1. Feasibility of Peer-led, Professionals Assisted Pulmonary rehabilitation (PLPAPR): Exploratory pilot study Qualitative Evaluation Protocol in collaboration with RUHSA Department, CMC, Vellore. (October – February 2020)
There is evidence to show that a pulmonary rehabilitation programme comprising of elements like patient assessment, maximising benefits of medicinal treatment, physical exercise, self-management awareness, nutritional support and psychological as well as social support when given to the patient, improves physical endurance and quality of life. It is a fact that the present treatment processes are not satisfactory and are ineffective in stemming the disease or the associated disabilities. They also do not provide adequate relief from the symptoms. A study to develop and test the feasibility of implementation of a peer-led, professional assisted pulmonary rehabilitation (PR) programme including respiratory exercise training, nutritional, psychosocial and counselling support has been developed by CMC. The intervention entails training of peer supporters who will be individuals identified in the community to supervise the PR activities of patients with chronic pulmonary problems. Samarth is being sub-contracted to undertake the process and endline evaluation of this programme. with the following specific objectives:
Objectives for Process Evaluation
i) To examine fidelity to the planned intervention
ii) To obtain patient perceptions about and satisfaction with the intervention
iii) To obtain perceptions of peer supporters on their capability to deliver the intervention and any barriers or challenges faced
Objectives for Endline Evaluation
i) To explore patient perceptions on their overall experiences with regard to the intervention, their satisfaction with it, challenges or difficulties faced and their capability to continue with it
ii) To understand perceptions of peer supporters on their experiences of delivering the intervention, challenges or difficulties faced and how they coped
iii) To understand perceptions of HCPs on their experiences in training the peer supporters, challenges faced and how they coped
2. Translation and Transculturation Services for Coping with COVID-19. Funded by Sally Spencer-Thomas, LLC “the Company” May 2020-August 2020)
The project involves undertaking the Tamil translation of a series of documents that will be made available online to assist people who are depressed/suicidal. The work has been sub-contracted to Samarth. The different documents to be translated into Tamil are:
- Construction Working Minds Website (http://www.constructionworkingminds.org/): the entire website inclusive of 39 pages, country specific resources, especially around crisis, such as hotlines and telehealth/on-line support, country specific media around suicide prevention/mental health and construction
- Coping Cards Resource Package: 54 coping cards,4-page check-in survey and results, 1-page leadership talking points and digital, local resources for organization's web page (once)
Contractor Workbook: estimated 25 pages out of 50 total of text/copy including 15,000 words to help contractors build mental health supports
3. Understanding community and health care provider’s awareness, risk perceptions, behaviours and barriers around COVID-19: A qualitative study in collaboration with CMC Vellore (May 2020 – August 2020)
This study is being carried out in collaboration with the RUHSA department of CMC Vellore and forms a small component of a larger study titled, “Trends in COVID19 epidemic and Impact study”, which is being funded by the Scottish Funding Council-Global Challenges Research Fund (SFC-GCRF) Fund –University of Edinburgh. The study will describe the current disease burden in Vellore district by determining the prevalence of COVID19 among suspects in K.V Kuppam block. The RUHSA department will partner with Samarth in undertaking the qualitative component which will also be carried out in Kuppam block located in Vellore. Samarth will undertake the data collection which will be facilitated by RUHSA and also carry out the analysis of the qualitative data. The specific objectives of this qualitative study are:
i) To understand the awareness in rural areas about COVID-19, their acceptance, willingness and practical difficulties related to following preventive measures (such as social distancing), their willingness to respond to messages about prevention and treatment in appropriate ways, and potential cultural, social and financial barriers to responding to preventive measures, participating in testing or seeking treatment.
ii) To understand health care providers’ and administrators’ awareness of COVID19 and their perceptions of its likely impact in rural Tamil Nadu, type and capacity of services available - including outpatient facilities, in-patient facilities, rural hospital beds, testing facilities, availability of personal protective equipment (PPE), availability of funds, specific measures for vulnerable populations, options for care seeking, supply chains for equipment, and practicalities associated with shielding/isolating vulnerable patients and health care personnel
iii) To make recommendations based on the emerging findings from the study to help shape the local response to COVID19 – this will include community education and preventive measures.
