Table 1 Replicating Effective framework for the implementation of cascade training for perinatal depression in primary healthcare in Nigeria
From: Cascade training for scaling up care for perinatal depression in primary care in Nigeria
REP Component | REP Elements | Program Activities | Decision/ outcome |
|---|---|---|---|
Pre-conditions | Identify effective intervention Identify barriers to implementation of training | -Review of findings from earlier trials -Stakeholder meetings -Qualitative interviews with clinic heads- assessment of the organization structure of the clinics, training needs -Planning workshop | -More feasible to use the mhGAP-IG interventions used in the low-intensity-intervention of earlier trial -Stagger training for PHCW in same clinic so as not disrupt service -Training venue outside of clinics to reduce distractions |
Pre-implementation | Draft intervention package | Development of training manuals Development of intervention manuals Development of support tools | -Training manual to include all components of the intervention manual, the powerpoint slides and training module. -Manual needs to be brief and in simple language -Desktop chart to guide assessment -Make available abridged version of the mhGAP-IG containing relevant modules to PHCW - Supportive supervision checklist |
Implementation | Training of trainers Training of frontline providers Evaluation Technical assistance | Interactive training workshops facilitated by master trainers (psychiatrists) Interactive workshops- didactic teachings, group work and role plays -Pre and post test questions at each workshop -Satisfaction with training -Fidelity to the delivery of the training sessions -Training on the use of PHQ-2 Supportive supervision | Selection of trainers to facilitate the training workshops from among the trained trainers All frontline PHCWs in all selected clinics trained in batches Half of the clinics randomized to use the PHQ-2 for screening Trainers visited clinics monthly to provide support and reported to the research team |
Maintenance and Evolution | Feedback and refinement | -Retention of knowledge evaluated 6 months after training -Debriefing -Refresher trainings | Same questionnaire used for the pretest administered -Group discussions held before each refresher training workshop -Training with emphasis on areas of difficulty |