Reducing stigma among healthcare providers to improve mental health services (RESHAPE): protocol for a pilot cluster randomized controlled trial of a stigma reduction intervention for training primary healthcare workers in Nepal

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dc.contributor.authorKohrt, Brandon A
dc.contributor.authorJordans, Mark J D
dc.contributor.authorTurner, Elizabeth L
dc.contributor.authorSikkema, Kathleen J
dc.contributor.authorLuitel, Nagendra P
dc.contributor.authorRai, Sauharda
dc.contributor.authorSingla, Daisy R.
dc.contributor.authorLamichhane, Jagannath
dc.contributor.authorLund, Crick
dc.contributor.authorPatel, Vikram
dc.date.accessioned2018-04-17T08:16:27Z
dc.date.available2018-04-17T08:16:27Z
dc.date.issued2018-01-24
dc.date.updated2018-04-09T15:05:29Z
dc.description.abstractAbstract Background Non-specialist healthcare providers, including primary and community healthcare workers, in low- and middle-income countries can effectively treat mental illness. However, scaling-up mental health services within existing health systems has been limited by barriers such as stigma against people with mental illness. Therefore, interventions are needed to address attitudes and behaviors among non-specialists. Aimed at addressing this gap, REducing Stigma among HealthcAre Providers to ImprovE mental health services (RESHAPE) is an intervention in which social contact with mental health service users is added to training for non-specialist healthcare workers integrating mental health services into primary healthcare. Methods This protocol describes a mixed methods pilot and feasibility study in primary care centers in Chitwan, Nepal. The qualitative component will include key informant interviews and focus group discussions. The quantitative component consists of a pilot cluster randomized controlled trial (c-RCT), which will establish parameters for a future effectiveness study of RESHAPE compared to training as usual (TAU). Primary healthcare facilities (the cluster unit, k = 34) will be randomized to TAU or RESHAPE. The direct beneficiaries of the intervention are the primary healthcare workers in the facilities (n = 150); indirect beneficiaries are their patients (n = 100). The TAU condition is existing mental health training and supervision for primary healthcare workers delivered through the Programme for Improving Mental healthcarE (PRIME) implementing the mental health Gap Action Programme (mhGAP). The primary objective is to evaluate acceptability and feasibility through qualitative interviews with primary healthcare workers, trainers, and mental health service users. The secondary objective is to collect quantitative information on health worker outcomes including mental health stigma (Social Distance Scale), clinical knowledge (mhGAP), clinical competency (ENhancing Assessment of Common Therapeutic factors, ENACT), and implicit attitudes (Implicit Association Test, IAT), and patient outcomes including stigma-related barriers to care, daily functioning, and symptoms. Discussion The pilot and feasibility study will contribute to refining recommendations for implementation of mhGAP and other mental health services in primary healthcare settings in low-resource health systems. The pilot c-RCT findings will inform an effectiveness trial of RESHAPE to advance the evidence-base for optimal approaches to training and supervision for non-specialist providers. Trial registration ClinicalTrials.gov identifier, NCT02793271
dc.identifier.apacitationKohrt, B. A., Jordans, M. J. D., Turner, E. L., Sikkema, K. J., Luitel, N. P., Rai, S., ... Patel, V. (2018). Reducing stigma among healthcare providers to improve mental health services (RESHAPE): protocol for a pilot cluster randomized controlled trial of a stigma reduction intervention for training primary healthcare workers in Nepal. <i>Pilot and Feasibility Studies</i>, http://hdl.handle.net/11427/27797en_ZA
dc.identifier.chicagocitationKohrt, Brandon A, Mark J D Jordans, Elizabeth L Turner, Kathleen J Sikkema, Nagendra P Luitel, Sauharda Rai, Daisy R. Singla, Jagannath Lamichhane, Crick Lund, and Vikram Patel "Reducing stigma among healthcare providers to improve mental health services (RESHAPE): protocol for a pilot cluster randomized controlled trial of a stigma reduction intervention for training primary healthcare workers in Nepal." <i>Pilot and Feasibility Studies</i> (2018) http://hdl.handle.net/11427/27797en_ZA
dc.identifier.citationPilot and Feasibility Studies. 2018 Jan 24;4(1):36
