Acceptability and feasibility of digital technology for training community health workers to deliver brief psychological treatment for depression in rural India
Open accessAbstract
Introduction: Digital technology offers opportunities to train community health workers to deliver psychological treatments towards closing the gap in existing mental health services in low-resource settings. This study explored the acceptability and feasibility of using digital technology for training community health workers to deliver evidence-based brief psychological treatment for depression in rural India. Methods: This study consisted of two sequential evaluations of digital training prototypes using focus group discussions to explore community health worker perspectives about the digital training platform and the program content. Through an iterative design process, feedback was collected about the first prototype to inform modifications to the second prototype. Qualitative data was analyzed using a framework analysis approach. Results: Thirty-two community health workers participated in three separate focus group discussions. Five overarching themes related to acceptability and feasibility of digital training revealed that training on detection and treatment of depression was considered important by study participants for addressing ‘stress’ and ‘tension’ within their communities, while the digital platform was viewed as useful and convenient despite limited familiarity with using digital technology. Moreover, participants suggested simple language for the program and use of interactive content and images to increase interest and improve engagement. Discussion: Digital technology appears acceptable and feasible for supporting training of community health workers to deliver evidence-based depression care in rural India. These findings can inform use of technology as a tool for developing the clinical skills of community health workers for treating depression in low-resource settings.
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- Findingown data
ASHAs found digital training convenient because it avoided several days away from family for in-person sessions.
“The ASHAs also described the convenience of the digital training program, because they would no longer need to spend time away from their family for several days to attend in-person trainings, where they often worried about their family while away:”
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ASHAs' limited familiarity with digital devices was a challenge that extra instruction could overcome.
“Limited familiarity with using digital devices among ASHAs emerged as one challenge, which can be addressed with additional instruction.”
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ASHAs believed the digital program could help them use a mobile device with images and stories to explain depression, its symptoms, and treatment-seeking to patients or older caregivers.
“The digital training program could also help ASHAs explain depression, its symptoms and importance of seeking treatment to their patients, or elderly caregivers, by using the mobile device with pictures and stories:”
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ASHAs without prior clinical depression training identified with difficulties in managing depressive symptoms, particularly in women.
“Importantly, the ASHAs, who did not have prior clinical training about depression, could relate to challenges of addressing symptoms of depression, especially among their female patients:”
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Several ASHAs had a positive experience learning on the digital platform.
“Learning on the digital platform appeared to be a positive experience for several ASHAs.”
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- Findingown data
In all three focus groups, ASHAs viewed training on depression identification and treatment as helpful for addressing community stress, 'tension', and other depressive symptoms.
“According to ASHAs across all three focus group discussions, training about how to identify and treat depression was seen as useful for helping their community address prominent concerns of stress, “tension” (a local metaphor for common mental health problems), and other symptoms of depression.”
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ASHAs appreciated digital learning for letting them study and review material at their own speed.
“This was reflected when they talked about the value of learning using digital technology as this can give them freedom to learn and re-learn different aspects of the course content at their own pace.”
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ASHAs also considered the training personally useful, since their work brings frequent stress and tension.
“ASHAs also found this training useful for themselves, as they can face stress and tension at many times in their work:”
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ASHAs liked the second prototype's new images, videos, and graphics, including visuals explaining depression symptoms.
“The ASHAs also appreciated the new images, videos and graphics included in the second prototype. For example, images were used to explain symptoms of depression:”
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In the second prototype test, ASHAs seemed more engaged than in the first.
“When testing the second prototype, ASHAs appeared more engaged”
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ASHAs' input indicated that using interactive videos with characters from their setting, plain wording, helpful pictures, case stories, and learning exercises can make material more engaging, interesting, and comprehensible.
“Feedback from ASHAs on course content and engagement suggested that use of interactive videos with context-specific characters, simple language, illustrative images, case vignettes and learning activities can make the content more interesting, engaging and easy to understand.”
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ASHAs said that drag-and-drop response activities maintained their interest in learning.
“they expressed that completing activities with drag and drop response options kept them interested in learning the content”
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Low audio quality was a concern for some ASHAs.
