- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05890222
IMPlementation of Evidence Based Facility and Community Interventions to Reduce the Treatment Gap for depRESSion (IMPRESS)
November 17, 2023 updated by: Sangath
The goal of this Hybrid Type 2 Implementation-Effectiveness Cluster Randomised Controlled Trial is to reduce the treatment gap for depression through the integrated implementation of interventions in facility and community platforms, in Goa, India.
The primary question is to examine whether a community intervention ("Community Model") enhances the demand for, and improves the outcomes of, an evidence-based, brief psychological treatment for depression delivered by non-specialist health workers in primary health care facilities ("Facility Model").
Participants in the Facility Model arm will receive only a psychosocial intervention for depression (the Healthy Activity Program - HAP) while participants in the Community Model will receive both the HAP and the community intervention.
We will compare the Facility Model and the Community Model to assess if the latter is superior in increasing the demand for depression treatment in primary care, increasing uptake of treatment by people with depression, increasing treatment completion rates, and reducing the severity of depression.
Study Overview
Status
Recruiting
Conditions
Intervention / Treatment
Study Type
Interventional
Enrollment (Estimated)
1680
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
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Goa, India
- Recruiting
- Sangath
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Contact:
- Urvita Bhatia
- Phone Number: +91-95525 30557
- Email: urvita.bhatia@sangath.in
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Contact:
- Yashi Gandhi
- Email: yashi.gandhi@sangath.in
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Principal Investigator:
- Abhijit Nadkarni
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Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
No
Description
(A) Contact Coverage Outcome
Inclusion Criteria
- Adults (>18 years)
- Residing in the clusters included in the trial
- Speak English or one of the local languages (Konkani, Marathi, Hindi)
Exclusion Criteria
- Patients with significant speech, hearing, or language impairment that interferes with completion of the screening and/or receipt of psychosocial intervention
- Patients who present to the health centre for emergency medical attention
- Patients with active psychotic symptoms
(B) Effectiveness Coverage Outcome
Inclusion Criteria
- Adults (>18 years);
- Residing in the clusters included in the trial
- Speak English or one of the local languages (Konkani, Marathi, Hindi).
- Screen positive for moderately severe or severe depression (total score >15) on the Patient Health Questionnaire-9 items (PHQ-9)
- Intend to reside in the trial clusters for at least 3 months (to enhance the likelihood of completion of treatment)
Exclusion Criteria
- Patients with significant speech, hearing, or language impairment that interferes with completion of the screening and/or receipt of psychosocial intervention
- Patients who present to the health centre for emergency medical attention
- Patients with active psychotic symptoms
- Patients who do not have access to a mobile phone as that will be needed for communicating with the counsellors and Sangathis, for example, to follow-up if the patient misses an appointment.
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Community Model
In addition to the facility model, village clusters in this arm will receive community intervention strategies delivered by community volunteers.
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Community intervention strategies will be delivered by community volunteers (called Sangathis - which means companion in Konkani, one of the local languages) to i) enhance demand for the HAP treatment and ii) promote engagement with, and completion of, the HAP treatment.
The community intervention is co-produced with local community members and includes strategies such as activities to increase awareness about depression (community meetings, street plays and health camps), and dissemination of psycho-educational materials (i.e., leaflets and posters), identify people with possible depression in the community, and facilitate access to HAP in the health centres.
Additionally, the Sangathis will coordinate continuing care of people receiving HAP, through home visits to encourage behavioural activation, homework completion and following up with the counsellor, and engaging family members to support the patient in achieving treatment goals.
HAP includes the following strategies: psychoeducation, behavioural assessment, activity monitoring, activity structuring and scheduling, activation of social networks, and problem-solving.
HAP will be delivered in an individual format.
It entails three phases of treatment, delivered over six to eight sessions, each lasting up to 40 minutes, with the sessions being at weekly intervals.
Sessions will be delivered face-to-face, at the health centre where the counsellors already work.
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Active Comparator: Facility Model
The HAP, a manualized and evidence-based psychological treatment based on behavioural activation, will be delivered by existing healthcare workers (called counsellors from here onwards) within the health centres who will be trained to deliver the HAP.
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HAP includes the following strategies: psychoeducation, behavioural assessment, activity monitoring, activity structuring and scheduling, activation of social networks, and problem-solving.
HAP will be delivered in an individual format.
It entails three phases of treatment, delivered over six to eight sessions, each lasting up to 40 minutes, with the sessions being at weekly intervals.
Sessions will be delivered face-to-face, at the health centre where the counsellors already work.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Contact coverage
Time Frame: Three months post recruitment
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Patient Health Questionnaire 9 items (PHQ-9) score >4.
The minimum score is 0 and maximum score is 27; with higher scores indicating greater severity of depression.
