Skip to main content Accessibility help
×
Home

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

  • Atif Rahman (a1), Parveen Akhtar (a2), Syed Usman Hamdani (a2), Najia Atif (a2), Huma Nazir (a2), Iftikhar Uddin (a3), Anum Nisar (a2), Zille Huma (a2), Joanna Maselko (a2) (a4), Siham Sikander (a2) (a5) and Shamsa Zafar (a2) (a6)...

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.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      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
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      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
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      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
      Available formats
      ×

Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited

Corresponding author

*Address for correspondence: Atif Rahman, Professor of Psychiatry, Department of Psychological Sciences, University of Liverpool, Block B, Waterhouse Building, 1–5 Dover Street, Liverpool L69 3BX, UK. (Email: atif.rahman@liverpool.ac.uk)

Footnotes

Hide All

Siham Sikander and Shamsa Zafar are joint last authors.

Footnotes

References

Hide All
Alipour, S, Jannat, F, Hosseini, L (2014). Teaching breast cancer screening via text messages as part of continuing education for working nurses: a case-control study. Asian Pacific Journal of Cancer Prevention 15, 56075609.
Bennett, IM, Schott, W, Krutikova, S, Behrman, JR (2016). Maternal mental health, and child growth and development, in four low-income and middle-income countries. Journal of Epidemiology & Community Health 70(2), 168173.
Bile, KM, Hafeez, A (2009). Crisis in the Swat Valley of Pakistan: need for international action. The Lancet 374(9683), 23.
Chibanda, D, Weiss, HA, Verhey, R, Simms, V, Munjoma, R, Rusakaniko, S, Chingono, A, Munetsi, E, Bere, T, Manda, E, Abas, M, Araya, R (2016). Effect of a primary care-based psychological intervention on symptoms of common mental disorders in Zimbabwe: a randomized. Clinical Trial JAMA 316, 26182626.
Cooper, Z, Bailey-Straebler, S, Morgan, KE, O'Connor, ME, Caddy, C, Hamadi, L, Fairburn, CG (2017). Using the internet to train therapists: randomized comparison of two scalable methods. Journal of Medical Internet Research 19(10), e355.
Dayan, J, Creveuil, C, Herlicoviez, M, Herbel, C, Baranger, E, Savoye, C, Thouin, A (2002). Role of anxiety and depression in the onset of spontaneous preterm labor. American Journal of Epidemiology 155, 293301.
Din, IU, Mumtaz, Z, Ataullahjan, A (2012). How the Taliban undermined community healthcare in Swat, Pakistan. British Medical Journal 344. doi: 10.1136/bmj.e2093.
Fairburn, CG, Allen, E, Bailey-Straebler, S, O'Connor, ME, Cooper, Z (2017). Scaling up psychological treatments: a countrywide test of the online training of therapists. Journal of Medical Internet Research 19, e214.
Fairburn, CG, Cooper, Z (2011). Therapist competence, therapy quality, and therapist training. Behaviour Research and Therapy 49, 373378.
Fisher, J, Mello, MCD, Patel, V, Rahman, A, Tran, T, Holton, S, Holmes, W (2012). Prevalence and determinants of common perinatal mental disorders in women in low-and lower-middle-income countries: a systematic review. Bulletin of the World Health Organization 90, 139149.
Grote, NK, Bridge, JA, Gavin, AR, Melville, JL, Iyengar, S, Katon, WJ (2010). A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction. Archives of General Psychiatry 67, 10121024.
Halfon, N, Larson, K, Lu, M, Tullis, E, Russ, S (2014). Lifecourse health development: past, present and future. Maternal and Child Health Journal 18, 344365.
Hamdani, SU, Minhas, FA, Iqbal, Z, Rahman, A (2015). Model for service delivery for developmental disorders in low-income countries. Pediatrics 136, 11661172.