“Other ASHAs mentioned low sound quality as a concern:”
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In the first prototype test, ASHAs struggled with certain technical terms related to depression or counselling.
“When testing the first prototype, the ASHAs found some technical terms about depression or counselling difficult to understand:”
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ASHAs reported that pictures, stories, and role-play conversations helped them learn the content.
“ASHAs indicated that learning through pictures, stories and role-play conversations were helpful techniques for learning the content”
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In the first prototype test, participants seemed distracted, talking among themselves and moving in and out of the classroom.
“When testing the first prototype, participants appeared distracted, as they were talking to each other and were going out and coming back into the classroom.”
Quote in the paperSubstantial claim - Premisecitation
Research on digital tools for community health workers has largely addressed continuing education, data collection, decision support, emergency referrals, and work planning, not clinical skill development.
“Much of the literature on digital technology, including mobile interventions and text messaging, has primarily been in the context of providing continuing educational support and training to community health workers on data collection and reporting, decision support, emergency referrals and work planning through alerts and reminders, as opposed to developing clinical skills (Winters et al., 2018;”
Quote in the paperSubstantial claim0 of 2 sources checked - Premisecitation
Less attention has been paid to using digital technologies to train community health workers in delivering psychological interventions, particularly in rural India.
“Digital interventions appear to have been effective for training community health workers in general health care delivery (Agarwal et al., 2015), though use of digital technologies for training community health workers to deliver psychological interventions, especially in settings in rural India, has received less attention (Barnett et al., 2018; Borkum et al., 2014; Modi et al., 2017; Naslund et”
Quote in the paperSubstantial claim0 of 3 sources checked - Premisecitation
The treatment gap in India is partly caused by a severe shortage of mental health providers.
“This treatment gap stems in part from a severe shortage of mental health providers (Mugisha et al., 2017).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Mugisha et al., 2017 source
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- Premisecitation
The most common way health workers are trained in low- and middle-income countries is through in-person didactic sessions and supervised role-plays.
“In low- and middle-income countries, in-person didactic and supervised role-plays are most commonly utilized for training health workers (Singla et al., 2017).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Singla et al., 2017 source
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- Premisecitation
Behavioral activation effectively treats depression.
“HAP was selected in this study because it is a manualized psychological treatment adapted from behavioral activation, which is an effective approach for treating depression (Dimidjian et al., 2011) that is recommended by the WHO as part of mhGAP (World Health Organization, 2016).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Dimidjian et al., 2011 source
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- Premisecitation
Web-based training could be a highly scalable way to grow the mental health workforce.
“Innovative approaches are necessary to expand the mental health work-force, and web-based training is a solution that is potentially highly scalable (Fairburn and Cooper, 2011; Fairburn and Patel, 2014).”
Quote in the paperSubstantial claim0 of 2 sources checked - Premisecitation
By moving psychological treatment delivery from specialists to non-specialist community health workers, task-sharing can increase the supply of mental health providers.
“Task-sharing is a strategy that can expand the availability of mental health providers by shifting delivery of psychological treatments from specialist providers to non-specialist community health workers (Chibanda et al., 2016; Patel et al., 2011; Rahman et al., 2008; Raviola et al., 2019).”
Quote in the paperSubstantial claim0 of 3 sources checked - Premisecitation
In the VISHRAM study, lay health workers providing HAP in rural India increased how well the community understood depression and its readiness to seek care.
“Similarly, in the VISHRAM study, delivery of HAP by lay health workers in a rural population of India showed improvements in community understanding of depression and willingness to seek treatment (Shidhaye et al., 2017).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Shidhaye et al., 2017 source
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- Interpretationcitation
In India, expanding digital training efforts seems probable because ASHAs and other community health workers are set to get IT instruction through the National Digital Literacy Mission.
“Importantly, in India, training community health workers using digital technology and scaling up digital training programs is likely feasible as part of future efforts because ASHAs and other community health workers will be trained in information technology (IT) under the Government of India’s initiative of the National Digital Literacy Mission (Ministry of Electronics and Information Technology,”
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- Interpretationcitation
Training community health workers to use digital devices can potentially address their limited digital experience.
