The impact of a lay counselor led collaborative care intervention for common mental disorders in public and private primary care

A qualitative evaluation nested in the Manas trial in Goa, India

Bibliographic Data

ID4860673
AuthorsSanjyot Shinde (0000-0001-6369-4212, Sangath), Sachin Shinde, Gracy Andrews, Gracy Andrew (Sangath), Omer Bangash (London School of Hygiene & Tropical Medicine), Alex Cohen (0000-0001-5040-0342, London School of Hygiene & Tropical Medicine), Burton Kirkwood (0000-0001-5274-6072, London School of Hygiene & Tropical Medicine), Betty Kirkwood, Vikram Patel (0000-0003-1066-8584, London School of Hygiene & Tropical Medicine, corresponding author)
Year2013
Volume88
Pages48-55
Publication date2013-07-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueSocial Science & Medicine (JOURNAL)
Journal identifiersISSN: 0277-9536 • E-ISSN: 1873-5347
PublisherElsevier BV (PUBLISHER)
DOI10.1016/j.socscimed.2013.04.002
PMID23702209
PMCIDPMC3675686
OpenAlexW2101491264
LanguageEN
Citations received4
References cited18

The MANAS trial evaluated the effectiveness of a lay counselor led collaborative stepped care intervention for Common Mental Disorders (CMD) in public and private sector primary care settings in Goa, India. This paper describes the qualitative findings of the experience of the intervention and its impact on health and psychosocial outcomes. Twenty four primary care facilities (12 public and private each) were randomized to provide either collaborative stepped care (CSC) or enhanced usual care (EUC) to adults who screen positive for CMDs. Participants were sampled purposively based on two criteria: gender and, in the CSC arm, adherence with the intervention. The qualitative study component involved two semi-structured interviews with participants of both arms (N = 115); the first interview within 2 months of recruitment and the second 6-8 months after recruitment. Data were collected between September 2007 and November 2009. More participants in the CSC than EUC arm reported relief from symptoms and an improvement in social functioning and positive impact on work and activities of daily life. The CSC participants attributed their improvement both to medication received from the doctors and the strategies suggested by the lay Health Counselors (HC). However, two key differences were observed in the results for the two types of facilities. First, the CSC participants in the public sector clinics were more likely to consider the HCs to be an important component of providing care who served as a link between patient and the doctor, provided them skills on stress management and helped in adherence to medication. Second, in the private sector, doctors performed roles similar to those of the HCs and participants in both arms placed much faith in the doctor who acted as a confidante and was perceived to understand the participant's health and context intimately. Lay counselors working in a CSC model have a positive effect on symptomatic relief, social functioning and satisfaction with care in patients with CMD attending primary care clinics although the impact, compared with usual care, is greater in the public sector

Collaborative Care · Family medicine · Intervention (counseling · Mental health · Primary care · Private sector · Psychiatry · Psychological intervention · Psychosocial · Public health · Public sector · Qualitative research · Randomized controlled trial · Family Caregiving in Mental Illness · Medicine · Mental Health Treatment and Access · Nursing · Schizophrenia research and treatment

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