4. Protocol on a multi-centre statistical and economic modelling study of risk-based stratified and personalised screening for diabetes and its complications in India (SMART India Study) Study led by Vision Research Foundation, Sankara Nethralaya (October 2020 –July 2021)
The aim of this study is to develop practical and affordable models to (a) diagnose people with diabetes and pre-diabetes and (b) identify those at risk of diabetes complications so that these models can be applied to the population in low and middle-income countries (LMIC) where laboratory tests are unaffordable. This qualitative component has been sub-contracted to Samarth and will be carried out on a sample of participants who had been involved in a quantitative survey carried out in communities in 20 sites across India as part of the SMART India study. The survey identified a large proportion of individuals who had Sight Threatening Diabetic Retinopathy (STDR) and who were not seeking treatment in a hospital despite repeated reminders and advice given about the possible threat of losing their vision. This study has the following qualitative objectives:
- Explore perceptions regarding:
- Understand perceptions of family members of STDR patients on their understanding of STDR and barriers, benefits to seeking treatment
- susceptibility to and severity of eye related problems
- potential benefits, possible barriers and sense of self efficacy with respect to seeking treatment among patients with STDR identified during the SMART study community survey
- Understand perceptions of health care providers (HCPs) regarding barriers to care seeking for treatment of STDR in patients with a focus on recommendations for future intervention strategies
1. Intervening with Pregnant Women on Depression in South India
Collaborative project with Dr. Deepa Rao, Department of Global Health & Department of Psychiatry, University of Washington, USA. Submitted to NIH as an R01
India has high numbers of maternal mortality and subsequent preterm birth. Depressive symptoms have been linked to high rates of preterm births in India. Despite clear linkages between maternal depressive symptoms and negative consequences for birth outcomes, no published studies have examined ways of intervening on depressive symptoms in antenatal care settings in India. The proposed intervention targets pregnant women in South India who have significant depressive symptoms and combines Motivational Interviewing (MI) and Interpersonal Counseling using materials already adapted for the Indian context. We aim to determine the effectiveness of the combined intervention and identify mechanisms involved in reducing maternal depression in Karnataka and Tamil Nadu. We will also train research staff and junior investigators in conducting mental health intervention research through intensive mentorship of pilot projects and coursework. We expect that this study will result in information on the feasibility of the intervention’s use in India and preliminary data on reduced rates of depressive symptoms along with improved understanding of the mechanisms involved in achieving these outcomes.
2. Suicide Prevention in South Asia: Understanding the Cultural Context of Suicide and its Effects in South India and Sri Lanka GCRF New Social and Cultural Insights into Mental, Neurological, and Substance Use Disorders in Developing Countries
This research aims to understand the significance of social and cultural factors in suicide and focuses on a South Asian region with high suicide rates to explore the diversity of causes and devastating effects of suicide. This will enable us to shape specific testable interventions and inform policy globally. It is known that suicide has multi-causality and there are advances in identifying risk and protective factors at the individual level. Epidemiological research has mapped population-level trends and correlating factors but it is impossible to explain the varied patterns and causes of suicide in populations without in-depth, contextual and qualitative studies on suicide which “are practically non-existent. The south Indian and Sri Lankan cultural region has one of the highest suicide rates globally and the pattern contrasts with Western countries (such as the UK) in that deaths by suicide are most prevalent in the less disadvantaged regions with better education, faster growth and improved indicators of human capital. In India, southern states with 20% of the population have 40% of over 190,000 annual suicides. In Sri Lanka, a post-1990s fall in its even higher death rate(with pesticide regulation) leaves questions about high underlying (gendered) rates of self-harm behaviour.This qualitative, ethnographic and historical research aims to throw light on the high rate/particular pattern of suicide in this cultural region to inform global understanding of suicide. It aims an in-depth study of the processes involved among specific at-risk groups, while directly influencing regional policy on suicide prevention and ‘postvention’ (with/ for suicide survivors) through a new inter-disciplinary research network linked-in to medical and public health expertise.
