrt); Centre for Complex Interventions, Centre for Addiction and Mental Health, and Department of Psychiatry, University of Toronto, Toronto (Singla)
| | - Sheena Wood
- Department of Global Health and Social Medicine, Harvard Medical School (V. Patel, Naslund, Wood, Chauvin, Amara) and Harvard T. H. Chan School of Public Health (V. Patel, A. Patel), Harvard University, Boston; Sangath, Bhopal, Madhya Pradesh, India (Bhan, Agrawal, Joshi); Division of Global Mental Health, George Washington University, Washington, DC (Kohrt); Centre for Complex Interventions, Centre for Addiction and Mental Health, and Department of Psychiatry, University of Toronto, Toronto (Singla)
| | - Anushka Patel
- Department of Global Health and Social Medicine, Harvard Medical School (V. Patel, Naslund, Wood, Chauvin, Amara) and Harvard T. H. Chan School of Public Health (V. Patel, A. Patel), Harvard University, Boston; Sangath, Bhopal, Madhya Pradesh, India (Bhan, Agrawal, Joshi); Division of Global Mental Health, George Washington University, Washington, DC (Kohrt); Centre for Complex Interventions, Centre for Addiction and Mental Health, and Department of Psychiatry, University of Toronto, Toronto (Singla)
| | - Joshua J. Chauvin
- Department of Global Health and Social Medicine, Harvard Medical School (V. Patel, Naslund, Wood, Chauvin, Amara) and Harvard T. H. Chan School of Public Health (V. Patel, A. Patel), Harvard University, Boston; Sangath, Bhopal, Madhya Pradesh, India (Bhan, Agrawal, Joshi); Division of Global Mental Health, George Washington University, Washington, DC (Kohrt); Centre for Complex Interventions, Centre for Addiction and Mental Health, and Department of Psychiatry, University of Toronto, Toronto (Singla)
| | - Ravindra Agrawal
- Department of Global Health and Social Medicine, Harvard Medical School (V. Patel, Naslund, Wood, Chauvin, Amara) and Harvard T. H. Chan School of Public Health (V. Patel, A. Patel), Harvard University, Boston; Sangath, Bhopal, Madhya Pradesh, India (Bhan, Agrawal, Joshi); Division of Global Mental Health, George Washington University, Washington, DC (Kohrt); Centre for Complex Interventions, Centre for Addiction and Mental Health, and Department of Psychiatry, University of Toronto, Toronto (Singla)
| | - Anant Bhan
- Department of Global Health and Social Medicine, Harvard Medical School (V. Patel, Naslund, Wood, Chauvin, Amara) and Harvard T. H. Chan School of Public Health (V. Patel, A. Patel), Harvard University, Boston; Sangath, Bhopal, Madhya Pradesh, India (Bhan, Agrawal, Joshi); Division of Global Mental Health, George Washington University, Washington, DC (Kohrt); Centre for Complex Interventions, Centre for Addiction and Mental Health, and Department of Psychiatry, University of Toronto, Toronto (Singla)
| | - Udita Joshi
- Department of Global Health and Social Medicine, Harvard Medical School (V. Patel, Naslund, Wood, Chauvin, Amara) and Harvard T. H. Chan School of Public Health (V. Patel, A. Patel), Harvard University, Boston; Sangath, Bhopal, Madhya Pradesh, India (Bhan, Agrawal, Joshi); Division of Global Mental Health, George Washington University, Washington, DC (Kohrt); Centre for Complex Interventions, Centre for Addiction and Mental Health, and Department of Psychiatry, University of Toronto, Toronto (Singla)
| | - Margaux Amara
- Department of Global Health and Social Medicine, Harvard Medical School (V. Patel, Naslund, Wood, Chauvin, Amara) and Harvard T. H. Chan School of Public Health (V. Patel, A. Patel), Harvard University, Boston; Sangath, Bhopal, Madhya Pradesh, India (Bhan, Agrawal, Joshi); Division of Global Mental Health, George Washington University, Washington, DC (Kohrt); Centre for Complex Interventions, Centre for Addiction and Mental Health, and Department of Psychiatry, University of Toronto, Toronto (Singla)
| | - Brandon A. Kohrt
- Department of Global Health and Social Medicine, Harvard Medical School (V. Patel, Naslund, Wood, Chauvin, Amara) and Harvard T. H. Chan School of Public Health (V. Patel, A. Patel), Harvard University, Boston; Sangath, Bhopal, Madhya Pradesh, India (Bhan, Agrawal, Joshi); Division of Global Mental Health, George Washington University, Washington, DC (Kohrt); Centre for Complex Interventions, Centre for Addiction and Mental Health, and Department of Psychiatry, University of Toronto, Toronto (Singla)
