Training and Supervising Lay-providers in Low-income Settings: A Mixed-methods Study of Task-sharing from the Shamiri Randomized Controlled Trial
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Objective: Training lay-providers to deliver mental health interventions is both effective and cost-effective. However, more research is needed to document training and supervision procedures and to collect lay-providers’ feedback. We analyzed the acceptability of a 10-hour lay-provider training and supervision delivered primarily by undergraduates. We also tested layprovider fidelity and quality. Methods: This study documents training and supervision from an RCT of the Shamiri intervention, a 4-session, school-based intervention which significantly reduced symptoms of anxiety and depression in Kenyan adolescents. We delivered a 10-hour training to 13 lay providers (M(SD)age=21.00(1.95), %female=61.54). We also hosted 30-minute supervision meetings twice weekly. Independent raters coded session recordings for fidelity and quality. We also collected quantitative and qualitative feedback from lay-providers. Results: Reliability and mean ratings for all six of our fidelity and quality measures (delivering required content, adhering to specified details, thoroughness, skillfulness, clarity, and purity) were very good to excellent. Lay-provider quantitative ratings of training were also overwhelmingly positive, with an overall satisfaction rating of 6.46/7.00. We identified central qualitative themes in lay provider comments: Generally, comments about training style, content, and personal interactions were overwhelmingly positive, and many lay-providers reported personal growth. Comments about timing and location were mixed. Conclusions: This study provides preliminary evidence that a very brief training delivered primarily by undergraduates can teach high-schoolgraduate lay-providers to deliver effective mental health interventions. Additionally, we discuss lessons-learned and implications for future research, including the importance of considering local context when planning and of continuously collecting and addressing lay-provider feedback.