1.Evaluation of the six ‘Delivering HOPE- India’ NGO partners programme. Supported by BMSF (November 2014 - December 2018)
The Bristol-Meyers Squibb (BMS FOUNDATION) Foundation has undertaken several programmes to implement strategies to reduce the incidence of Hepatitis (B and C) in India.The BMS Foundation has been working with several NGO partners in several states across India in implementing these programmes. These NGO partners have been involved in carrying out education and awareness programmes aimed at communities, schools and colleges, running vaccination camps and training health care providers on various prevention and treatment aspects of Hepatitis B and C. In an effort to improve the efficiency of programmes and to understand their effectiveness, BMSF recruited Samarth to monitor and evaluate the hepatitis reduction programmes being undertaken by 6 partner NGOs, namely Mamta, LFWB, AmeriCares, United Way, Hope and AIIDR. Samarth has been carrying out the evaluations on a periodic basis for the last three years. With funding for these projects now coming to a close, Samarth undertook one final evaluation of each of the projects during this period (2017-2018). Described below is a summary of activities undertaken under this project during this time period.
1.Workshop on Monitoring and Evaluation
On the request of United Way Mumbai, a two day workshop on monitoring and evaluation was carried out by Samarth team members in Mumbai on May 2nd and 3rd 2017. The topics covered included developing a monitoring and evaluation plan, developing programme indicators, methods of data collection, behaviour change theories and behaviour change communication, developing survey questionnaires, ethical issues and writing up a protocol. The workshop was attended by staff of United Way.
2.Evaluation Visit to Gujarat: AIIDR
A final evaluation of the work undertaken by AIIDR with health care providers was carried out to assess the sustainability of knowledge about Hepatitis B & C among health care providers and to assess understanding of Hepatitis B by ANC women in the selected intervention sites. The Samarth team visited Ahmedabad from 13th – 15th February 2018. The same field team who had worked with us on earlier evaluation were hired to undertake the data collection. The HCPs comprised doctors and field health workers (Nurses and ANMs). A total of 17 and 20 medical officers from the intervention and control sites participated in the evaluation. The FHWs comprised of 25 who had participated in the refresher training programme and 18 who had not. A total of 51 PNC mothers also participated in the survey.
In terms of the key findings emerging from this evaluation, we found that among the medical officers, vaccination status was good among those in the intervention site while among those in control site, 4 doctors had not got vaccinated. But, despite being vaccinated, many doctors continued to perceive themselves to be at risk of contracting Hepatitise B. While knowledge about symptoms and modes of transmission of Hepatitis was good in both groups, there were gaps in knowledge with respect to issues relating to mother to child transmission. There were also gaps in practice related issues with many of them reporting that re-capping and wearing gloves would protect against needle stick injuries. As regards the FHWs, of the 50 who had participated in the survey only 39 had attended the refresher training programme. Although 47 reported getting vaccinated only 23 had completed the requisite 3 doses. There was also no significant difference in knowledge about Hepatitis between the two groups which was just average. Also there was poor awareness about universal precautions and bio-waste management. Among the ANC mothers we found that a majority of them reported having received counseling on hepatitis, had been tested for Hepatitis B and over 60% had been vaccinated. Knowledge about signs and symptoms and modes of transmission was good among the mothers. Understanding of safe sex practices and risk of mother to child transmission was poor with most mothers reporting that they had not received counseling on these issues.
3.Evaluation Visit to Mumbai – United Way
United Way, Mumbai have been undertaking education and sensitization of school and college children and community health workers (CHWS) on Hepatitis B and other health related topics like sanitation and hygiene, nutrition and health and mosquito borne diseases 4. Samarth carried out a final evaluation of this programme and made a site visit to Mumbai on Feb. 1st -2nd 2018. The same field team engaged in earlier evaluations were hired to carry out the data collection. The sample for evaluation comprised of, 444 school students studying in class VII aged between 11- 15 years; 160 college students aged between 17-20 years from different streams of education and 92 CHWs all of whom were female with a mean age of 43 years.