| | - Daisy R. Singla
- Department of Global Health and Social Medicine, Harvard Medical School (V. Patel, Naslund, Wood, Chauvin, Amara) and Harvard T. H. Chan School of Public Health (V. Patel, A. Patel), Harvard University, Boston; Sangath, Bhopal, Madhya Pradesh, India (Bhan, Agrawal, Joshi); Division of Global Mental Health, George Washington University, Washington, DC (Kohrt); Centre for Complex Interventions, Centre for Addiction and Mental Health, and Department of Psychiatry, University of Toronto, Toronto (Singla)
| | - Christopher G. Fairburn
- Department of Global Health and Social Medicine, Harvard Medical School (V. Patel, Naslund, Wood, Chauvin, Amara) and Harvard T. H. Chan School of Public Health (V. Patel, A. Patel), Harvard University, Boston; Sangath, Bhopal, Madhya Pradesh, India (Bhan, Agrawal, Joshi); Division of Global Mental Health, George Washington University, Washington, DC (Kohrt); Centre for Complex Interventions, Centre for Addiction and Mental Health, and Department of Psychiatry, University of Toronto, Toronto (Singla)
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Vial S, Boudhraâ S, Dumont M. Human-Centered Design Approaches in Digital Mental Health Interventions: Exploratory Mapping Review. JMIR Ment Health 2022; 9:e35591. [PMID: 35671081 PMCID: PMC9214621 DOI: 10.2196/35591] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/22/2022] [Accepted: 04/19/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Digital mental health interventions have a great potential to alleviate mental illness and increase access to care. However, these technologies face significant challenges, especially in terms of user engagement and adoption. It has been suggested that this issue stems from a lack of user perspective in the development process; accordingly, several human-centered design approaches have been developed over the years to consider this important aspect. Yet, few human-centered design approaches to digital solutions exist in the field of mental health, and rarely are end users involved in their development. OBJECTIVE The main objective of this literature review is to understand how human-centered design is considered in e-mental health intervention research. METHODS An exploratory mapping review was conducted of mental health journals with the explicit scope of covering e-mental health technology. The human-centered design approaches reported and the core elements of design activity (ie, object, context, design process, and actors involved) were examined among the eligible studies. RESULTS A total of 30 studies met the inclusion criteria, of which 22 mentioned using human-centered design approaches or specific design methods in the development of an e-mental health solution. Reported approaches were classified as participatory design (11/27, 41%), codesign (6/27, 22%), user-centered design (5/27, 19%), or a specific design method (5/27, 19%). Just over half (15/27, 56%) of the approaches mentioned were supported by references. End users were involved in each study to some extent but not necessarily in designing. About 27% (8/30) of all the included studies explicitly mentioned the presence of designers on their team. CONCLUSIONS Our results show that some attempts have indeed been made to integrate human-centered design approaches into digital mental health technology development. However, these attempts rely very little on designers and design research. Researchers from other domains and technology developers would be wise to learn the underpinnings of human-centered design methods before selecting one over another. Inviting designers for assistance when implementing a particular approach would also be beneficial. To further motivate interest in and use of human-centered design principles in the world of e-mental health, we make nine suggestions for better reporting of human-centered design approaches in future research.
