Work

Development and pilot testing of workflow for screening and management of mental health conditions by front-line non-physician care providers in India: a mixed-methods approach

Year: 2026

Type: article

Abstract: Introduction: Mental and substance use disorders (MSUDs) are prevalent in India and community health officers (CHOs) are the first point of contact in primary healthcare settings but have limited skills and training in mental healthcare. We developed and pilot tested a simplified Mental Health Management Workflow to support CHOs in screening, categorising, triaging and managing MSUDs. We also evaluated its feasibility and training outcomes in terms of knowledge, attitude and practice (KAP) and competency in workflow application. Methods: The workflow was co-developed through expert consultation and iteratively refined using mixed-methods design across six Indian states. CHOs were selected through purposive sampling by the state based on availability and feasibility of being released from routine duties to participate in the training. CHOs underwent a 3-day classroom training and 1-day supervised field practice. Pre-post-training KAP scores were assessed using an adapted Mental Health Literacy Scale. Competency in workflow application was assessed using a structured observational checklist. Qualitative data consisted of the trainer's observations and post-training CHO feedback. These were analysed thematically to guide iterative refinement of the workflow. Quantitative data were analysed using paired t-tests or Wilcoxon signed-rank tests as appropriate. Results: A total of 107 CHOs participated across all sites. Results showed significant improvements from baseline to post-training: knowledge from 12.5±2.00 to 14.1±1.70 (+12.8%), attitude score reduced from 13.7±5.30 to 12.1±5.01 (-11.7%, indicating a reduction in negative attitudes) and practice scores improved from 17.6±4.15 to 20.5±4.09 (+16.5%), (p<0.001). CHOs were able to apply PHQ-9 (92.9%), GAD-7 (89.3%) and substance use questionnaires (81%). Around 88% of CHOs identified mental-health emergencies correctly. The mean time to apply the full workflow was 16.7±5.2 min. CHOs reported that the workflow was easy to use and improved their confidence in managing mental-health issues. Conclusions: The workflow was found to be practical, acceptable, and user-friendly, and has the potential to support CHOs in the identification and management of common mental health conditions within routine primary care. It has potential for scale-up across primary health care systems in India and similar low- and middle-income country settings because of its structured, colour-coded and evidence-based management approach.

Source: BMJ Public Health

DOI: 10.1136/bmjph-2025-004832