dc.identifier.ris TY - Journal Article AU - Kohrt, Brandon A AU - Jordans, Mark J D AU - Turner, Elizabeth L AU - Sikkema, Kathleen J AU - Luitel, Nagendra P AU - Rai, Sauharda AU - Singla, Daisy R. AU - Lamichhane, Jagannath AU - Lund, Crick AU - Patel, Vikram AB - Abstract Background Non-specialist healthcare providers, including primary and community healthcare workers, in low- and middle-income countries can effectively treat mental illness. However, scaling-up mental health services within existing health systems has been limited by barriers such as stigma against people with mental illness. Therefore, interventions are needed to address attitudes and behaviors among non-specialists. Aimed at addressing this gap, REducing Stigma among HealthcAre Providers to ImprovE mental health services (RESHAPE) is an intervention in which social contact with mental health service users is added to training for non-specialist healthcare workers integrating mental health services into primary healthcare. Methods This protocol describes a mixed methods pilot and feasibility study in primary care centers in Chitwan, Nepal. The qualitative component will include key informant interviews and focus group discussions. The quantitative component consists of a pilot cluster randomized controlled trial (c-RCT), which will establish parameters for a future effectiveness study of RESHAPE compared to training as usual (TAU). Primary healthcare facilities (the cluster unit, k = 34) will be randomized to TAU or RESHAPE. The direct beneficiaries of the intervention are the primary healthcare workers in the facilities (n = 150); indirect beneficiaries are their patients (n = 100). The TAU condition is existing mental health training and supervision for primary healthcare workers delivered through the Programme for Improving Mental healthcarE (PRIME) implementing the mental health Gap Action Programme (mhGAP). The primary objective is to evaluate acceptability and feasibility through qualitative interviews with primary healthcare workers, trainers, and mental health service users. The secondary objective is to collect quantitative information on health worker outcomes including mental health stigma (Social Distance Scale), clinical knowledge (mhGAP), clinical competency (ENhancing Assessment of Common Therapeutic factors, ENACT), and implicit attitudes (Implicit Association Test, IAT), and patient outcomes including stigma-related barriers to care, daily functioning, and symptoms. Discussion The pilot and feasibility study will contribute to refining recommendations for implementation of mhGAP and other mental health services in primary healthcare settings in low-resource health systems. The pilot c-RCT findings will inform an effectiveness trial of RESHAPE to advance the evidence-base for optimal approaches to training and supervision for non-specialist providers. Trial registration ClinicalTrials.gov identifier, NCT02793271 DA - 2018-01-24 DB - OpenUCT DO - 10.1186/s40814-018-0234-3 DP - University of Cape Town J1 - Pilot and Feasibility Studies LK - https://open.uct.ac.za PB - University of Cape Town PY - 2018 T1 - Reducing stigma among healthcare providers to improve mental health services (RESHAPE): protocol for a pilot cluster randomized controlled trial of a stigma reduction intervention for training primary healthcare workers in Nepal TI - Reducing stigma among healthcare providers to improve mental health services (RESHAPE): protocol for a pilot cluster randomized controlled trial of a stigma reduction intervention for training primary healthcare workers in Nepal UR - http://hdl.handle.net/11427/27797 ER - en_ZA
dc.identifier.urihttp://dx.doi.org/10.1186/s40814-018-0234-3
dc.identifier.urihttp://hdl.handle.net/11427/27797
dc.identifier.vancouvercitationKohrt BA, Jordans MJD, Turner EL, Sikkema KJ, Luitel NP, Rai S, et al. Reducing stigma among healthcare providers to improve mental health services (RESHAPE): protocol for a pilot cluster randomized controlled trial of a stigma reduction intervention for training primary healthcare workers in Nepal. Pilot and Feasibility Studies. 2018; http://hdl.handle.net/11427/27797.en_ZA
dc.language.isoen
dc.publisherBioMed Central
dc.publisher.departmentDepartment of Public Health and Family Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rights.holderThe Author(s).
dc.sourcePilot and Feasibility Studies
dc.source.urihttps://pilotfeasibilitystudies.biomedcentral.com/
dc.subject.otherAttitudes
dc.subject.otherCompetence
dc.subject.otherLow- and middle-income countries
dc.subject.otherMental health
dc.subject.otherNon-specialists
dc.subject.otherPrimary care
dc.subject.otherService users
dc.subject.otherTask-shifting
dc.subject.otherTraining
dc.subject.otherStigma
dc.titleReducing stigma among healthcare providers to improve mental health services (RESHAPE): protocol for a pilot cluster randomized controlled trial of a stigma reduction intervention for training primary healthcare workers in Nepal
dc.typeJournal Article
uct.type.filetypeText
uct.type.filetypeImage
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