ABSTRACT
BACKGROUND:
The poor
detection of
depression in
primary healthcare (PHC) in low- and middle-
income countries continues to threaten the plan to scale up mental
healthcare coverage.
AIMS:
To describe the process followed to develop an intervention package to improve
detection of
depression in PHC settings in rural
Ethiopia.
METHOD:
The study was conducted in Sodo, a rural district in south
Ethiopia. The
Medical Research Council's framework for the development of complex interventions was followed. Qualitative interviews, observations of provider-
patient communication, intervention development
workshops and pre-testing of the
screening component of the intervention were conducted to develop the intervention.
RESULTS:
A multicomponent intervention package was developed, which included (a) manual-based
training of PHC
workers for 10 days, adapted from the
World Health Organization's
Mental Health Gap Action Programme Intervention Guide, with emphasis on
depression, locally identified
depressive symptoms,
communication skills,
training by people with lived experience and
active learning methods; (b)
screening for culturally salient manifestations of
depression, using a four-item tool; (c) raising
awareness among people attending
out-patient clinics about
depression, using information leaflets and
health education; and (d) system-level interventions, such as supportive
supervision, use of posters at
health facilities and a
decision support
mobile app.
CONCLUSIONS:
This contextualised, multicomponent intervention package may
lead to meaningful impact on the
detection of
depression in PHC in rural
Ethiopia and
similar settings. The intervention
will be
pilot tested for feasibility, acceptability and
effectiveness before its wider implementation.