“This type of challenge has been reported previously, and can potentially be addressed by providing training to community health workers on using digital devices (Medhanyie et al., 2015).”
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- Interpretationown data
Digital technology seems acceptable and feasible for training community health workers in rural India to provide evidence-based depression care.
“Digital technology appears acceptable and feasible for supporting training of community health workers to deliver evidence-based depression care in rural India.”
Quote in the paperSubstantial claim- Rests on an assumption: The three community health centers in Sehore district are representative of rural India for assessing the acceptability and feasibility of digital training.
- Rests on an assumption: The digital training prototypes tested in this study are representative of the digital technology that would be used to train ASHAs to deliver HAP.
- Study design and conductreasoning
Testing in community health centers was a study limitation, since that classroom-like environment might have aided ASHAs in learning the material.
“The study setting was also a limitation because the prototype testing was conducted in community health centers. This classroom style setting may have been supportive for helping ASHAs learn the content.”
Quote in the paperNot a substantial claim - Interpretationown data
The first prototype test may have had low participant engagement with the training material.
“This suggested that participants may have had low engagement with the training content.”
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- May combine two claims. 31
- Classified as probably not a substantial claim. 27
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Findingown dataASHAs said they could take the course in free moments and return to content when they forgot it.
“ASHAs indicated that they can learn the course whenever they will get free time and can revisit course content anytime if they forget something:”
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Findingown dataASHAs thought the training would let them guide community members toward appropriate depression treatment.
“This training can also potentially help ASHAs give advice to individuals in their community about seeking the right treatment for depression:”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Findingown dataAn ASHA said the training could enable prompt assistance and possibly prevent a death from depression.
“One ASHA reported that receiving training about depression could help her with providing help on time, which could even save the life of someone facing challenges of depression:”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
Findingown dataASHAs noted that digital training could cut the time and money spent on travel, lodging, food, venues, and trainers for in-person training.
“ASHAs also mentioned that digital training could save time and costs that are typically spent on travelling to attend in-person trainings, including their time, lodging, food, venue and cost of trainers:”
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Findingown dataThirty-two ASHAs took part in three separate focus groups over two phases.
“In total, 32 ASHAs participated in three separate groups across two phases.”
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Findingown dataASHAs proposed using videos of real people teaching to make the course more engaging.
“To make the course content more interesting, ASHAs suggested including videos of real persons teaching the course:”
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Findingown dataASHAs recommended adding synonyms for hard terms and words.
“The ASHAs suggested that synonyms could be given covering difficult terms and words:”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataAnalysis of focus group discussions identified five themes: the value of depression training, acceptability of digital training, feasibility of digital technology, content and language, and engagement.
“Thematic analysis of focus group discussions yielded five themes: importance of depression training; acceptability of digital training; feasibility of using digital technology; content and language of digital training; and engagement with digital training.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataThe digital platform seemed helpful for ASHA training, with possible savings in time and money, convenience, and the ability to study at a self-chosen pace.
“The digital platform appeared useful for supporting training of ASHAs, in terms of potential time and cost savings, convenience, and freedom to learn at their own pace.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataWhen evaluating the second prototype, ASHAs found the revised language easy to follow and called it their own.
“In the evaluation of the second prototype, ASHAs appeared to find the modified language easy to understand and indicated, “it was their own language”:”
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Findingown dataASHAs said that a lot of community members endure stress and tension.
“ASHAs in this study reported that based on their observations and their interactions with individuals from their communities, that many people suffer from stress and tension.”
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Findingown dataASHAs judged the digital training program suitable for learning new material and practical to use.
“The study findings suggested that ASHAs found the digital training program acceptable for learning new content and feasible to use.”
- Also stated in: § Discussion · hedged
“Similarly, in the current study, ASHAs showed acceptability towards digital training and found it potentially feasible in their practice.”
Quote in the paperSubstantial claim- Also stated in: § Discussion · hedged
May combine two claims.