The school students displayed good knowledge about Hepatitis and the other health related topics. College students too showed a mixed picture with good knowledge on some issues and average on others. Thus, knowledge about signs and symptoms was average while that on the modes of transmission was good. Although, 98 out of 160 college students reported having received the vaccination, only 26 had completed the three doses. As regards the CHWs there was good knowledge about the symptoms and modes of transmission of Hepatitis B but understanding of other aspects like whether it is curable and whether vaccination would protect against the disease was average indicating gaps in knowledge. Furthermore, very few had talked to others about Hepatitis. Considering that they were also meant to serve as ambassadors in spreading awareness about the disease, this was a limitation in the effectiveness of the programme
4.Evaluation Visit to Imphal - MNP+
The work undertaken by MAMTA in the states of Manipur and Punjab was with Injection Drug Users (IDUs). In the state of Manipur, MAMTA worked with an NGO called MNP+ based in Imphal while in Punjab they worked with the Abhivyakti Foundation. In both states the NGOs undertook programmes aimed at creating awareness about Hepatitis B and C among IDUs and assisted them in getting tested and vaccinated. The Samarth team carried out a final evaluation of the programme undertaken by MNP+ in Imphal during this period and visited the city during the period 19th to 22nd March 2018. The same field team who had worked on earlier evaluations were hired to carry out data collection. A total of 100 IDUs, 10 doctors, 50 nurses and 20 counsellors participated in the survey.
The IDUs had been abusing drugs for several years but most were no longer chronic users. However, on special occasion or on festivals they tended to use drugs thereby exposing themselves to the risk of contracting Hepatitis. Although knowledge about symptoms and modes of transmission was good only half had got tested for Hepatitis B & C and the proportion vaccinated for Hep. B was less than 29%. Only 12 out of 36 IDUs who were positive for Hep. C, had been linked to treatment. Issues concerning cost of treatment for Hep. C and of vaccination for Hep. B continue to be major problems as many IDUs are not able to support these subsidized cost
2.citiesRise (June 2018 – August 2018)
CitiesRISE is a global platform that will mobilize collaboration, innovation, and investment in mental health. By engaging a global network of cities to pursue partnerships and initiatives at local, national, and international levels. CitiesRISE seeks to bring about systemic changes in mental health and well-being. Samarth is partnering with SCARF (Schizophrenia Research Foundation), Chennai on this project, the key objectives of which are: 1.To promote mental health among young people utilizing technology; and, to identify prevention strategies to reduce the risk of common mental health problems among young people 2.To optimize and facilitate early access to mental health promotion, prevention and treatment & care among young people with mental health concerns3.To reduce “stigma” associated with mental health and mental illness among young people. The formative phase of the study involving focus groups discussions (FGDs) with various cadres of youth and in-depth interviews with mental health care providers has been completed. Thus FGDs were conducted with college students, young people employed in the corporate sector, young boys and girls living in slums to obtain their perceptions on what they understand by the term mental wellbeing and mental illness, what kinds of psychological and emotional problems the youth face and what they think needs to be done. Similar issues were ascertained from mental health care providers. A preliminary report on the initial findings have been submitted and manuscript preparation is currently underway.
3.A cross cultural study of the experience of recovery by people with schizophrenia in Australia and India(November 2017 - September 2018)
This study explored and described the experience of recovery from schizophrenia. Persons with schizophrenia are faced with the experience of illness and recovery, with the two occurring simultaneously as well as sequentially. Knowledge about the experience of illness is necessary to give a better understanding of the experience of recovery. Recovery occurs in the clinical, functional, social, personal and existential domains.Several factors modulate the experience of the illness and process of recovery. These factors relate to the individual (e.g. age, gender, education), personal attributes (e.g., hope, self-identity, power and control), society (e.g. family, social network, community, religion), and the environment (e.g. health and welfare services, policies). Culture is the medium through which these factors relate to the processes and experiences of illness and recovery. People with schizophrenia, their family members living with and caring for them, and mental health professionals as health service providers have different roles in the process of recovery, an understanding of which will contribute to deeper insights into the recovery process. The project specifically seeks to explore the nature and process of recovery from schizophrenia as experienced and described by people with schizophrenia, their family members and mental health professional care providers in Australia and India. It also seeks to understand how culture influences the experience of recovery from schizophrenia in Australia and India. This study was led by Dr. TN Srinivasan who works in the Psychiatric Rehabilitation Service at Hunter New England Local Health District in Newcastle Australia. Samarth partnered with Dr. Srinivasan and assisted in conceptualizing and planning the study and carrying out the coding of interviews. These activities have been completed.
