Sangraula 2020.
| Study characteristics | |
| Methods |
Study design: cluster‐RCT Duration of study: the study was conducted between 2017 and 2019. Country: Nepal Income classification: low‐middle‐income country Geographical scope: rural, Sindhuli district, Nepal Healthcare setting: Village Development Committees (VDC) |
| Participants | 1. Age: age PM+‐46.7 (14.0), EUC: 49.3 (13.6) 2. Gender: both 3. Socioeconomic background: the majority (48‐55%) were housewives, followed by 33‐35% being farmers. 4. Educational background: 59‐80% were illiterate; 12‐18% informal education. Inclusion criteria: a. 18 years and older; b. all sexes eligible; c. score > 2 on General Health Questionnaire (dichotomous item scoring method); d. score > 16 on World Health Organization Disability Assessment Scale; Exclusion criteria: a. presence of a severe mental disorder (e.g. psychosis); b. alcohol use disorder (score > 16 on the alcohol use disorders identification test [AUDIT]). Note: at baseline, the intervention and control group scores for the Patient Health Questionnaire‐9 (PHQ‐9) were, respectively, 9.8 (4.9) and 10.7 (4.4). At baseline, the intervention and control group scores for the General Health Questionnaire (GHQ‐12) were, respectively, 24.3 (4.8) and 21.3 (4.7). At baseline, the intervention and control group scores for the World Health Organization Disability Assessment Schedule (WHODAS) were, respectively, 21.8 (5.3) and 20.8 (4.1). Stated purpose: to assess the feasibility and acceptability of locally adapted Group PM+ for women and men in an earthquake‐affected region of rural Nepal |
| Interventions |
Name: Group Problem Management Plus (PM+) Title/name of PW and number: community‐based psychosocial workers/PM+ facilitators (4) 1. Selection: “The requirement for the non‐specialists will be at least 10 years of education, over 25 years of age, and living in either the EUC or Group PM+ VDC.” 2. Educational background: 10+ years of education 3. Training: nonspecialists will receive the standard training to become community psychosocial workers by TPO Nepal. This takes place over 20 days and consists of the teaching of basic psychological skills. Community‐based psychosocial workers (CPSWs) from the intervention were given an additional 10‐day Group PM+ training using the adapted manual and other clinical materials. Intervention training includes education on adversity and its impact upon mental health, basic counselling skills, delivering Group PM+, skills in group facilitation, and facilitator self‐care. Transcultural Psychosocial Organization (TPO) Nepal is a Nepali nongovernmental mental health research and training organization, with specific expertise in humanitarian settings. 4. Supervision: fidelity assessment as part of the feasibility study (adequate: all four Group PM+ facilitators adhered to 75% or more items in each of the group sessions they conducted). This was done by the research team. 5. Incentives/remuneration: not specified Prevention type: indicated – participants presented with some level of distress as indicated by PHQ‐9 scores. All those who presented with a severe mental disorder were excluded. Intervention details: participants in the intervention arm received five sessions of Group PM+, with each session lasting 2.5 to 3 hours. Sessions included: (1) managing stress, (2) behavioural activation, (3) managing problems, (4) strengthening social support and (5) review of techniques. Control: usual care (enhanced) – the group consisted of six to eight people separated by gender and with gender‐matched facilitators. Volunteer local helpers supported facilitators by organising logistics and reminding participants about the sessions. CPSWs were the service providers for the groups and are a cadre of psychosocial workers in Nepal that are trained through and work for NGOs, such as TPO Nepal. |
| Outcomes |
Participants’outcomes of interest for this review
Carers’ outcomes of interest for this review Nil Economic outcomes Nil Time points: baseline, post‐intervention (< 1 month) |
| Notes |
Source of funding: this study was funded by USAID/OFDA. The trial sponsors had no role in the collection, management, analysis, and interpretation of data; nor the decision to submit the report for publication. The authors alone are responsible for the views expressed in this article and they do not necessarily represent the views, decisions, or policies of the institutions with which they are affiliated. Notes on validation of instruments (screening and outcomes): the selected outcomes are well established and validated across contexts. Additional information: none Handling the data: the supplementary material for this article can be found at doi.org/10.1017/S2045796020000414. Raw data are available as additional supporting files. Prospective trial registration number: NCT03359486 |