Findingown dataDuring every prototype test, ASHAs reached the platform and, with extra guidance on device features and content access, learned to use it easily.
“In each round of prototype testing, the ASHAs accessed the digital training platform and learned to use the platform with ease when they were provided additional instruction about the different features of the device and how to access the content on the device:”
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Findingown dataASHAs suggested that training use plain language, alternative words for hard terms, images relevant to their context, and interactive material to increase interest and engagement.
“ASHAs also recommended using simple language, synonyms for difficult words, contextually specific images, and interactive content in order to make the training more interesting and engaging.”
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Findingown dataASHAs said images needed more rural people and places to fit their context better.
“The ASHAs commented that the pictures should include greater rural representation of people and places to make the course more specific to their context:”
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Findingown dataPrototype testing had technical problems such as unreliable slow internet, sluggish devices, and touchscreens that did not work well.
“Several technical issues occurred during the prototype testing, and these were mentioned by ASHAs. These included interrupted and slow internet, slow speed of the devices, and poorly functioning touchscreen:”
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Findingown dataSome ASHAs proposed offline access to reduce technical difficulties.
“Some ASHAs also suggested making the course available offline to remove some technical challenges:”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataASHAs had little previous experience using digital devices, which was a major difficulty and made it hard for them to access and navigate the digital training without help from the study team.
“ASHAs’ limited prior experience of using digital devices was one key challenge faced during the training.”
- Also stated in: § Discussion · plain
“Limited experience with using digital technology among ASHAs emerged as a common challenge in this study making it difficult for them to access and navigate the training on a digital platform without assistance from the study team.”
Quote in the paperNot a substantial claim- Also stated in: § Discussion · plain
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Findingown dataASHAs believed that teaching about depression could encourage earlier help-seeking and might avert severe crises when care is received promptly.
“ASHAs also indicated that training about depression would be useful for helping individuals seek early treatment, and perhaps even prevent serious crises if treatment is received in time.”
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PremisecitationThe WHO recommends behavioral activation within mhGAP.
“HAP was selected in this study because it is a manualized psychological treatment adapted from behavioral activation, which is an effective approach for treating depression (Dimidjian et al., 2011) that is recommended by the WHO as part of mhGAP (World Health Organization, 2016).”
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PremisecitationFramework analysis originated for qualitative data analysis in applied policy research.
“A framework analysis approach has been specifically developed for qualitative data analysis in applied policy analysis research (Bryman and Burgess, 1994).”
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PremisecitationHAP has been adapted for low-resource settings beyond India, including Nepal, where it treated depression in people receiving MDR-TB care and in primary care patients with severe depression.
“Further, HAP has been adapted for delivery in other low resource settings, such as Nepal, where it has been used for treating depression among people receiving treatment for multidrug-resistant tuberculosis (Walker et al., 2018) and people with severe depression in primary care settings (Jordans et al., 2019).”
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PremisecitationHAP is a manualized treatment that draws on behavioral activation.
“HAP was selected in this study because it is a manualized psychological treatment adapted from behavioral activation, which is an effective approach for treating depression (Dimidjian et al., 2011) that is recommended by the WHO as part of mhGAP (World Health Organization, 2016).”
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- cites World Health Organization, 2016
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PremisecitationDigital interventions seem to work for training community health workers in general health care delivery.
“Digital interventions appear to have been effective for training community health workers in general health care delivery (Agarwal et al., 2015), though use of digital technologies for training community health workers to deliver psychological interventions, especially in settings in rural India, has received less attention (Barnett et al., 2018; Borkum et al., 2014; Modi et al., 2017; Naslund et”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Agarwal et al., 2015 source
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PremisecitationHAP is an evidence-based short psychological treatment for moderate to severe depression, intended for primary care delivery by lay counsellors lacking formal mental health training.
“HAP is an evidence-based brief psychological treatment for moderate to severe depression designed for delivery in primary care settings by lay counsellors who do not have formal training in mental health care (Patel et al., 2017).”
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Study design and conductcitationFramework analysis offers a systematic, staged structure that makes the derivation of results from data transparent.
