Development of a community intervention to increase help-seeking and adherence to depression care in India:...

Access to depression care can be improved by overcoming a combination of supply-side barriers and demand-side factors.

To describe the systematic development of a community-based intervention to improve uptake of, and adherence to, a psychosocial treatment for depression delivered by trained primary healthcare staff in Goa, India.

This mixed-methods study included five steps: Step 1, Synthesis of existing evidence by conducting relevant systematic reviews and a review of public health programmes in India; Step 2, In-depth interviews with community stakeholders (n = 35); Step 3, Consultation workshops with community stakeholders (n = 19) and primary healthcare staff (n = 34); Step 4, Triangulation of findings from the preceding steps; and Step 5, Content development for the intervention (e-course for training and the community intervention toolkit for delivery).

Overall, 20 strategies to enhance help-seeking and 5 strategies to improve adherence were identified to constitute the intervention. The community-based intervention is organised into four domains (Learn, Inform, Engage and Follow-up), with self-care integrated throughout the intervention. This intervention is designed to be delivered by a community volunteer who is motivated to cater to the communities' needs. The community volunteer is trained to deliver the intervention via a blended approach, an e-course and in-person one-on-one learning support by a coach, who later acts as a facilitator during the intervention delivery phase.

The systematic method enabled the development of a comprehensive intervention with contextually appropriate delivery strategies. The effectiveness of the intervention is presently being tested as part of a Hybrid Type II Implementation-Effectiveness randomised controlled trial. If found effective, the intervention has the potential to be a low-cost and sustainable opportunity to improve demand and adherence to depression treatment while also providing essential social, emotional and logistical support during the recovery process.