The long-term goal of ESSENCE (Enabling translation of Science to Service to ENhance Depression CarE) is to bridge the science to service gap and strengthen an existing collaborative network of institutions in South Asia by generating knowledge on cost-effective implementation approaches for scaling up of evidence-based interventions for mental disorders, and building capacity in a range of key stakeholders to enhance the conduct of implementation research, the dissemination of its findings, and the uptake of this evidence in policy and programs, ultimately resulting in reduction of treatment gap for mental disorders.
Project Period: 1st July 2017 to 31st May 2022
Funder: National Institute of Mental Health
Objectives
1) Evolving the existing administrative infrastructure of SHARE Hub (the South Asian Hub for Advocacy, Research and Education on mental health) for International Mental Health Research, to provide overall coordination for the ESSENCE components and building on the existing research partnerships to establish a South Asian Mental Health Implementation Science Hub comprising of the ESSENCE partners which include governmental, non-governmental, academic, and implementing agencies in the region.
2) Carrying out implementation research to assess the comparative effectiveness of technology-enabled interventions to train non-specialist health workers and provide them implementation support to address the key barriers to the coordinated delivery of evidence-based clinical treatments for depression (Healthy Activity Program and Antidepressant Therapy) at the primary health care level.
3) Developing and offering a range of opportunities, including fellowships and online courses tailored for the region, to build the capacity of the researchers to generate knowledge, of the media professionals and service user representatives to disseminate that knowledge, and of policy makers and program, managers to ensure uptake of the knowledge.
Study Design
ESSENCE (Enabling translation of Science to Service to ENhance Depression CarE) is an implementation research project with a broader goal of bridging the science-to-service gap by identifying the most effective and cost-effective strategies for scaling up evidence-based clinical treatments for depression (i.e., the Healthy Activity Program, a brief psychological treatment delivered by Non-Specialist Health Workers) in primary care facilities in Madhya Pradesh, India.
ESSENCE consists of two complementary, sequential randomized controlled trials: 1) the ‘Training Trial’ to compare two forms of digital training (i.e., low-intensity and high-intensity) with traditional Face-to-Face training (F2F) of non-specialist health workers to deliver the Healthy Activity Program (HAP); and 2) the ‘Implementation Trial’ to compare different remote implementation support strategies on achieving fidelity of implementation of evidence-based clinical treatments for depression in primary care facilities and to assess impact on patient outcomes.
Background
In India, depression accounts for 37% of the mental health-related Disability Adjusted Life Years (DALYs) and significantly contributes to the burden attributed to suicide and ischemic heart disease thus making it a critical public health priority. However, despite the knowledge of evidence-based clinical treatments (EBT) treatment gaps exceed 90% in rural areas. ESSENCE will address the critical knowledge gap regarding the training and implementation support strategies necessary to scale-up evidence-based delivery strategies for treatments for depression in a low resource setting. The innovations in the study are focused on developing and testing strategies for effective delivery of evidence-based treatments in low-income settings.