Task-shifting psychological interventions for common mental disorders : the training and supervision of non-traditional providers

Background: The high prevalence of common mental disorders (CMDs) and barriers to accessing treatment has created a need for the task-shifting of psychological interventions to non-traditional providers (NTPs). For successful task-shifting to occur, the training and supervision that is provided to these individuals are of utmost importance, but little evidence exists on their training and supervision. This thesis addressed this issue by identifying the essential components of training required for successful task-shifting. Methods: This research consisted of four studies. Firstly, this thesis explored the evidence available on the training and supervision provided to NTPs task-shifting psychological interventions through two systematic reviews, one of which examined task-shifting in high-income countries (HICs) and the other in low- and middle-income countries (LMICs). A qualitative review was also conducted to explore the experiences of lay health workers (LHWs) on their training, supervision and intervention delivery. Lastly, a qualitative study using semi-structured interviews with NTPs (n=19) and experts (n=13) from four exemplars in Pakistan and the UK was conducted to explore their experiences during training, supervision and implementation of the intervention. Results: Eighteen papers were included in the systematic review conducted in HICs, thirty papers in the LMICs and fourteen papers (thirteen studies) in the qualitative review. In general, recommendations from all three reviews included the need for training to incorporate a mixture of didactic and experiential learning. Furthermore, sufficient time should be spent on learning about mental health conditions, and opportunities should be provided for skills practice. However, the reviews highlighted the limitations to drawing conclusions on the training due to poor reporting and a lack of documentation. Framework analysis of the semi-structured interviews led to the development of five key themes each for NTP and expert interviews. Synthesis of the findings from the reviews and interviews resulted in identifying essential components of training, leading to the eventual development of a taxonomy of essential training components divided into three phases: pre-training, training delivery and post-training. Lastly, a checklist for reporting training and supervision in papers was also developed to allow researchers to report their training with sufficient detail. Conclusions: Recommendations identified through this thesis can be used by researchers when developing training for NTPs in both HICs and LMICs. Furthermore, the reporting checklist may help researchers to improve the quality of documentation of training within papers, further adding to the database of evidence on effective training for NTPs. Improving the quality of NTP training may lead to an improvement in the quality of the interventions they deliver, which has potential to improve mental health outcomes. Further research should build on the current findings to develop the science of training and supervision in task-shifting.