Coach-Supported Versus Self-guided Digital Training Course for a Problem-solving Psychological Intervention for Nonspecialists: Protocol for a Pre-Post Nested Randomized Controlled Trial

BACKGROUND: Psychosocial interventions delivered by nonspecialists can be effective at reducing common adolescent mental health problems in low-resource settings. However, there is a lack of evidence on resource-efficient methods for building capacity to deliver these interventions. OBJECTIVE: The objective of this study is to evaluate the effects of a digital training (DT) course, delivered in a self-guided format or with coaching, on nonspecialists' competency to deliver a problem-solving intervention intended for adolescents with common mental health problems in India. METHODS: We will conduct a pre-post study with a nested parallel, 2-arm, individually randomized controlled trial. The study aims to recruit 262 participants, randomized 1:1 to receive either a self-guided DT course or a DT course with weekly individualized coaching provided remotely by telephone. In both arms, the DT will be accessed over 4 to 6 weeks. Participants will be nonspecialists (ie, without prior practice-based training in psychological therapies) recruited from among university students and affiliates of nongovernmental organizations in Delhi and Mumbai, India. RESULTS: Outcomes will be assessed at baseline and 6 weeks post randomization using a knowledge-based competency measure that incorporates a multiple-choice quiz format. The primary hypothesis is that self-guided DT will lead to increased competency scores among novices with no prior experience of delivering psychotherapies. The secondary hypothesis is that digital training with coaching will have an incremental effect on competency scores compared with DT alone. The first participant was enrolled on April 4, 2022. CONCLUSIONS: The study will address an evidence gap on the effectiveness of training methods for nonspecialist providers of adolescent mental health interventions in low-resource settings. The findings from this study will be used to support wider efforts to scale up evidence-based mental health interventions for young people. TRIAL REGISTRATION: ClinicalTrials.gov NCT05290142; https://clinicaltrials.gov/ct2/show/NCT05290142. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/41981

Feasibility and acceptability of a remote stepped care mental health programme for adolescents during the COVID-19 pandemic in India

Remote mental health services were rapidly deployed during the COVID-19 pandemic, yet there is relatively little contemporaneous evidence on their feasibility and acceptability. This study assessed the feasibility and acceptability of a stepped care mental health programme delivered remotely by lay counsellors to adolescents in New Delhi, India, during a period of ‘lockdown’. The programme consisted of a brief problem-solving intervention (“Step 1”) followed by a tailored behavioural module (“Step 2”) for non-responders. We enrolled 34 participants (M age = 16.4 years) with a self-identified need for psychological support. Feasibility and acceptability were assessed through quantitative process indicators and qualitative interviews (n = 17 adolescents; n = 5 counsellors). Thirty-one (91%) adolescents started Step 1 and 16 (52%) completed the planned Step 1 protocol. Twelve (75%) of the Step 1 completers were non-responsive. Eight (67%) non-responsive cases started Step 2, all of whom met response criteria when reassessed at 12 weeks post-enrolment. Adolescents favoured voice-only sessions over video-calls due to privacy concerns and difficulties accessing suitable devices. Counsellors noted challenges of completing remote sessions within the allotted time while recognising the importance of supervision for developing competence in new ways of working. Both adolescents and counsellors discussed the importance of working collaboratively and flexibly to fit around individual preferences and circumstances. Disentangling pandemic-specific barriers from more routine challenges to remote delivery should be a focus of future research

Knowledge Of Problem Solving (KOPS) scale: Design and evaluation of a scalable competency measure for a common practice element in task-shared youth mental health interventions

Objectives: Quality assurance methods for psychological interventions conventionally rely on expert-led assessments that are unfeasible for task-sharing. The current study was conducted in India to design and test a scalable therapeutic competency measure for use with non-specialists before and after training in an evidence-based, adolescent-focused problem-solving intervention. Methods: The developmental phase established a set of key competencies associated with problem-solving therapies, followed by item generation for a corresponding knowledge-based competency measure (the Knowledge of Problem Solving [KOPS] scale). Items were refined in a reference sample (N=31) that included experienced counsellors and individuals without mental health care experience. The resulting 17-item measure was structured around a series of session vignettes for a hypothetical case, with each vignette followed by 3-4 multiple questions. The validation phase evaluated two versions of the measure in a sample of 277 trainees from universities and non-governmental organisations before and after training. Results: Rasch analysis revealed similar results for the two forms. The difficulty level of the test items was well matched to the ability level of participants (i.e., most items being of moderate difficulty and few items being easy or difficult). Most items had a probability below 0.5 suggesting that a respondent of average ability would choose an incorrect response more often than a correct one. Only one item showed a negative discrimination index and was removed from the final 16-item versions. Conclusions: The KOPS measure provides a scalable method to assess key competencies required to deliver transdiagnostic problem-solving therapies. Similar formats could be developed and deployed to support scaling up of other common elements involved in evidence-based psychological interventions globally