4.Evaluation of a Programme titled, “Engaging Pharmacists in the TB Control Programme” being undertaken by REACH Study Funded by REACH ((June 2017 - Nov 2017).
Pharmacies are often the first point of contact for many TB patients in the private sector. REACH had engaged pharmacists in Chennai city to participate in TB control efforts by involving them in several ways. These included facilitating referral of presumptive TB and TB patients; actively notifying the number of TB patients; promoting awareness and education on TB to patients and the community and engaging the pharmacists as community DOT providers. Samarth had been entrusted with the task of undertaking an endline evaluation of this programme which had been ongoing in three Zones in Chennai city, namely South, North and Central. The evaluation was carried out using a mixed methods approach involving a quantitative survey and qualitative methods of focus group discussions and semi-structured interviews. A total of 156 pharmacists participated in the quantitative survey and filled in a questionnaire that elicited information on their knowledge about TB, their attitude towards the disease, practice related questions and whether or not they had participated in the sensitization programmes carried out by REACH. The qualitative component involved a total of 15 semi-structured interviews and 4 focus group discussions that were carried out on a sub-sample of pharmacists who had participated in the quantitative survey. Both the quantitative and qualitative data have been analyzed and the final report has been submitted to REACH.
5.Care Seeking in Childhood Pneumonia Management: An Exploratory Study Funded by the Bill and Melinda Gates Foundation & INCLEN ( Dec2015 – Mar 2017)
This study which was executed using a mixed methods approach in select districts in the states of Tamil Nadu, Madhya Pradesh and Uttar Pradesh, sought to assess care seeking behavior with respect to treatment of pneumonia in the community and understand the influences of cultural factors on care seeking. It also described the roles of the private and public health sectors in various state contexts with regard to care and management of pneumonia and understands their perceptions on the relative benefits of promotive/ preventive/ curative approaches towards childhood pneumonia management. The study has been completed and the final report was submitted on September 2017.
6.Development and Validation of a Questionnaire to Assess Attitudes of Health Care Providers towards Persons with Leprosy (April 2015 – March 2016) Qualitative Data Transcripts
HCP Interview Guide
Leprosy is one of the major diseases which have been closely associated with and sometimes even synonymous with stigma. The German Leprosy and TB Relief Association had sub-contracted Samarth to develop and validate a questionnaire that could be used to assess the attitudes of health care providers towards patients with leprosy. The study was divided into two phases. Phase I involved carrying out qualitative interviews and Focus Group Discussions (FGDs) with different cadres of health care providers (HCPs) and patients with leprosy. The findings so generated helped inform the development of a questionnaire to measure attitudes of HCPs towards persons with leprosy. Phase II involved the validation of this questionnaire. A draft questionnaire was developed based on findings emerging from the qualitative interviews and a review of instruments measuring attitudes towards stigmatizing conditions. This draft questionnaire comprising 38 items was subjected to the process of Thurstones equal interval scaling to determine how well the items in the construct ‘hung’ together. The scaling exercise resulted in a total of 27 items, the remainder of which were discarded owing to poor agreement among the experts regarding its relevance. The ICC for test-re-test reliability of the 27 item scale was 0.6 (95% CI 0.20-0.78) indicating moderate intra class correlation. The Cronbach’s alpha was 0.83 indicating good degree of consistency and homogeneity between the items. The final report was submitted to GLRA and paper writing is in progress.
