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Operational challenges in the pre-intervention phase of a mental health trial in rural India: reflections from SMART Mental Health.
Mukherjee, Ankita; Daniel, Mercian; Kaur, Amanpreet; Devarapalli, Siddhardha; Kallakuri, Sudha; Essue, Beverley; Raman, Usha; Thornicroft, Graham; Saxena, Shekhar; Peiris, David; Maulik, Pallab K.
  • Mukherjee A; The George Institute for Global Health, New Delhi, India. Amukherjee@georgeinstitute.org.in.
  • Daniel M; The George Institute for Global Health, New Delhi, India.
  • Kaur A; The George Institute for Global Health, New Delhi, India.
  • Devarapalli S; The George Institute for Global Health, Hyderabad, India.
  • Kallakuri S; The George Institute for Global Health, Hyderabad, India.
  • Essue B; Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
  • Raman U; Department of Communication, University of Hyderabad, Hyderabad, India.
  • Thornicroft G; Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
  • Saxena S; Harvard T H Chan School of Public Health, Boston, USA.
  • Peiris D; The George Institute for Global Health, UNSW Sydney, Sydney, Australia.
  • Maulik PK; The George Institute for Global Health, New Delhi, India.
Int J Ment Health Syst ; 16(1): 42, 2022 Aug 16.
Article in English | MEDLINE | ID: covidwho-1993371
ABSTRACT

BACKGROUND:

Availability of mental health services in low- and middle-income countries is largely concentrated in tertiary care with limited resources and scarcity of trained professionals at the primary care level. SMART Mental Health is a strategy that combines a community anti-stigma campaign with a primary health care workforce strengthening initiative, using electronic decision support with the goal of better identifying and supporting people with common mental disorders in India.

METHODS:

We describe the challenges faced and lessons learnt during the pre-intervention phase of SMART Mental Health cluster Randomised Controlled Trial. Pre-intervention phase includes preliminary activities for setting-up the trial and research activities prior to delivery of the intervention. Field notes from project site visit, project team meetings and detailed follow-up discussions with members of the project team were used to document operational challenges and strategies adopted to overcome them. The socio-ecological model was used as the analytical framework to organise the findings.

RESULTS:

Key challenges included delays in government approvals, addressing community health worker needs, and building trust in the community. These were addressed through continuous communication, leveraging support of relevant stakeholders, and addressing concerns of community health workers and community. Issues related to use of digital platform for data collection were addressed by a dedicated technical support team. The COVID-19 pandemic and political unrest led to significant and unexpected challenges requiring important adaptations to successfully implement the project.

CONCLUSION:

Setting up of this trial has posed challenges at a combination of community, health system and broader socio-political levels. Successful mitigating strategies to overcome these challenges must be innovative, timely and flexibly delivered according to local context. Systematic ongoing documentation of field-level challenges and subsequent adaptations can help optimise implementation processes and support high quality trials. TRIAL REGISTRATION The trial is registered with Clinical Trials Registry India (CTRI/2018/08/015355). Registered on 16th August 2018. http//ctri.nic.in/Clinicaltrials/showallp.php?mid1=23254&EncHid=&userName=CTRI/2018/08/015355.
Keywords

Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Experimental Studies / Prognostic study / Randomized controlled trials / Systematic review/Meta Analysis Language: English Journal: Int J Ment Health Syst Year: 2022 Document Type: Article Affiliation country: S13033-022-00549-4

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Experimental Studies / Prognostic study / Randomized controlled trials / Systematic review/Meta Analysis Language: English Journal: Int J Ment Health Syst Year: 2022 Document Type: Article Affiliation country: S13033-022-00549-4