Herba, CM, Glover, V, Ramchandani, PG, Rondon, MB (2016). Maternal depression and mental health in early childhood: an examination of underlying mechanisms in low-income and middle-income countries. The Lancet Psychiatry 3, 983992.
Jarde, A, Morais, M, Kingston, D, Giallo, R, MacQueen, GM, Giglia, L, Beyene, J, Wang, Y, McDonald, SD (2016). Neonatal outcomes in women with untreated antenatal depression compared with women without depression: a systematic review and meta-analysis. JAMA Psychiatry 73(8), 826837.
Kastrup, MC (2006). Mental health consequences of war: gender specific issues. World Psychiatry 5, 33.
Khan, MN, Chiumento, A, Dherani, M, Bristow, K, Sikander, S, Rahman, A (2015). Psychological distress and its associations with past events in pregnant women affected by armed conflict in Swat, Pakistan: a cross sectional study. Conflict and Health 9, 37.
Kohrt, BA, Ramaiya, MK, Rai, S, Bhardwaj, A, Jordans, MD (2015). Development of a scoring system for non-specialist ratings of clinical competence in global mental health: a qualitative process evaluation of the Enhancing Assessment of Common Therapeutic Factors (ENACT) scale. Global Mental Health 2, e23.
Lund, S, Boas, IM, Bedesa, T, Fekede, W, Nielsen, HS, Sørensen, BL (2016). Association between the safe delivery app and quality of care and perinatal survival in Ethiopia: a randomized clinical trial. JAMA Pediatrics 170, 765771.
Mangham, LJ, Hanson, K (2010). Scaling up in international health: what are the key issues? Health Policy and Planning 1, 12.
Murray, LK, Dorsey, S, Bolton, P, Jordans, MJ, Rahman, A, Bass, J, Verdeli, H (2011). Building capacity in mental health interventions in low resource countries: an apprenticeship model for training local providers. International Journal of Mental Health Systems 5, 30.
Murray, LK, Tol, W, Jordans, M, Zangana, GS, Amin, AM, Bolton, P, Bass, J, Bonilla-Escobar, FJ, Thornicroft, G (2014). Dissemination and implementation of evidence based, mental health interventions in post conflict, low resource settings. Intervention 12, 94112.
Naslund, JA, Aschbrenner, KA, Araya, R, Marsch, LA, Unützer, J, Patel, V, Bartels, SJ (2017). Digital technology for treating and preventing mental disorders in low-income and middle-income countries: a narrative review of the literature. Lancet Psychiatry 4(6), 486500.
National Institute of Population Studies (NIPS) [Pakistan] and ICF International. (2013). Pakistan Demographic and Health Survey 2012–13. NIPS and ICF International: Islamabad, Pakistan, Calverton, Maryland, USA.
Palazuelos, D, Diallo, AB, Palazuelos, L, Carlile, N, Payne, JD, Franke, MF (2013). User perceptions of an mHealth medicine dosing tool for community health workers. JMIR mHealth and uHealth 1(1), e2.
Patel, V, Saxena, S, Lund, C, Thornicroft, G, Baingana, F, Bolton, P, Chisholm, D, Collins, PY, Cooper, JL, Eaton, J, Herrman, H, Herzallah, MM, Huang, Y, Jordans, MJD, Kleinman, A, Medina-Mora, ME, Morgan, E, Niaz, U, Omigbodun, O, Prince, M, Rahman, A, Saraceno, B, Sarkar, BK, De Silva, M, Singh, I, Stein, DJ, Sunkel, C, Unützer, J (2018). The Lancet Commission on global mental health and sustainable development. The Lancet 392(10157), 15531598.
Patel, V, Weiss, HA, Chowdhary, N, Naik, S, Pednekar, S, Chatterjee, S, De Silva, MJ, Bhat, B, Araya, R, King, M, Simon, G, Verdeli, H, Kirkwood, BR (2010). Effectiveness of an intervention led by lay health counsellors for depressive and anxiety disorders in primary care in Goa, India (MANAS): a cluster randomised controlled trial. Lancet 376, 20862095.
Pereira, CA, Wen, CL, Miguel, EC, Polanczyk, GV (2015 a). A randomised controlled trial of a web-based educational program in child mental health for schoolteachers. European Child & Adolescent Psychiatry 24, 931940.
Pereira, CA, Wen, CL, Tavares, H (2015 b). Alcohol abuse management in primary care: an e-learning course. Telemedicine and e-Health 21, 200206.
