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

• Published in: Global mental health Vol. 6; p. e8
• Main Authors: Rahman, Atif, Akhtar, Parveen, Hamdani, Syed Usman, Atif, Najia, Nazir, Huma, Uddin, Iftikhar, Nisar, Anum, Huma, Zille, Maselko, Joanna, Sikander, Siham, Zafar, Shamsa
• Format: Journal Article
• Language: English
• Published: England Cambridge University Press 2019
• Subjects: Cellular telephones; Clinical trials; Cognition & reasoning; Councils; Health facilities; Internet access; Intervention; Interventions; Low income groups; Low- and middle-income countries; Maternal & child health; Mental depression; Mental health; Militancy; Original Research Paper; perinatal depression; psychosocial intervention; Studies; Supervision; technology-assisted training and supervision; Thinking Healthy Programme; Womens health; Canada; Pakistan; Africa; technology-assisted training and supervision; perinatal depression; Thinking Healthy Programme; psychosocial intervention; Low- and middle-income countries
• ISSN: 2054-4251; 2054-4251
• DOI: 10.1017/gmh.2019.7

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. 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 indicated no significant differences between health workers trained using TACTS and supervised from distance those trained and supervised by a specialist face-to-face (   =  24.97, s.d.  =  5.95 .  =  27.27, s.d.  =  5.60,   =  0.079, 95% CI 4.87-0.27) and at 3 months follow-up assessment (   =  44.48, s.d.  =  3.97 .  =  43.63, s.d.  =  6.34,   =  0.53, CI -1.88 to 3.59). 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.