Brief Culturally Adapted Behavioral Activation Therapy for Adults With Depression in Indonesian Primary Care: A Type-2 Hybrid Effectiveness-Implementation Trial

Conditions studied

Depression in Adults

About this study

This is a type-2 hybrid effectiveness-implementation study of brief culturally adapted behavioral activation for adults with depression in primary care setting. This clinical trial has two parallel aims: 1) to understand if brief culturally adapted behavioral activation therapy delivered by psychologist in primary care in individual face-to-face session is effective to reduce depressive symptoms among adult patients in Primary Healthcare Centers and 2) to test the outcome of clinical training and supervision on acceptability, feasibility, appropriateness, and fidelity of implementation of brief culturally adapted behavioral activation therapy in Primary Healthcare Centers. The main questions it aims to answer is: 1\) Is brief culturally adapted behavioral activation intervention delivered by primary care psychologist effective in reducing depressive symptoms among adult patients with depression in primary care settings and 2) Are training and supervision effective in enhancing acceptability, feasibility, appropriateness and fidelity of implementation of brief culturally adapted behavioral activation therapy for adults with depression in primary care settings?

Interventions

• Other: Training and supervision on BAT — Implementation strategy: Training and Supervision Training: Primary care psychologists will receive training which consists of 4-session online training of Behavioral Activation Therapy (BAT), 2-session of booster training focusing on BA principle and therapy protocol, and clinical practice with 2 participants during pilot study. Four-session online training, 1 booster session, and clinical practice with 2 participants have been delivered during pilot study phase. Supervision: Supervision will be provided during BAT implementation in two forms: 1) biweekly synchronous online supervision, starting from week 3 after the first day of recruitment and 2) asynchronous online supervision through online shared spreadsheet, available throughout BAT implementation. Participants in BAT implementation arm will receive 3 individual face-to-face sessions of Brief Culturally Adapted Behavioral Activation Therapy. No specific drug or device used during the interventions.

Primary outcomes

• Change from Baseline in Depressive Symptoms as Assessed by the Patient Health Questionnaire-9 (PHQ-9) at 1 Week after Intervention (Baseline and 1 week post intervention)
• Participant's Acceptability of Intervention as Assessed by the Client Satisfaction Questionnaire-8 (CSQ-8) (Post intervention (immediately after intervention completed))
• Clinical Provider's Perceived Acceptability as Assessed by Acceptability of Intervention Measure (AIM) (through study completion, an average of 3 months)
• Clinical Provider's Perceived Feasibility as Assessed by Feasibility of Intervention Measure (FIM) (through study completion, an average of 3 months)
• Clinical Provider's Perceived Appropriateness as Assessed by Intervention Appropriateness Measure (IAM) (through study completion, an average of 3 months)
• Qualitative Feedback on Acceptability, Feasibility, and Appropriateness from Participants as Assessed using Semi-structured Interview (From enrollment to 1 week after intervention completed (for participants) through study completion, an average of 3 months (for clinical providers))
• Qualitative Feedback on Acceptability, Feasibility, and Appropriateness from Clinical Providers as Assessed using Semi-structured Interview (From enrollment to 1 week after intervention completed (for participants) through study completion, an average of 3 months (for clinical providers))

Eligibility information

Study locations

• Puskesmas (Primary Healthcare Center), Sleman, Special Region of Yogyakarta Indonesia