“We followed the framework analysis approach and stages (Gale et al., 2013), which provided a systematic structure for the analysis process, with visible stages making it possible to clearly follow how the results were obtained from the data (Lacey and Luff, 2001).”
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PremisecitationHAP is a short psychological intervention for depression that non-specialist counsellors deliver.
“One such intervention is the Healthy Activity Program (HAP), a brief psychological treatment for depression delivered by non-specialist counsellors that achieved moderate effect on reducing depressive symptoms and emerged as cost-effective in routine primary care attenders (Patel et al., 2017; Weobong et al., 2017).”
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PremisecitationEvidence also shows HAP's effectiveness and cost-effectiveness are sustained, suggesting it could be implemented in Indian health systems.
“There is also evidence demonstrating the sustained effectiveness and cost-effectiveness of HAP, highlighting its potential for implementation within health systems in India (Weobong et al., 2017).”
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PremisecitationFramework analysis permits both pre-set and emerging codes.
“Additionally, this approach allows for the use of a priori and emergent codes in the analysis process (Lacey and Luff, 2001).”
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Study design and conductown dataThe developers of the initial prototypes did not take part in testing or evaluation.
“Members of the team who developed the initial prototypes were not involved in the testing and evaluation process.”
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Study design and conductown dataThree researchers examined the topics, grouped them into themes, and held repeated discussions until they agreed on the final themes.
“Next, three researchers (SM, RDS, & JAN) reviewed the topics identified across the focus group discussions and grouped these topics into common themes with relevance for further informing digital intervention design. In this process, referred to as charting, the researchers engaged in multiple rounds of discussion to reach consensus about the final list of themes.”
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PremisecitationIn India, the majority of people with depression lack adequate treatment, with over 90% affected.
“Over 90% of individuals with depression in India do not receive adequate treatment (Patel et al., 2016).”
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PremisecitationIn routine primary care attenders, HAP produced a moderate reduction in depressive symptoms and was cost-effective.
“One such intervention is the Healthy Activity Program (HAP), a brief psychological treatment for depression delivered by non-specialist counsellors that achieved moderate effect on reducing depressive symptoms and emerged as cost-effective in routine primary care attenders (Patel et al., 2017; Weobong et al., 2017).”
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PremisecitationSuch in-person teaching methods are expensive and demand considerable staff and logistical support.
“However, these teaching strategies are costly and require substantial personnel and logistic resources (Fairburn and Cooper, 2011).”
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PremisecitationHAP was developed and tested in Goa, India, with strong evidence that lay counselors can deliver it effectively and cost-effectively to reduce depressive symptoms in primary care.
“HAP was designed and tested in Goa state in India, and is supported with robust evidence showing its clinical effectiveness and cost-effectiveness for reducing depressive symptoms in primary care settings delivered by lay counselors (Patel et al., 2017).”
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Interpretationown dataThe study offers preliminary evidence that digital training on psychological depression treatments is acceptable and in demand among community health workers in India.
“This study provides initial evidence supporting the acceptability and demand for digital training about psychological treatments for depression among community health workers in India.”
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PremisecitationIn Balhara and Singh (2019), teachers and counselors who finished the online course gained more knowledge, skills, and ability to identify, briefly treat, and refer students with problematic Internet-related behavioral addictions.
“Additionally, in the study by Balhara and Singh (2019), after completion of the online course, participating school teachers and counselors showed increases in their knowledge, skills, and capacity to screen, deliver brief intervention, and refer cases of behavioral addictions involving problematic Internet use (Balhara and Singh, 2019).”
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PremisecitationDelivering digital material through interactive rich media might enhance how well participants learn the treatment and could improve results.
“Presenting digital content in an interactive rich media format may help participants better learn the intervention while offering potential to improve outcomes (Florez-Arango et al., 2011).”
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PremisecitationEarlier research indicates digital tools are well accepted and workable for community health workers across different contexts when tracking outcomes and gathering data.
“This is consistent with prior studies, where digital interventions have shown acceptability and feasibility for use among community health workers in diverse settings for outcome monitoring and data collection (Chaiyachati et al., 2013; Chang et al., 2013; Little et al., 2013; Medhanyie et al., 2015).”
