Accepted for/Published in: JMIR Research Protocols
Date Submitted: Nov 10, 2023
Date Accepted: May 16, 2024
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Feasibility trial of a low-intensity preventive intervention delivered at community doorsteps by frontline workers in rural Pakistan: mPareshan Study protocol
ABSTRACT
Background:
There is a dearth of specialized mental health workforce in low- and middle-income countries. In the presence of huge treatment gaps, the feasibility of utilizing frontline community workers to promote mental well-being needs to be explored.
Objective:
To assess the feasibility, acceptability, and usefulness of an app-based counselling intervention delivered by Lady Health Workers (LHWs) to reduce anxiety and depression at the community level in Pakistan.
Methods:
This is a single-arm, pre- and post-test feasibility trial using mixed methods of data collection in a rural district of Sindh, Pakistan. After a baseline screening survey using PHQ-9 and GAD-7, individuals with mild and moderate symptoms of anxiety and depression are invited to take part in face-to-face, home-based, counselling sessions. The counselling sessions are delivered by LHWs through the mPareshan app (intervention). Each 20-minute session imparts psychoeducation through audio and video clips, breathing exercises and promotes coping skills. WHO mhGAP guide 2.0 is used to improve mental health literacy of LHWs and LHSs. Change in mean symptomatic scores of anxiety and depression will be assessed for intervention effectiveness. Feasibility will be measured by participant recruitment, retention, and adherence to the intervention. Knowledge and skills of health workers in identification of symptoms, counselling techniques and appropriate referrals, will be determined.
Results:
This paper describes the protocol of the mPareshan feasibility trial. The trial was prospectively registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) on 14th August 2022. Ethical clearance was obtained in December 2021, and an extension granted in 2022. Data collection started in 2022. Data analysis is ongoing and study results will be disseminated in early 2024.
Conclusions:
Marginalized rural communities do not seek mental health care due to fear of stigmatization, lack of resources and specialized mental health workforce. This low-intensity preventive intervention will promote mental well-being at community doorsteps through early identification and prompt referrals. This study marks the first instance of utilizing frontline healthcare workers at the primary care level to promote mental well-being through a technology-assisted intervention. Clinical Trial: ACTRN12622000989741
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