ECHO ADHD in India: a feasible and acceptable training model for child-care physicians to identify and manage attention deficit hyperactivity disorder

Background: Children with attention deficit hyperactivity disorder (ADHD) have complex unmet needs. Physicians cite lack of knowledge, skills and resources as barriers to meeting these. ECHO (Extension of community health outcomes) ADHD, a case based tele-mentoring model was designed to address gaps in physician knowledge and skills regarding ADHD. A study was conducted to assess 1. Acceptability and feasibility of the program 2. Change in knowledge, self-efficacy and perception about appropriateness and feasibility of role in ADHD diagnosis and management pre and post program. Methods: The 6-month pilot trained pediatricians, developmental pediatricians, psychiatrists, neurologists through 14 sessions comprising lectures, case discussions. Participants completed measures for knowledge (KADDS-knowledge of attention deficit disorders scale), self-efficacy, and acceptability and feasibility of role at baseline and endline. Descriptive and non-parametric analysis assessed acceptability and feasibility of program and change in knowledge, self-efficacy, appropriateness and feasibility of role. De-identified case summaries helped in analysing participant queries.Results: Sixty four percent (57/88) participants completed baseline and endline evaluations and were included. Most were pediatricians and developmental pediatricians who found the model acceptable and feasible. Significant improvement was noted in knowledge about ADHD diagnosis, self-efficacy and perceptions about appropriateness and feasibility of role. Improvement in knowledge about ADHD comorbidities and management was not significant on KADDS. Case summaries, questions to hub team, discussions indicated participant focus on ADHD diagnosis. Conclusions: ECHO ADHD is an acceptable and feasible model in low- and middle-income country (LMIC) setting which improved knowledge and self-efficacy among participants.