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Affiliation(s)
- Stéphane Vial
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, École de Design, Université du Québec à Montréal, Montréal, QC, Canada
| | - Sana Boudhraâ
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, École de Design, Université du Québec à Montréal, Montréal, QC, Canada
| | - Mathieu Dumont
- Département D'ergothérapie, Université du Québec à Trois-Rivières, Drummondville, QC, Canada
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Joshi U, Naslund JA, Anand A, Tugnawat D, Vishwakarma R, Bhan A, Patel V, Lu C. Assessing costs of developing a digital program for training community health workers to deliver treatment for depression: A case study in rural India. Psychiatry Res 2022; 307:114299. [PMID: 34871874 PMCID: PMC8730743 DOI: 10.1016/j.psychres.2021.114299] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 08/29/2021] [Accepted: 11/19/2021] [Indexed: 01/03/2023]
Abstract
Digital technology has emerged as a promising approach for training and building capacity of community health workers in low-income and middle-income countries (LMICs). Little is known about the cost of developing digital training programs in LMICs, which hinders the adoption, implementation, and scaling up of the programs in routine primary care settings. This study assessed the costs of developing a digital program for training community health workers to deliver a psychological treatment for depression in a rural district of Madhya Pradesh, India. We developed survey instruments to document required resources in development, including involved personnel (their roles, responsibilities, time spent, and salaries or payments), information technologies (e.g., smartphones, software programs), and infrastructure-related costs (e.g., vehicle, office space, utilities). Costs were estimated from an accounting perspective. Over a 10-month developmental period, the total costs were 208,814 USD, with the largest portion on human resources (61%, with 14% on management and supervision), followed by information technologies (33%), and infrastructure-related costs (6%). These findings could inform policymakers in LMICs on costs of developing online-training programs, which will be especially useful during the COVID-19 pandemic.
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Affiliation(s)
| | - John A. Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA
| | | | | | | | | | - Vikram Patel
- Sangath, Bhopal, Madhya Pradesh, India,Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Chunling Lu
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA.
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16
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Carter H, Araya R, Anjur K, Deng D, Naslund JA. The emergence of digital mental health in low-income and middle-income countries: A review of recent advances and implications for the treatment and prevention of mental disorders. J Psychiatr Res 2021; 133:223-246. [PMID: 33360867 PMCID: PMC8801979 DOI: 10.1016/j.jpsychires.2020.12.016] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 11/26/2020] [Accepted: 12/09/2020] [Indexed: 12/24/2022]
Abstract
In low-income and middle-income countries (LMICs), emerging digital mental health interventions should be accompanied by regular and comprehensive assessment of available scientific evidence. This review aims to support efforts to monitor progress in digital mental health research, ensuring new evidence can guide researchers, clinicians, policymakers and program managers positioned to adopt and implement these digitally-enabled treatments. In accordance with PRISMA guidelines, an electronic database search from 2016 to 2020 yielded 37 digital intervention studies for detection, diagnosis, prevention, treatment, and/or management of a broad range of mental disorders in 13 LMICs. This date range was selected to update previous reviews. Most studies involved online interventions and many reported feasibility and acceptability, reflected by participant satisfaction or program adherence. About half the studies (N = 23) reported clinical benefits based on changes in mental health. For depression and mood disorders, some digital interventions showed improvements in depressive symptoms, quality of life, treatment adherence, and recovery. However, sample sizes were small and studies focused primarily on adults. Further limiting generalizability was the lack of consistency in clinical assessment and measurement tools between studies. No studies reported worsening symptoms, negative acceptability or dissatisfaction with digital interventions, suggesting possible publication bias. While digital interventions show promise, it remains difficult to conclude that digital interventions are effective from these studies, as it is prudent to exercise caution before drawing conclusions about clinical effectiveness. This review reflects continued growth in digital mental health research in LMICs and further highlights the need for rigorous evaluation of effectiveness and cost-effectiveness.
