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
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 fo...
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Published in | Global mental health Vol. 6; p. e8 |
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Main Authors | , , , , , , , , , , |
Format | Journal Article |
Language | English |
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England
Cambridge University Press
2019
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Abstract | 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. |
---|---|
AbstractList | BACKGROUNDThe 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. METHODSA 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. RESULTSResults 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). CONCLUSIONSTACTS 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. 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. 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. 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. 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. |
ArticleNumber | e8 |
Author | Sikander, Siham Zafar, Shamsa Akhtar, Parveen Atif, Najia Maselko, Joanna Hamdani, Syed Usman Uddin, Iftikhar Nisar, Anum Huma, Zille Rahman, Atif Nazir, Huma |
AuthorAffiliation | 2 Human Development Research Foundation , Islamabad , Pakistan 5 Health Services Academy , Islamabad , Pakistan 4 University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA 6 Fazaia Medical College , Islamabad , Pakistan 3 Bacha Khan Medical College , Mardan , Pakistan 1 University of Liverpool , Liverpool , UK |
AuthorAffiliation_xml | – name: 5 Health Services Academy , Islamabad , Pakistan – name: 4 University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA – name: 6 Fazaia Medical College , Islamabad , Pakistan – name: 3 Bacha Khan Medical College , Mardan , Pakistan – name: 1 University of Liverpool , Liverpool , UK – name: 2 Human Development Research Foundation , Islamabad , Pakistan |
Author_xml | – sequence: 1 givenname: Atif surname: Rahman fullname: Rahman, Atif organization: University of Liverpool, Liverpool, UK – sequence: 2 givenname: Parveen surname: Akhtar fullname: Akhtar, Parveen organization: Human Development Research Foundation, Islamabad, Pakistan – sequence: 3 givenname: Syed Usman surname: Hamdani fullname: Hamdani, Syed Usman organization: Human Development Research Foundation, Islamabad, Pakistan – sequence: 4 givenname: Najia surname: Atif fullname: Atif, Najia organization: Human Development Research Foundation, Islamabad, Pakistan – sequence: 5 givenname: Huma surname: Nazir fullname: Nazir, Huma organization: Human Development Research Foundation, Islamabad, Pakistan – sequence: 6 givenname: Iftikhar surname: Uddin fullname: Uddin, Iftikhar organization: Bacha Khan Medical College, Mardan, Pakistan – sequence: 7 givenname: Anum surname: Nisar fullname: Nisar, Anum organization: Human Development Research Foundation, Islamabad, Pakistan – sequence: 8 givenname: Zille surname: Huma fullname: Huma, Zille organization: Human Development Research Foundation, Islamabad, Pakistan – sequence: 9 givenname: Joanna surname: Maselko fullname: Maselko, Joanna organization: Human Development Research Foundation, Islamabad, Pakistan – sequence: 10 givenname: Siham surname: Sikander fullname: Sikander, Siham organization: Health Services Academy, Islamabad, Pakistan – sequence: 11 givenname: Shamsa surname: Zafar fullname: Zafar, Shamsa organization: Fazaia Medical College, Islamabad, Pakistan |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/31157115$$D View this record in MEDLINE/PubMed |
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Keywords | technology-assisted training and supervision perinatal depression Thinking Healthy Programme psychosocial intervention Low- and middle-income countries |
Language | English |
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Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Siham Sikander and Shamsa Zafar are joint last authors. |
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Title | 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 |
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