The major research objective of the SHARE project is to implement and test the THPP, a variation of the Thinking Healthy Programme (THP) originally developed in Pakistan. It incorporates cognitive and behavioral techniques such as active listening, collaboration with the family and non-threatening inquiry into the family’s health beliefs through challenging beliefs and if necessary offering substitutes for some of these through alternative information. Starting from pregnancy till 6 months postnatal. THPP delivers an established psychological treatment that reduces the burden of depression in mothers in South Asia using an innovative, feasible, effective and sustainable community-based approach.
The training for Peers is brief (5-7 days) and can be conducted by non-specialists with some experience of using THP in their work. A cascade model of training and supervision has been developed whereby a specialist supervises a number of non-specialist trainers through distance, and the non-specialist trainers cascade this training to the peers.
The primary innovation in the SHARE-THPP approach is the use of peers, who are lay women/peers with no prior health training. The delivery and content of THP are adapted to be:
- Deliverable by peers (local mothers) in the community
- Feasible, acceptable, affordable and effective for delivery in varied settings in South Asia
- Scalable – using a cascade model of training and supervision
SHARE-THPP is adapting and evaluating the intervention for scale-up in two different settings in India and Pakistan:
- Community-based rural population in Rawalpindi, Pakistan
- Facility-based urban population in Goa, India
The major difference between the trials is that in Goa, interventions will be delivered one-on-one by peers. In Pakistan, the intervention includes a group session format and is delivered as part of the established village based “Lady Health Worker” program.
An embedded sub-component of this research is the Shared Research project. The Shared Research project is a cross collaborative Hub activity which aims to identify barriers and facilitators to task sharing of mental health services, with the objective of informing future replication and scaling up of services beyond the study sites.
Perceptions of barriers and facilitators to task sharing will be looked at from various perspectives, including those of the trial participant, spouse, peer supervisor and other health professionals. Focus group discussions and in depth interviews will be carried out, and based on the identified barriers and facilitators, tools will be developed. These tools could be used to monitor and evaluate the impact that barriers and facilitators have on task sharing services at scale up.
The literature on barriers and facilitators to task sharing has been reviewed and qualitative data from the formative research examined to identify potential barriers and facilitators across various domains such as logistical, structural, attitudinal and stigma related barriers and facilitators. Topic guides for focus group discussions and in depth interviews are being developed and data collection will begin from the first quarter of 2016.