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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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.
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In 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).”
From Acceptability and feasibility of digital technology for training community health workers to deliver brief psychological treatment for depression in rural India (2019) · cites this paper as Rahman et al., 2019
Growing 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).”
From Acceptability and feasibility of digital technology for training community health workers to deliver brief psychological treatment for depression in rural India (2019) · cites this paper as Rahman et al., 2019
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- Authors
- Rahman, A., Akhtar, P., Hamdani, S. U., Atif, N., Nazir, H., Uddin, I., Nisar, A., Huma, Z., Maselko, J., Sikander, S., & Zafar, S.
- Affiliations
- Human Development Research Foundation (PK)
- Bacha Khan Medical College (PK)
- University of North Carolina at Chapel Hill (US)
- ORCID
- Venue
- Global Mental Health
- Publisher
- Cambridge University Press (CUP)
- Published
- 2019
- Volume
- 6
- Pages
- e8-e8
- ISSN
- 2054-4251 (ISSN-L)
- PMC
- PMC6533850
- OpenAlex
- W2946019115
- Cited by
- 99
- References
- 39
- Citations by year
- 2026: 9 · 2025: 11 · 2024: 19 · 2023: 17 · 2022: 18 · 2021: 14 · 2020: 5 · 2019: 6
- FWCI
- 9.90
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Cambridge Prisms Global Mental Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- Government of Canada
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD075875, P2CHD050924)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Keywords
- perinatal depression, community health workers, Lady Health Workers, distance supervision, non-specialist mental health workers, health worker competence, ENACT, post-conflict societies, Swat District
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