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Affiliation(s)
- Helena Carter
- The Center for Global Mental Health, King's College London, London, UK
| | - Ricardo Araya
- The Center for Global Mental Health, King's College London, London, UK; Health Service & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Kavya Anjur
- Johns Hopkins University, Baltimore, MD, USA
| | - Davy Deng
- Harvard T.H. Chan School of Public Health, Boston, MA, USA; The Mental Health for All Lab, Harvard Medical School, Boston, MA, USA
| | - John A Naslund
- The Mental Health for All Lab, Harvard Medical School, Boston, MA, USA; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
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17
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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. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E6368. [PMID: 32883018 PMCID: PMC7503742 DOI: 10.3390/ijerph17176368] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/23/2020] [Accepted: 08/28/2020] [Indexed: 12/13/2022]
Abstract
Introduction: Task sharing holds promise for scaling up depression care in countries such as India, yet requires training large numbers of non-specialist health workers. This pilot trial evaluated the feasibility and acceptability of a digital program for training non-specialist health workers to deliver a brief psychological treatment for depression. Methods: Participants were non-specialist health workers recruited from primary care facilities in Sehore, a rural district in Madhya Pradesh, India. A three-arm randomized controlled trial design was used, comparing digital training alone (DGT) to digital training with remote support (DGT+), and conventional face-to-face training. The primary outcome was the feasibility and acceptability of digital training programs. Preliminary effectiveness was explored as changes in competency outcomes, assessed using a self-reported measure covering the specific knowledge and skills required to deliver the brief psychological treatment for depression. Outcomes were collected at pre-training and post-training. Results: Of 42 non-specialist health workers randomized to the training programs, 36 including 10 (72%) in face-to-face, 12 (86%) in DGT, and 14 (100%) in DGT+ arms started the training. Among these participants, 27 (64%) completed the training, with 8 (57%) in face-to-face, 8 (57%) in DGT, and 11 (79%) in DGT+. The addition of remote telephone support appeared to improve completion rates for DGT+ participants. The competency outcome improved across all groups, with no significant between-group differences. However, face-to-face and DGT+ participants showed greater improvement compared to DGT alone. There were numerous technical challenges with the digital training program such as poor connectivity, smartphone app not loading, and difficulty navigating the course content-issues that were further emphasized in follow-up focus group discussions with participants. Feedback and recommendations collected from participants informed further modifications and refinements to the training programs in preparation for a forthcoming large-scale effectiveness trial. Conclusions: This study adds to mounting efforts aimed at leveraging digital technology to increase the availability of evidence-based mental health services in primary care settings in low-resource settings.
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Affiliation(s)
- Shital S. Muke
- Sangath, 120 Deepak Society, Chuna Bhatti, Kolar Road, Bhopal 462016, India; (S.S.M.); (D.T.); (U.J.); (A.A.); (A.K.); (R.S.); (A.S.); (A.B.)
| | - Deepak Tugnawat
- Sangath, 120 Deepak Society, Chuna Bhatti, Kolar Road, Bhopal 462016, India; (S.S.M.); (D.T.); (U.J.); (A.A.); (A.K.); (R.S.); (A.S.); (A.B.)
| | - Udita Joshi
- Sangath, 120 Deepak Society, Chuna Bhatti, Kolar Road, Bhopal 462016, India; (S.S.M.); (D.T.); (U.J.); (A.A.); (A.K.); (R.S.); (A.S.); (A.B.)
| | - Aditya Anand
- Sangath, 120 Deepak Society, Chuna Bhatti, Kolar Road, Bhopal 462016, India; (S.S.M.); (D.T.); (U.J.); (A.A.); (A.K.); (R.S.); (A.S.); (A.B.)
| | - Azaz Khan
- Sangath, 120 Deepak Society, Chuna Bhatti, Kolar Road, Bhopal 462016, India; (S.S.M.); (D.T.); (U.J.); (A.A.); (A.K.); (R.S.); (A.S.); (A.B.)
| | - Ritu Shrivastava
- Sangath, 120 Deepak Society, Chuna Bhatti, Kolar Road, Bhopal 462016, India; (S.S.M.); (D.T.); (U.J.); (A.A.); (A.K.); (R.S.); (A.S.); (A.B.)
| | - Abhishek Singh
- Sangath, 120 Deepak Society, Chuna Bhatti, Kolar Road, Bhopal 462016, India; (S.S.M.); (D.T.); (U.J.); (A.A.); (A.K.); (R.S.); (A.S.); (A.B.)
| | - Juliana L. Restivo
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA; (J.L.R.); (V.P.)
| | - Anant Bhan
- Sangath, 120 Deepak Society, Chuna Bhatti, Kolar Road, Bhopal 462016, India; (S.S.M.); (D.T.); (U.J.); (A.A.); (A.K.); (R.S.); (A.S.); (A.B.)
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA; (J.L.R.); (V.P.)
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA 02115, USA
| | - John A. Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA; (J.L.R.); (V.P.)
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