Kohrt 2018.

Study name	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
Methods	Pilot cluster‐randomised controlled trial
Participants	Clusters are primary healthcare facilities. The direct beneficiaries are the primary healthcare workers at these facilities. The indirect beneficiaries are their patients Inclusion criteria Primary care workers 1. Participating in either prescriber or non‐prescriber PRIME trainings  2. 21 to 65 years of age 3. Recruitment will attempt to balance gender distribution in recruitment health clusters 4. Nepali language competency, actively engaged in care provision in the health cluster, with a valid certificate of practice from the Ministry of Health 5. Permission from the health supervisor to attend the entire duration of training Patients 1. Receiving PRIME services including persons with diagnosis of depression, psychosis, harmful drinking, or epilepsy. Providers make the diagnosis based on mhGAP criteria 2. 21 to 65 years of age 3. Fluency in Nepali Exclusion criteria 1. Primary care trainees will be excluded if they have any prior citations on their clinical practice licensure 2. Patients who cannot provide consent
Interventions	Intervention PRIME/mhGAP + RESHAPE = Mental health services users and primary care workers who have previously completed training are trained using PhotoVoice and other techniques to participate as co‐facilitators. They participate in introductions to the intervention, myth busting, recovery stories, psychosocial communication role‐plays, and collaborative activities addressing challenges and barriers to task‐sharing/task‐shifting mental health services in primary care Other name: social contact anti‐stigma behavioural intervention Control Treatment as usual (PRIME/mhGAP). Primary care workers are trained using the mental health Global Action Programme (mhGAP) to identify and treat mental disorders in primary care. Primary care "prescribers" (those who can administer psychotropic medication) are trained to treat disorders including depression, alcohol use disorder, psychosis/schizophrenia, and epilepsy. "Non‐prescribers" (primary care workers not authorised to dispense medications) are trained to deliver psychosocial and psychological interventions
Outcomes	Primary outcomes (health provider) Change in stigmatising attitudes, as measured by the Social Distance questionnaire Secondary outcomes (health provider) 1. Change in clinical knowledge, as measured by the mhGAP knowledge assessment 2. Change in implicit attitudes, as measured by the Implicit Association Test (IAT) [Time Frame: baseline, +4 months, + 16 months] 3. Change in stigmatising attitudes, as measured by the mhGAP Attitudes Questionnaire 4. Change in clinical competence, as measured by Enhancing Assessment of Common Therapeutic Factors Secondary outcomes (patient) 1. Change in patient functioning, as measured by the World Health Organization Disability Assessment Scale (WHODAS) [Time Frame: baseline, 6 months] 2. Change in patient‐perceived stigma as a barrier to accessing care, as measured by the Barriers to Access to Care Evaluation (BACE) [Time Frame: baseline, 6 months] 3. Change in patient depression, as measured by the Patient Health Questionnaire (PHQ‐9) [Time Frame: baseline, 6 months]
Starting date	8 June 2016
Contact information	bkohrt@gwu.edu
Notes	Recruitment completed