7.Process Evaluation of Integrated Management of Neonatal and Childhood Illness (IMNCI) Programme in India: (2015-2016)
The Integrated Management of Neonatal and Childhood Illnesses (IMNCI), a national programme started in India in 2003 was a major initiative by the Government of India that focused on newborn and child health. As on 2011, programme implementation had been completed in 433 of India’s 640 districts and more than 470,000 workers had been trained. Given that the IMNCI programme was an important strategy towards the achievement of MDG goal 4 (reduction of under 5 mortality), the Indian Council of Medical Research (ICMR) undertook an evaluation of the programme to determine how well it had succeeded in achieving its mandate. The National Institute of Epidemiology (NIE), Chennai, was entrusted with the task of carrying out a process evaluation of the IMNCI programmein 8 states in India. The evaluation aimed to, i) describe the implementation of the programme in 8 states in India, ii) evaluate its implementation at the district level with respect to human resources, training, logistics, infrastructure, reporting and supervision iii) evaluate the quality of IMNCI trained health workers in terms of quality of care provided by them at home and at health facility level, and iv) evaluate community perceptions on the programme. Both quantitative and qualitative methods were employed for this process evaluation. The 8 states that were selected for the evaluation were, Tamil Nadu, Karnataka, Uttar Pradesh, Himachal Pradesh, Gujarat, Assam, Maharashtra and Orissa. Within each state, two districts were selected in consultation with the respective state National Rural Health Mission (NRHM) project directors. Dr. Shuba Kumar and Dr. Rani Mohanraj from Samarth were engaged as Qualitative Research consultants to undertake the training of the field teams from each state in qualitative data collection. They also carried out the analysis of the qualitative data. Dr. Saradha Suresh, in her capacity as paediatrician served as the external consultant providing technical inputs into the planning and conduct of the study. The analysis of all qualitative data was completed and the final report was submitted to NIE in Feb. 2017
8.An Intervention to Prevent Suicides among Srilankan Refugees: A Feasibility Study Supported by Sneha India & ADRA India & VHS (June 2014- December 2015)
A collaborative study between Sneha India, the Voluntary Health Services (VHS), ADRA India and Samarth was carried out to understand suicidal behavior and depression among Sri Lankan Tamil refugees living in refugee camps in Tamil Nadu state. This study aimed to test the effectiveness of Contact and Safety Planning (CASP), as an intervention strategy to reduce/prevent suicidal behavior among the refugees residing in these camps. The CASP intervention involved using community volunteers empowered with skill sets to deliver pycho- social support to depressed and suicidal individuals to reduce their distress and thereby their suicidal thoughts and tendencies. A household survey in the selected intervention and control camps was first carried out to identify depressed and suicidal individuals. Consenting adults who scored 16 or more on the CESD-R (Centers for Epidemiological Studies-Depression Revised) in the intervention sites were asked to participate in the CASP programme wherein community volunteers met with them once in two weeks and provided psycho social support. In the control site participants were given some basic information about where they could go to seek mental health care. Focus groups discussions were also carried out in both intervention and control sites before and after the intervention to understand perceptions of Sri Lankan refugees about suicidal behavior in their camps and their attitude towards the CASP intervention. In total, 639 refugees from intervention and 664 from control camps participated. Of the 288 high-risk refugees in intervention camp, 139 completed the intervention. In the control camp, 187 were categorised as high risk. Prevalence of suicide attempts was 6.1%. Following intervention, differences between sites in changes in combined suicide (attempted suicides and suicides) rates per 100,000 per year were 519 (95% confidence interval (CI): 136–902; p < .01). This paper has been published in the IJSP.
9.Collaborative Care for Depression and Diabetes in India. Collaborative project with University of Washington, USA, Emory University, USA, Madras Diabetes Research Foundation (MDRF), Chennai, All India Institute of Medical Sciences, New Delhi. Funded by NIMH, USA. (February 2014- July 2014) The over-arching goal of this study is the adaptation of an integrated depression-diabetes intervention programme developed in the US, to Indian settings. The adaptation was carried out through qualitative interviews with patients, family members and health care providers which helped provide insights as to its cultural acceptability and relevance. This qualitative component was sub-contracted to Samarth. The adapted intervention will be tested in a randomized clinical trial.
