“I am honored to be a recipient of the Burke Fellowship, and to have this exciting opportunity to expand my research in collaboration with Sangath to use widely available digital technology to address stress and to promote mental health and wellbeing among community health workers in rural India. This project represents a critical part of my research and career development, because it will set the stage for supporting the eventual roll out of this scalable digital program in low-resource settings, and is especially timely given the devastating impact of the COVID-19 pandemic across the country, and urgent need to address the resulting psychological distress and elevated risk of burnout among community health workers on the frontlines.” - Dr. John Naslund
The Burke Global Health Fellowship program at the Harvard Global Health Institute provides funding for Harvard junior faculty members from across the University for innovative research and curriculum development and teaching (particularly at the undergraduate level) in global health. The Fellowships are made possible through the generous support of Harvard alumna Katherine States Burke, AB’79, and her husband, T. Robert Burke, who established the Burke Fund to help launch and advance the careers of promising junior faculty in global health.
Fellowship Project Title: Developing a scalable digital program for stress reduction and mental health promotion for community health workers in rural India
Fellowship Project Description: Community health workers (CHWs) represent the backbone of most health systems, particularly in low-income and middle-income countries (LMICs), such as India, where they are responsible for delivering essential primary health care services in remote communities and underserved settings. CHWs are now increasingly playing a critical role in efforts to scale up mental health care globally, referred to as task sharing. Despite recent initiatives to strengthen health systems and improve performance of CHWs, through supervision, better training, and improved data collection, one notable gap in the global health literature is the limited attention to the mental health and wellbeing of CHWs themselves. This is a major concern because CHWs in LMICs face high levels of stress, driven by high work demands, low compensation, and facing adversity such as poverty, gender inequality, and being at the bottom of health system power hierarchies. The COVID-19 pandemic has significantly exacerbated risks of psychological distress and burnout among CHWs on the frontlines. It seems intuitive that mentally healthy and motivated CHWs will be better positioned to deliver high quality care to their patients, and as a result, support the successful implementation of mental health care. Our study seeks to address this gap by developing and pilot testing a digital stress reduction and mental health promotion program for CHWs embedded within an ongoing large-scale NIMH U19 implementation project called ESSENCE (Enabling Science to Service to ENhance depression CarE) focused on scaling up mental health services in primary care in rural India. This Burke Fellowship builds on our team’s track record using digital technology for training and supporting CHWs, and will first involve developing a scalable digital stress reduction program for CHWs in rural India by adapting the World Health Organization’s evidence-based Self Help Plus intervention for psychological distress to fit the local context and culture, while digitizing the content so that it is entirely accessible from a smartphone app. Next, we will conduct a pilot study to evaluate the feasibility, acceptability and preliminary effectiveness of the digital stress reduction program for CHWs. Lastly, we will explore whether reducing stress among CHWs may impact their wellbeing and the quality of care they deliver. Our exploratory findings hold promise for offering a scalable approach for reducing stress to support frontline health workers in delivering evidence-based mental health services in low-resource settings. This study could also inform efforts to alleviate the added burden and elevated stress levels and risk of burnout among CHWs in LMICs due to the ongoing response to the COVID-19 pandemic.