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Perinatal depression is a common, under-treated condition in Sri Lanka, where approximately one in five perinatal women experiences depressive symptoms and access to specialist mental health care is limited. The World Health Organization’s Thinking Healthy Programme (THP) is an evidence-based cognitive-behavioural intervention designed for delivery by non-specialist workers, but a locally validated Sinhala version for Public Health Midwife (PHM) delivery in Galle District was not available. We translated the THP manual from English into Sinhala using forward and back translation by four bilingual investigators, culturally adapted the draft using Bernal’s Ecological Validity Framework with a five-member multidisciplinary group and pre-tested the adapted version with five PHMs across five Medical Officer of Health areas in Galle District. We then validated the manual through a Modified Delphi process involving a nine-member multidisciplinary expert panel that assessed face, content and consensual validity over two iterative rounds and a final roundtable. The scale-level Content Validity Index was 0.96, with mean (SD) ratings of 3.8 (0.7) for relevance and 3.8 (0.1) for clarity. The panel reached unanimous consensus, supporting field-testing of THP delivery by PHMs.

Background.

The Thinking Healthy Programme (THP) is an evidence-based psychological intervention endorsed by the World Health Organization, tailored for non-specialist health workers in low- and middle-income countries. However, training and supervision of large numbers of health workers is a major challenge for the scale-up of THP. We developed a ‘Technology-Assisted Cascaded Training and Supervision system’ (TACTS) for THP consisting of a training application and cascaded supervision delivered from a distance.

Methods.

A single-blind, non-inferiority, randomized controlled trial was conducted in District Swat, a post-conflict area of North Pakistan. Eighty community health workers (called Lady Health Workers or LHWs) were randomly assigned to either TACTS or conventional face-to-face training and supervision by a specialist. Competence of LHWs in delivering THP post-training was assessed by independent observers rating a therapeutic session using a standardized measure, the ‘Enhancing Assessment of Common Therapeutic factors’ (ENACT), immediately post-training and after 3 months. ENACT uses a Likert scale to score an observed interaction on 18 dimensions, with a total score of 54, and a higher score indicating greater competence.

Results.

Results indicated no significant differences between health workers trained using TACTS and supervised from distance v. those trained and supervised by a specialist face-to-face (mean ENACT score M = 24.97, s.d. = 5.95 v. M = 27.27, s.d. = 5.60, p = 0.079, 95% CI 4.87–0.27) and at 3 months follow-up assessment (M = 44.48, s.d. = 3.97 v. M = 43.63, s.d. = 6.34, p = 0.53, CI −1.88 to 3.59).

Conclusions.

TACTS can provide a promising tool for training and supervision of front-line workers in areas where there is a shortage of specialist trainers and supervisors.

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Translation, cultural adaptation and validation of the Thinking Healthy Programme manual for perinatal depression in Galle District, Sri Lanka

Using technology to scale-up training and supervision of community health workers in the psychosocial management of perinatal depression: a non-inferiority, randomized controlled trial

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Translation, cultural adaptation and validation of the Thinking Healthy Programme manual for perinatal depression in Galle District, Sri Lanka

Using technology to scale-up training and supervision of community health workers in the psychosocial management of perinatal depression: a non-inferiority, randomized controlled trial