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Operational challenges in the pre-intervention phase of a mental health trial in rural India: reflections from SMART Mental Health

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 wit...

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Autores principales: Mukherjee, Ankita, Daniel, Mercian, Kaur, Amanpreet, Devarapalli, Siddhardha, Kallakuri, Sudha, Essue, Beverley, Raman, Usha, Thornicroft, Graham, Saxena, Shekhar, Peiris, David, Maulik, Pallab K.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9379869/
https://www.ncbi.nlm.nih.gov/pubmed/35974341
http://dx.doi.org/10.1186/s13033-022-00549-4
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author Mukherjee, Ankita
Daniel, Mercian
Kaur, Amanpreet
Devarapalli, Siddhardha
Kallakuri, Sudha
Essue, Beverley
Raman, Usha
Thornicroft, Graham
Saxena, Shekhar
Peiris, David
Maulik, Pallab K.
author_facet Mukherjee, Ankita
Daniel, Mercian
Kaur, Amanpreet
Devarapalli, Siddhardha
Kallakuri, Sudha
Essue, Beverley
Raman, Usha
Thornicroft, Graham
Saxena, Shekhar
Peiris, David
Maulik, Pallab K.
author_sort Mukherjee, Ankita
collection PubMed
description 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
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spelling pubmed-93798692022-08-16 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. Int J Ment Health Syst Research 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 BioMed Central 2022-08-16 /pmc/articles/PMC9379869/ /pubmed/35974341 http://dx.doi.org/10.1186/s13033-022-00549-4 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Mukherjee, Ankita
Daniel, Mercian
Kaur, Amanpreet
Devarapalli, Siddhardha
Kallakuri, Sudha
Essue, Beverley
Raman, Usha
Thornicroft, Graham
Saxena, Shekhar
Peiris, David
Maulik, Pallab K.
Operational challenges in the pre-intervention phase of a mental health trial in rural India: reflections from SMART Mental Health
title Operational challenges in the pre-intervention phase of a mental health trial in rural India: reflections from SMART Mental Health
title_full Operational challenges in the pre-intervention phase of a mental health trial in rural India: reflections from SMART Mental Health
title_fullStr Operational challenges in the pre-intervention phase of a mental health trial in rural India: reflections from SMART Mental Health
title_full_unstemmed Operational challenges in the pre-intervention phase of a mental health trial in rural India: reflections from SMART Mental Health
title_short Operational challenges in the pre-intervention phase of a mental health trial in rural India: reflections from SMART Mental Health
title_sort operational challenges in the pre-intervention phase of a mental health trial in rural india: reflections from smart mental health
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9379869/
https://www.ncbi.nlm.nih.gov/pubmed/35974341
http://dx.doi.org/10.1186/s13033-022-00549-4
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