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PremisecitationGrowing evidence indicates digital tools aid the instruction and oversight of community health workers and help deliver health services in low- and middle-income nations.
“Digital technology has increasingly been found beneficial for facilitating the training and supervision of community health workers, and supporting health care delivery in low- and middle income countries (Long et al., 2019; Mishra et al., 2019; Rahman et al., 2019).”
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PremisecitationOther digital health studies have noted technical problems like weak internet, screens that do not respond, and sluggish devices.
“Technical challenges, such as poor internet connectivity, non-responsive device screens, and slow device speed have also been observed in other digital intervention studies (Medhanyie et al., 2015).”
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InterpretationreasoningASHAs value depression training, and this could meet a need for such programs in communities.
“This is noteworthy because it suggests that ASHAs recognize the importance of training about depression, which could address demand for such interventions in community settings.”
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PremisecitationIn New Delhi, an online course proved practical and well-received for preparing school teachers and counselors to screen, provide brief interventions, and help prevent and manage behavioral addictions related to Internet use among students.
“One recent study conducted in New Delhi, India demonstrated that an online course appeared feasible and acceptable for training school teachers and counselors for screening, delivering brief interventions, and supporting the prevention and management of behavioral addictions involving Internet use among school students (Balhara and Singh, 2019).”
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Study design and conductreasoningBecause the sample was small and the learning content limited, the results require cautious interpretation and might not apply to the broader ASHA workforce in varied parts of India.
“The small sample size and limited learning content was a limitation with this study, and thus the findings need to be interpreted cautiously and may not generalize to the larger ASHA workforce from diverse regions across India.”
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PremisecitationRecent work indicates digital tools may boost efficiency in how community health workers are trained, managed, communicated with, and how widely services reach.
“For example, recent studies suggest that digital technology can improve efficiency in training, personnel management, communication and health service coverage among community health workers (Long et al., 2019; Mishra et al., 2019).”
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- cites Mishra et al., 2019 source
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PremisecitationMedhanyie et al. (2015) described digital obstacles in Ethiopia, such as smartphones with brief battery life, touch screens that lost sensitivity, and weak mobile network signals.
“For example, Medhanyie et al. (2015) reported ‘digital bottlenecks’ including short battery life of smartphones, insensitivity of the phones’ touch screens with time and poor mobile network connectivity were common concerns in their study using mobile applications to collect maternal health data in Ethiopia.”
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PremisecitationEarlier research cautioned that even when community health workers respond well to digital programs, actual use remains low, evidenced by incomplete reporting in South Africa and Uganda.
“However, prior studies have cautioned that despite positive reception towards digital interventions among community health workers, uptake of these programs in practice has been low as reflected by incomplete reporting for digital interventions in South Africa (Chaiyachati et al., 2013) and Uganda (Haberer et al., 2010).”
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PremisecitationIn Pakistan, training aided by technology seemed just as good as in-person training for community health workers to gain clinical skills in perinatal depression care.
“In another recent study, Rahman et al. (2019), found that technology assisted training appears equally effective as face-to-face training in terms of achieving clinical competencies for delivering perinatal depression care by community health workers in Pakistan (Rahman et al., 2019).”
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The paper relies on this without support.
The three community health centers in Sehore district are representative of rural India for assessing the acceptability and feasibility of digital training.
“This study was conducted in 3 community health centers (CHCs) in Sehore district in the state of Madhya Pradesh, India.”
“Digital technology appears acceptable and feasible for supporting training of community health workers to deliver evidence-based depression care in rural India.”
The paper relies on this without support.
The digital training prototypes tested in this study are representative of the digital technology that would be used to train ASHAs to deliver HAP.
“The initial prototypes of the digital training consisted of content related to introducing depression, screening for depression, and what is counselling and how it differs from a friendly chat.”
“Digital technology appears acceptable and feasible for supporting training of community health workers to deliver evidence-based depression care in rural India.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Studies conducted in India [25] and Nepal [25] also report poor staff familiarity with smartphones as a key barrier to the delivery of mental care by frontline healthcare workers using the platform.
