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STUDY PROTOCOL article

Front. Health Serv.
Sec. Implementation Science
Volume 4 - 2024 | doi: 10.3389/frhs.2024.1477444

Remote coaching for supporting the implementation of treatment for depression in primary care in Madhya Pradesh, India: Protocol for a cluster randomized controlled trial

Provisionally accepted
Ameya Bondre Ameya Bondre 1Abhishek Singh Abhishek Singh 1Deepak Tugnawat Deepak Tugnawat 1Dinesh Chandke Dinesh Chandke 1Azaz Khan Azaz Khan 1Ritu Shrivastava Ritu Shrivastava 1Chunling Lu Chunling Lu 2,3Rohit Ramaswamy Rohit Ramaswamy 4Vikram Patel Vikram Patel 3Anant Bhan Anant Bhan 1John A. Naslund John A. Naslund 3*
  • 1 Sangath, Bhopal, Madhya Pradesh, India
  • 2 Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
  • 3 Harvard Medical School, Boston, United States
  • 4 Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States

The final, formatted version of the article will be published soon.

    Background: Upwards of ninety percent of individuals living with depression in India do not have access to evidence-based treatments, especially in rural areas. Integrating these treatments into primary care is essential for bridging this care gap. This trial aims to evaluate whether a remote coaching implementation support strategy, referred to as Enhanced Implementation Support, is superior to routine support, referred to as Routine Implementation Support, in supporting the delivery of collaborative depression care in rural primary care centers. Methods: Employing a cluster-randomized hybrid type-III implementation trial design, 14 primary care facilities in Sehore district, Madhya Pradesh, will implement a collaborative depression care package based on the WHO’s mhGAP program. Facilities will be randomized to either Enhanced Implementation Support or the Routine Implementation Support control condition. Enhanced Implementation Support consists of remote coaching and technical assistance, supplemented with in-person visits, and guided by the Plan-Do-Study-Act implementation cycles. The primary implementation outcome is the proportion of outpatients screened for depression by facility staff, with secondary outcomes including the proportions of outpatients who screen positive for depression, are referred to the medical officer, and initiate treatment. Secondary patient outcomes include proportion of patients who achieve reduction in depression symptom severity at 3-month follow up. Acceptability, feasibility, and fidelity of the depression care package will be assessed through routine observations collected during field visits, facility audits, and qualitative exit interviews with facility staff. Costs of delivering the Enhanced Implementation Support strategy will also be estimated. Discussion: This trial can inform efforts to integrate depression care in rural primary care facilities in a low-resource setting, and illuminate whether external coaching support is superior relative to existing implementation support for achieving these goals. Trial Registration: NCT05264792

    Keywords: Primary Care, rural, Depression, Mental Health, implementation, hybrid trial, implementation support strategy

    Received: 07 Aug 2024; Accepted: 09 Sep 2024.

    Copyright: © 2024 Bondre, Singh, Tugnawat, Chandke, Khan, Shrivastava, Lu, Ramaswamy, Patel, Bhan and Naslund. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: John A. Naslund, Harvard Medical School, Boston, United States

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.