REMOTE COACHING AND TECHNOLOGY FOR TRAINING COMMUNITY HEALTH WORKERS TO TREAT DEPRESSION IN PRIMARY CARE: CASE EXAMPLE FROM INDIA AND OPPORTUNITIES TO SCALE UP MENTAL HEALTH CARE GLOBALLY

Objectives: Depression is a leading cause of disability that disproportionately impacts low- and middle-income countries. With greater likelihood of access to a mobile phone than mental health care in most countries, there may be opportunities to leverage these digital tools toward increasing access to depression care. We present a case example from the ESSENCE project in India using digital technology to build capacity of community health workers (CHWs), the essential workforce responsible for frontline maternal and child health services in the country, to deliver a brief evidence-based psychological treatment for depression in primary care. Methods: We discuss key considerations in the design and evaluation of the digital training program, with emphasis on strategies to overcome poor mobile connectivity in rural and underresourced settings, and ensuring participant engagement. We describe the systematic approach to tailor the program to meet the needs of the target user group of CHWs. This involved careful design of the digital program and adapting the training content to the local culture and context. We also describe the use of remote coaching and other support techniques to promote engagement and completion of the training program. Results: We present findings from a pilot study with 42 CHWs that directly informed refinements to the training program and design of a subsequent randomized controlled trial enrolling 340 CHWs. We illustrate the progression from formative research to a larger trial, and the integration of remote coaching support, text messaging, and automated reminders within the digital program to promote engagement. We describe how these efforts are informing the design of a digital platform for training frontline health workers to deliver brief psychological treatments in other settings, including the United States. Conclusions: This example of reciprocal learning in global mental health is particularly timely given the impacts of the COVID-19 pandemic, and renewed efforts to train and support frontline health workers to meet the anticipated surge in mental health challenges globally. This study could yield a blueprint for using widely available digital technology for training and supporting frontline health workers toward scaling up mental health services in India and globally. DDD, TREAT, R