Reducing stigma among healthcare providers to improve mental health services (RESHAPE): protocol for a pilot cluster randomized controlled trial of a stigma reduction intervention for training primary healthcare workers in Nepal.
Abstract
Background: Non-specialist healthcare providers, including primary and community healthcare
workers, in low- and middle-income countries can effectively treat mental illness.
However, scaling-up mental health services within existing health systems has been
limited by barriers such as stigma against people with mental illness. Therefore,
interventions are needed to address attitudes and behaviors among non-specialists.
Aimed at addressing this gap,REducingStigma amongHealthcAreProviders to ImprovEmental
health services (RESHAPE) is an intervention in which social contact with mental health
service users is added to training for non-specialist healthcare workers integrating
mental health services into primary healthcare. Methods: This protocol describes a
mixed methods pilot and feasibility study in primary care centers in Chitwan, Nepal.
The qualitative component will include key informant interviews and focus group discussions.
The quantitative component consists of a pilot cluster randomized controlled trial
(c-RCT), which will establish parameters for a future effectiveness study of RESHAPE
compared to training as usual (TAU). Primary healthcare facilities (the cluster unit,k = 34)
will be randomized to TAU or RESHAPE. The direct beneficiaries of the intervention
are the primary healthcare workers in the facilities (n = 150); indirect beneficiaries
are their patients (n = 100). The TAU condition is existing mental health training
and supervision for primary healthcare workers delivered through the Programme for
Improving Mental healthcarE (PRIME) implementing the mental health Gap Action Programme
(mhGAP). The primary objective is to evaluate acceptability and feasibility through
qualitative interviews with primary healthcare workers, trainers, and mental health
service users. The secondary objective is to collect quantitative information on health
worker outcomes including mental health stigma (Social Distance Scale), clinical knowledge
(mhGAP), clinical competency (ENhancing Assessment of Common Therapeutic factors,
ENACT), and implicit attitudes (Implicit Association Test, IAT), and patient outcomes
including stigma-related barriers to care, daily functioning, and symptoms. Discussion:
The pilot and feasibility study will contribute to refining recommendations for implementation
of mhGAP and other mental health services in primary healthcare settings in low-resource
health systems. The pilot c-RCT findings will inform an effectiveness trial of RESHAPE
to advance the evidence-base for optimal approaches to training and supervision for
non-specialist providers. Trial registration: ClinicalTrials.gov identifier, NCT02793271.
Type
Journal articleSubject
AttitudesCompetence
Low- and middle-income countries
Mental health
Non-specialists
Primary care
Service users
Stigma
Task-shifting
Training
Permalink
https://hdl.handle.net/10161/16112Published Version (Please cite this version)
10.1186/s40814-018-0234-3Publication Info
Kohrt, Brandon A; Jordans, Mark JD; Turner, Elizabeth L; Sikkema, Kathleen J; Luitel,
Nagendra P; Rai, Sauharda; ... Patel, Vikram (2018). Reducing stigma among healthcare providers to improve mental health services (RESHAPE):
protocol for a pilot cluster randomized controlled trial of a stigma reduction intervention
for training primary healthcare workers in Nepal. Pilot Feasibility Stud, 4. pp. 36. 10.1186/s40814-018-0234-3. Retrieved from https://hdl.handle.net/10161/16112.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
Collections
More Info
Show full item recordScholars@Duke
Brandon A. Kohrt
Adjunct Associate Professor in the Department of Psychiatry and Behavioral Sciences
Brandon Kohrt is a medical anthropologist and psychiatrist who completed his MD-PhD
at Emory University in 2009. He is currently Assistant Professor of Psychiatry, Global
Health, and Cultural Anthropology at Duke University. Dr. Kohrt has worked in Nepal
since 1996 researching and aiding victims of war including child soldiers. Since 2006
has worked with Transcultural Psychosocial Organization (TPO) Nepal. Dr. Kohrt has
been a consultant to The Carter Center Mental Health Program Liberia Init
Kathleen J. Sikkema
Research Professor in the Department of Psychology and Neuroscience
Kathleen J. Sikkema, Ph.D., Gosnell Family Professor of Global Health, Psychology
and Neuroscience, and Psychiatry and Behavioral Sciences at Duke University, is a
clinical psychologist with emphases in health and community psychology. She is the
Director of Doctoral Studies at the Duke Global Health Institute (DGHI), Director
of the Social and Behavioral Science Core in Duke's Center for AIDS Research (CFAR),
an
Elizabeth Louise Turner
Associate Professor of Biostatistics & Bioinformatics
Dr. Turner is Associate Professor of Biostatistics and Global Health and serves as
Director of the Research Design and Analysis Core of the Duke Global Health Institute.
Her primary methodological focus is on the design and analysis of randomized controlled
trials, particularly those that involve clustering such as cluster randomized trials
(CRTs), stepped wedge CRTs and individually-randomized group treatment trials. She
is expert in the implementation of trials in low resource settings, with a
Alphabetical list of authors with Scholars@Duke profiles.

Articles written by Duke faculty are made available through the campus open access policy. For more information see: Duke Open Access Policy
Rights for Collection: Scholarly Articles
Works are deposited here by their authors, and represent their research and opinions, not that of Duke University. Some materials and descriptions may include offensive content. More info