“Studies conducted in India [25] and Nepal [25] also report poor staff familiarity with smartphones as a key barrier to the delivery of mental care by frontline healthcare workers using the platform.”
From Perception of providers on use of the WHO mental health Gap Action Programme-Intervention Guide (mhGAP-IG) electronic version and smartphone-based clinical guidance in Nigerian primary care settings (2022) · cites this paper as [25]
The Results (Qualitative findings) identify limited familiarity with digital devices among ASHAs in rural India as a challenge to using the training platform. The Discussion likewise says limited experience made the platform difficult to navigate without assistance. This paper does not report a study in Nepal, and the barrier concerns training to deliver depression treatment rather than delivering care through the platform itself. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThere was a consistent discrepancy between HICs and LMICs, with coverage estimates in the former on average double those in the latter: though even in HIC, less than a fifth of adults meeting criteria received effective care.
“There was a consistent discrepancy between HICs and LMICs, with coverage estimates in the former on average double those in the latter: though even in HIC, less than a fifth of adults meeting criteria received effective care (Figure 11).”
From Time for united action on depression: a Lancet–World Psychiatric Association Commission (2022) · cites this paper as [600]
Data from the WMHS covering 15 countries indicate that, among community-dwelling adults meeting diagnostic criteria for depression, less than half had any contact with a general medical or specialist provider, and only 10% received effective care.
“Data from the WMHS covering 15 countries indicate that, among community-dwelling adults meeting diagnostic criteria for depression, less than half had any contact with a general medical or specialist provider, and only 10% received effective care. 600”
From Time for united action on depression: a Lancet–World Psychiatric Association Commission (2022) · cites this paper as [600]
A study in rural India reported limited familiarity of health care providers with digital technology as a key challenge for delivering depression care.
“For example, a study conducted to assess the acceptability and feasibility of using digital technology in mental health care in rural India also reported limited familiarity of health care providers’ with digital technology as a key challenge for delivering depression care [46].”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Recruitment sites do not match the stated facility types
MinorThe methods describe the three study sites as community health centers, but the results identify participants from one community health center, one primary healthcare center, and one civil hospital.
“This study was conducted in 3 community health centers (CHCs) in Sehore district in the state of Madhya Pradesh, India.”
“Eight ASHAs from the Doraha Community Health Center participated in prototype 1.0 testing and 24 ASHAs, including 11 from the Ahmadpur Primary Healthcare Center and 13 from the Ashta Civil Hospital, participated in prototype 2.0 testing.”
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Self-citation
- Authors
- Muke, S. S., Shrivastava, R. D., Mitchell, L., Khan, A., Murhar, V., Tugnawat, D., Shidhaye, R., Patel, V., & Naslund, J. A.
- Affiliations
- Sangath (IN)
- Harvard University (US)
- Public Health Foundation of India (IN)
- Corresponding author
- Muke, Shital S.
- ORCID
- Venue
- Asian Journal of Psychiatry
- Publisher
- Elsevier BV
- Published
- 2019-10
- Volume
- 45
- Pages
- 99-106
- ISSN
- 1876-2018 (ISSN-L)
- PMC
- PMC6810794
- OpenAlex
- W2971618255
- Semantic Scholar
- cf6deb16d256aec2c3d7ba06c0f46cf4c8c19ece
- Cited by
- 98
- References
- 33
- Citations by year
- 2026: 8 · 2025: 14 · 2024: 28 · 2023: 16 · 2022: 14 · 2021: 7 · 2020: 10 · 2019: 1
- FWCI
- 9.95
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Asian Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health
- Topics
- Physical Sciences › Computer Science › Information Systems › ICT in Developing Communities
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- community health workers, digital training, depression, rural mental health, acceptability, feasibility, resource-limited settings, digital health platforms, India
- MeSH terms
- Adult, Attitude of Health Personnel, Community Health Workers, Computer-Assisted Instruction, Depression, Feasibility Studies, Female, Humans, India, Middle Aged, Psychotherapy, Brief, Rural Population, Young Adult
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