Rahman, A, Bunn, J, Lovel, H, Creed, F (2007). Maternal depression increases infant risk of diarrhoeal illness: a cohort study. Archives of Disease in Childhood 92, 2428.
Rahman, A, Iqbal, Z, Harrington, R (2003). Life events, social support, depression and childbirth: perspectives from a rural population in a developing country. Psychological Medicine 33, 11611167.
Rahman, A, Malik, A, Sikander, S, Roberts, C, Creed, F (2008). Cognitive behaviour therapy-based intervention by community health workers for mothers with depression and their infants in rural Pakistan: a cluster-randomised controlled trial. The Lancet 372, 902909.
Rahman, A, Fisher, J, Bower, P, Luchters, S, Tran, T, Yasamy, MT, Saxena, S, Waheed, W (2013). Interventions for common perinatal mental disorders in women in low-and middle-income countries: a systematic review and meta-analysis. Bulletin of the World Health Organization 91, 593601I.
Rahman, A, Hafeez, A, Bilal, R, Sikander, S, Malik, A, Minhas, F, Tomenson, B, Creed, F (2016 a). The impact of perinatal depression on exclusive breastfeeding: a cohort study. Maternal & Child Nutrition 12, 452462.
Rahman, A, Hamdani, SU, Awan, NR, Bryant, RA, Dawson, KS, Khan, MF, Azeemi, MM, Akhtar, P, Nazir, H, Chiumento, A, Sijbrandij, M, Wang, D, Farooq, S, van Ommeren, M (2016 b). Effect of a multicomponent behavioral intervention in adults impaired by psychological distress in a conflict-affected area of Pakistan: a randomized clinical trial. JAMA 316, 26092617.
Sikander, S, Lazarus, A, Bangash, O, Fuhr, DC, Weobong, B, Krishna, RN, Ahmad, I, Weiss, HA, Price, L, Rahman, A, Patel, V (2015). The effectiveness and cost-effectiveness of the peer-delivered Thinking Healthy Programme for perinatal depression in Pakistan and India: the SHARE study protocol for randomised controlled trials. Trials 16, 534.
UNICEF. (2018). Every Child Alive: The Urgent Need to End Newborn Deaths. United Nations Children's Fund (UNICEF), 2018.
Vos, T, Flaxman, AD, Naghavi, M, Lozano, R, Michaud, C, Ezzati, M, Shibuya, K, Salomon, JA, Abdalla, S, Aboyans, V, Abraham, J, Ackerman, I, Aggarwal, R, Ahn, SY, Ali, MK, Alvarado, M, Anderson, HR, Anderson, LM, Andrews, KG, Atkinson, C, Baddour, LM, Bahalim, AN, Barker-Collo, S, Barrero, LH, Bartels, DH, Basáñez, MG, Baxter, A, Bell, ML, Benjamin, EJ, Bennett, D, Bernabé, E, Bhalla, K, Bhandari, B, Bikbov, B, Bin Abdulhak, A, Birbeck, G, Black, JA, Blencowe, H, Blore, JD, Blyth, F, Bolliger, I, Bonaventure, A, Boufous, S, Bourne, R, Boussinesq, M, Braithwaite, T, Brayne, C, Bridgett, L, Brooker, S, Brooks, P, Brugha, TS, Bryan-Hancock, C, Bucello, C, Buchbinder, R, Buckle, G, Budke, CM, Burch, M, Burney, P, Burstein, R, Calabria, B, Campbell, B, Canter, CE, Carabin, H, Carapetis, J, Carmona, L, Cella, C, Charlson, F, Chen, H, Cheng, AT, Chou, D, Chugh, SS, Coffeng, LE, Colan, SD, Colquhoun, S, Colson, KE, Condon, J, Connor, MD, Cooper, LT, Corriere, M, Cortinovis, M, de Vaccaro, KC, Couser, W, Cowie, BC, Criqui, MH, Cross, M, Dabhadkar, KC, Dahiya, M, Dahodwala, N, Damsere-Derry, J, Danaei, G, Davis, A, De Leo, D, Degenhardt, L, Dellavalle, R, Delossantos, A, Denenberg, J, Derrett, S, Des Jarlais, DC, Dharmaratne, SD, Dherani, M, Diaz-Torne, C, Dolk, H, Dorsey, ER, Driscoll, T, Duber, H, Ebel, B, Edmond, K, Elbaz, A, Ali, SE, Erskine, H, Erwin, PJ, Espindola, P, Ewoigbokhan, SE, Farzadfar, F, Feigin, V, Felson, DT, Ferrari, A, Ferri, CP, Fèvre, EM, Finucane, MM, Flaxman, S, Flood, L, Foreman, K, Forouzanfar, MH, Fowkes, FG, Franklin, R, Fransen, M, Freeman, MK, Gabbe, BJ, Gabriel, SE, Gakidou, E, Ganatra, HA, Garcia, B, Gaspari, F, Gillum, RF, Gmel, G, Gosselin, R, Grainger, R, Groeger, J, Guillemin, F, Gunnell, D, Gupta, R, Haagsma, J, Hagan, H, Halasa, YA, Hall, W, Haring, D, Haro, JM, Harrison, JE, Havmoeller, R, Hay, RJ, Higashi, H, Hill, C, Hoen, B, Hoffman, H, Hotez, PJ, Hoy, D, Huang, JJ, Ibeanusi, SE, Jacobsen, KH, James, SL, Jarvis, D, Jasrasaria, R, Jayaraman, S, Johns, N, Jonas, JB, Karthikeyan, G, Kassebaum, N, Kawakami, N, Keren, A, Khoo, JP, King, CH, Knowlton, LM, Kobusingye, O, Koranteng, A, Krishnamurthi, R, Lalloo, R, Laslett, LL, Lathlean, T, Leasher, JL, Lee, YY, Leigh, J, Lim, SS, Limb, E, Lin, JK, Lipnick, M, Lipshultz, SE, Liu, W, Loane, M, Ohno, SL, Lyons, R, Ma, J, Mabweijano, J, MacIntyre, MF, Malekzadeh, R, Mallinger, L, Manivannan, S, Marcenes, W, March, L, Margolis, DJ, Marks, GB, Marks, R, Matsumori, A, Matzopoulos, R, Mayosi, BM, McAnulty, JH, McDermott, MM, McGill, N, McGrath, J, Medina-Mora, ME, Meltzer, M, Mensah, GA, Merriman, TR, Meyer, AC, Miglioli, V, Miller, M, Miller, TR, Mitchell, PB, Mocumbi, AO, Moffitt, TE, Mokdad, AA, Monasta, L, Montico, M, Moradi-Lakeh, M, Moran, A, Morawska, L, Mori, R, Murdoch, ME, Mwaniki, MK, Naidoo, K, Nair, MN, Naldi, L, Narayan, KM, Nelson, PK, Nelson, RG, Nevitt, MC, Newton, CR, Nolte, S, Norman, P, Norman, R, O'Donnell, M, O'Hanlon, S, Olives, C, Omer, SB, Ortblad, K, Osborne, R, Ozgediz, D, Page, A, Pahari, B, Pandian, JD, Rivero, AP, Patten, SB, Pearce, N, Padilla, RP, Perez-Ruiz, F, Perico, N, Pesudovs, K, Phillips, D, Phillips, MR, Pierce, K, Pion, S, Polanczyk, GV, Polinder, S, Pope, CA 3rd, Popova, S, Porrini, E, Pourmalek, F, Prince, M, Pullan, RL, Ramaiah, KD, Ranganathan, D, Razavi, H, Regan, M, Rehm, JT, Rein, DB, Remuzzi, G, Richardson, K, Rivara, FP, Roberts, T, Robinson, C, De Leòn, FR, Ronfani, L, Room, R, Rosenfeld, LC, Rushton, L, Sacco, RL, Saha, S, Sampson, U, Sanchez-Riera, L, Sanman, E, Schwebel, DC, Scott, JG, Segui-Gomez, M, Shahraz, S, Shepard, DS, Shin, H, Shivakoti, R, Singh, D, Singh, GM, Singh, JA, Singleton, J, Sleet, DA, Sliwa, K, Smith, E, Smith, JL, Stapelberg, NJ, Steer, A, Steiner, T, Stolk, WA, Stovner, LJ, Sudfeld, C, Syed, S, Tamburlini, G, Tavakkoli, M, Taylor, HR, Taylor, JA, Taylor, WJ, Thomas, B, Thomson, WM, Thurston, GD, Tleyjeh, IM, Tonelli, M, Towbin, JA, Truelsen, T, Tsilimbaris, MK, Ubeda, C, Undurraga, EA, van der Werf, MJ, van Os, J, Vavilala, MS, Venketasubramanian, N, Wang, M, Wang, W, Watt, K, Weatherall, DJ, Weinstock, MA, Weintraub, R, Weisskopf, MG, Weissman, MM, White, RA, Whiteford, H, Wiersma, ST, Wilkinson, JD, Williams, HC, Williams, SR, Witt, E, Wolfe, F, Woolf, AD, Wulf, S, Yeh, PH, Zaidi, AK, Zheng, ZJ, Zonies, D, Lopez, AD, Murray, CJ, AlMazroa, MA, Memish, ZA (2012). Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. The Lancet 380, 21632196.
World Health Organization. (2016). mhGAP intervention guide for mental, neurological and substance use disorders in non-specialized health settings: mental health Gap Action Programme (mhGAP) – version 2.0. Geneva: World Health Organization.
Zafar, S, Sikander, S, Hamdani, SU, Atif, N, Akhtar, P, Nazir, H, Maselko, J, Rahman, A (2016). The effectiveness of Technology-assisted Cascade Training and Supervision of community health workers in delivering the Thinking Healthy Program for perinatal depression in a post-conflict area of Pakistan–study protocol for a randomized controlled trial. Trials 17, 188.
Zolfo, M, Iglesias, D, Kiyan, C, Echevarria, J, Fucay, L, Llacsahuanga, E, de Waard, I, Suàrez, V, Llaque, WC, Lynen, L (2010). Mobile learning for HIV/AIDS healthcare worker training in resource-limited settings. AIDS Research and Therapy 7, 35.

Keywords

Related content

Powered by UNSILO

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

  • Atif Rahman (a1), Parveen Akhtar (a2), Syed Usman Hamdani (a2), Najia Atif (a2), Huma Nazir (a2), Iftikhar Uddin (a3), Anum Nisar (a2), Zille Huma (a2), Joanna Maselko (a2) (a4), Siham Sikander (a2) (a5) and Shamsa Zafar (a2) (a6)...

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.