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Three months post recruitment
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Effectiveness coverage
Time Frame: Three months post recruitment
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Mean Patient Health Questionnaire 9 items (PHQ-9 score).
The minimum score is 0 and maximum score is 27; with higher scores indicating greater severity of depression.
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Three months post recruitment
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Sustained effectiveness
Time Frame: Six months post recruitment
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Mean Patient Health Questionnaire 9 items (PHQ-9 score).
The minimum score is 0 and maximum score is 27; with higher scores indicating greater severity of depression.
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Six months post recruitment
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Remission
Time Frame: Three months post recruitment
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Patient Health Questionnaire 9 items (PHQ-9 score) score <10. .
The minimum score is 0 and maximum score is 27; with higher scores indicating greater severity of depression.
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Three months post recruitment
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Remission
Time Frame: Six months post recruitment
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Patient Health Questionnaire 9 items (PHQ-9 score) score <10. .
The minimum score is 0 and maximum score is 27; with higher scores indicating greater severity of depression.
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Six months post recruitment
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Response to treatment
Time Frame: Three months post recruitment
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>50% reduction in Patient Health Questionnaire 9 items (PHQ-9 score) score.
The minimum score is 0 and maximum score is 27; with higher scores indicating greater severity of depression.
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Three months post recruitment
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Response to treatment
Time Frame: Six months post recruitment
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>50% reduction in Patient Health Questionnaire 9 items (PHQ-9 score) score.
The minimum score is 0 and maximum score is 27; with higher scores indicating greater severity of depression.
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Six months post recruitment
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Client Service Receipt Inventory
Time Frame: Baseline, 3- and 6- months post recruitment
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Out-of-pocket costs for receiving care and the related non-medical costs
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Baseline, 3- and 6- months post recruitment
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Depression awareness
Time Frame: Baseline, 6 and 12 months of implementation
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Awareness about depression.
This will be a bespoke tool developed for our trial and will have questions to assess awareness related to depression based on the information disseminated in our community intervention and higher scores will indicate greater awareness.
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Baseline, 6 and 12 months of implementation
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Treatment completion
Time Frame: Across 12 months of implementation
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Met treatment goals or completed the maximum number of sessions or were referred to mental health specialists
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Across 12 months of implementation
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WHO Disability Assessment Schedule (WHODAS 2.0)
Time Frame: Baseline, 3- and 6- months post recruitment
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Standardized disability scores used to estimate Quality Adjusted Life Years (QALYs).
The 12-item WHODAS 2.0 score ranges from 12 to 60, where higher scores indicate higher disability or loss of function.
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Baseline, 3- and 6- months post recruitment
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Survey form for collecting costs of receiving HAP intervention to patients
Time Frame: Baseline, 3 months post recruitment
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Out-of-pocket costs for receiving HAP intervention (e.g.
time loss, travel)
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Baseline, 3 months post recruitment
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Inventory form for collecting system-level economic costs of delivering interventions
Time Frame: Monthly, through study completion up to approximately 12 months
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System-level costs: Economic costs in WHO six building blocks for delivering the interventions
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Monthly, through study completion up to approximately 12 months
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Perceived social support
Time Frame: 3- and 6- months post recruitment
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Perception of social support received.
This will be a bespoke tool developed for our trial and will have questions to assess perceived support related to support provided by community volunteers in our community intervention and higher scores will indicate greater support.
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3- and 6- months post recruitment
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Multidimensional Scale of Perceived Social Support (MSPSS)
Time Frame: Baseline, 3- and 6-months post-recruitment
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12 item short instrument designed to measure an individual's perception of support from 3 sources: family, friends and a significant other.
Minimum score 12 and maximum 84
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Baseline, 3- and 6-months post-recruitment
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Behavioral activation
Time Frame: Baseline, 3- and 6- months post recruitment.
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Level of behavioral activation measured using PREMIUM Abbreviated Activation Scale.
This is a five-item scale, originally developed based on the Behavioural Activation for Depression Scale.
It includes five self-reported indicators and the total score can range from 0 to 20.
Higher scores indicate greater level of behavioural activation such as engagement with a variety of activities, and associated pleasure and mastery.
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Baseline, 3- and 6- months post recruitment.
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Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
November 1, 2023
Primary Completion (Estimated)
January 31, 2025
Study Completion (Estimated)
April 30, 2025
Study Registration Dates
First Submitted
May 12, 2023
First Submitted That Met QC Criteria
May 26, 2023
First Posted (Actual)
June 6, 2023
Study Record Updates
Last Update Posted (Estimated)
November 22, 2023
Last Update Submitted That Met QC Criteria
November 17, 2023
Last Verified
November 1, 2023
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- SAN_IMPRESS_2023
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
UNDECIDED
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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