Dental Caries Prevalence among Diabetics Acrylic Partial Denture Wearer’s- A Review

Introduction: Dental caries is one of the most common oral health conditions affecting 60-90% of the population. The progression of dental caries results in tooth loss if not treated properly. Tooth loss will presumably cause functional impairment which might ultimately affect the quality of life. Removable partial denture is one of the most widely accepted means of tooth replacement. It had been noticed that removable partial dentures increased the likelihood of new or recurrent caries on remaining adjacent natural teeth. Diabetes mellitus is the most routinely encountered disease among various systemic diseases. Studies revealed that dental caries has been more prevalent and even severe in diabetic patients than nondiabetics. Aim: To assess the effect of Acrylic Removable Partial Dentures (RPD) and diabetes in prevalence of dental caries. Materials and Methods: This study was carried out in JSSDCH, JSSAHER, Mysuru, Karnataka in the year July 2017. The duration of conducting literature search was from July 2017 to Dec 2019. Individuals participating in the study should be partially edentulous and aged between 18-64 years either diabetic or nondiabetic. 69 articles were identified from searching electronic data base (Pubmed, Cochrane, Google scholar) and manual searching from July 2017 to December 2019. 19 articles were excluded following an initial screening. 50 articles were included for the further review. Scientific evidence supporting the hypothesis of the study 10 articles where five articles were review and five articles were original research. The main outcome of intervention involved both methodology and assessment tools applied by investigator to assess the effect of RPD and diabetes in terms of prevalence of dental caries. Results: Studies had shown that RPD wearers shows high caries prevalence as compared to nonwearers, Diabetic patients reported high caries prevalence compared to nondiabetic patients. This literature review states that RPD and Diabetes had an impact on prevalence of dental caries. Conclusion: The conclusion from this present review would indicates that good metabolic control in diabetic patients, periodic monitoring of the removable partial denture, oral hygiene, good RPD design framework, following post-insertion instruction of the RPD, following regular recall visits contributes towards prevention of plaque favouring inhibition of caries prevalence among diabetic and nondiabetic patients wearing RPD

Developing knowledge-based psychotherapeutic competencies in non-specialist providers: A pre-post study with a nested randomised controlled trial of a coach-supported versus self-guided digital training course for a problem-solving psychological intervention in India

We evaluated a digital learning programme for non-specialists to develop knowledge-based competencies in a problem-solving intervention for adolescents to examine the overall impact of training on knowledge-based competencies among learners; and to compare the effects of two training conditions (self-guided digital training with or without coaching) in a nested parallel, two-arm, individually randomised controlled trial. Eligible participants were 18 or older; fluent in Hindi or English; able to access digital training; and had no prior experience of delivering structured psychotherapies. 277 participants were enrolled from 31 March 2022 to 19 June 2022 of which 230 (83%) completed the study. There was a significant increase in competency score from pre-training (Mean = 7.01, SD = 3.29) to post-training (Mean = 8.88, SD = 3.80), 6 weeks after the pre-training assessment. Knowledge competency scores showed larger increase among participants randomised to the coaching arm (AMD = 1.09, 95% CI 0.26–1.92, p = 0.01) with an effect size (d) of 0.33 (95% CI 0.08–0.58). More participants completed training in the coaching arm (n = 96, 69.6%) compared to the self-guided training arm (n = 56, 40.3%). In conclusion, a coach-supported remote digital training intervention is associated with enhanced participation by learners and increased psychotherapeutic knowledge competencies

Developing knowledge-based psychotherapeutic competencies in non-specialist providers: a pre-post study with a nested randomised controlled trial of a coach-supported versus self-guided digital training course for a problem-solving psychological intervention in India

We evaluated a digital learning programme for non-specialists to develop knowledge-based competencies in a problem-solving intervention for adolescents to examine the overall impact of training on knowledge-based competencies among learners; and to compare the effects of two training conditions (self-guided digital training with or without coaching) in a nested parallel, two-arm, individually randomised controlled trial. Eligible participants were 18 or older; fluent in Hindi or English; able to access digital training; and had no prior experience of delivering structured psychotherapies. 277 participants were enrolled from 31 March 2022 to 19 June 2022 of which 230 (83%) completed the study. There was a significant increase in competency score from pre-training (Mean = 7.01, SD = 3.29) to post-training (Mean = 8.88, SD = 3.80), 6 weeks after the pre-training assessment. Knowledge competency scores showed larger increase among participants randomised to the coaching arm (AMD = 1.09, 95% CI 0.26-1.92, p = 0.01) with an effect size (d) of 0.33 (95% CI 0.08-0.58). More participants completed training in the coaching arm (n = 96, 69.6%) compared to the self-guided training arm (n = 56, 40.3%). In conclusion, a coach-supported remote digital training intervention is associated with enhanced participation by learners and increased psychotherapeutic knowledge competencies.</p