10.Evaluation of Hep. B Programmes of Bristol Meyers Foundation (Jan. 2013 – March 2014) The Bristol-Meyers Squibb (BMS FOUNDATION) Foundation has undertaken several programmes to provide information and training about Hep.B, which includes capacity building for healthcare professionals and lay health workers on disease education and prevention. In addition, the Foundation strives to share best practices in the prevention and management of Hep. B and C and informs public health policy. Their four thrust areas are: Awareness, Education and Prevention programmes. These programmes aim to create awareness about Hep. B and C conduct education programmes about the disease and teach beneficiaries regarding methods of prevention. They also aim at early diagnosis and prevention of further spread of the disease. The BMS Foundation has been operating in India for some time now and have been working with several NGO partners in several states across India. These NGO partners for the last 5 years have been involved in carrying out education and awareness programmes aimed at communities, schools and colleges, running vaccination camps and training health care providers on various prevention and treatment aspects of Hepatitis B.
11. Assessment and Documentation of Access and Utilisation of Family Planning Services and Linkages with Prevention of Parent To Child Transmission (PPTCT) and Maternal and Child Health Care Services for Women and Couples Living with HIV in Select districts in Tamil Nadu. Project carried out in collaboration with UNICEF and funded by UNICEF. (December 2013 – December 2014)
This study broadly sought to understand the family planning and contraceptive services provided and accessed by HIV positive pregnant and lactating women in select districts in the state of Tamil Nadu with a view to understanding potential barriers to accessing such services. The study also documented the capacities of health care providers under the RCH and HIV programmes to provide effective linkages and access to family planning services for mothers and couples living with HIV. The long-term aim of the study was to guide policy recommendations for implementation and operationalization of integrated services for RCH and HIV.
12. Amphetamine-Type Stimulants in India: A Situation Assessment Study. Project funded by the United Nations Office of Drugs and Crime (UNODC) (February 2013- August 2013)
This study explored the range, pattern and frequency of Amphetamine Type Stimulants (ATS) use among a sample of young persons’ residing in the cities of Chennai, Chandigarh, Aizawl, Imphal and Kolkata in order to understand factors associated with its use. The study also explored the adverse consequences related to its use.
13. Psychological Distress among Pregnant Women in South India- Towards Intervention Development. Collaborative project with the University of Washington Global WACh (Women, Adolescent and Child Health) Integrated Health Seed Grant: (June 2012, May 2013)
This study estimated the prevalence of depressive and post traumatic stress disorder (PTSD) symptoms among pregnant women seeking antenatal care and examined the impact of these symptoms on birth outcomes. The information gathered provided insights into how to culturally adapt therapeutic techniques to reduce depression and PTSD symptoms in these women.
14. NIH Grant No.1 R21 - Integrating Screening into HIV Care settings in Southern India. Collaborative project with the University of Washington and CMC- Vellore- funded by NIH, USA (Nov. 2010- May 2013).
This study sought to integrate mental health care in HIV care settings and involved the identification and validation of the most appropriate tool to screen HIV positive individuals in South India for depression. The study also estimated the prevalence and correlates of depression among HIV patients seeking care in an urban HIV clinic and examined barriers and facilitators to integrating depression screening into existing HIV care services
15. Community Care for People with Schizophrenia in India (COPSI). Collaborative project with Sangath, Goa, funded by Wellcome Trust, London UK: (Jan 2011 – Sept. 2012).
This programme sought to understand which of two treatments was better for people with schizophrenia, in reducing their symptoms and in improving their social functioning: Facility Based Care (FBC) or Collaborative Community Based Care (CCBC). Initial qualitative interviews were carried out with patients, family members and mental health professionals to obtain their perceptions on the programme.
16. Premium Project: A Project on Effective Mental Health Interventions in Under-resourced Health Systems. Collaborative project with Sangath, Goa, funded by Wellcome Trust, London, UK (Feb. 20111- September 2011).
This study aimed at mapping the psychological procedures accessed by people affected by depressive disorders and alcohol use disorders and explored the acceptability, feasibility and effectiveness of these procedures from the patients’ perspective. It also mapped the psychological procedures delivered by health care providers and explored the acceptability, feasibility and effectiveness of these strategies from the care provider’s perspective. The study sought to prioritise the procedures identified for their perceived effectiveness and potential barriers/scalability in delivery by non-specialist health workers.
17. Acceptability Study of Substitution of Brown Rice for White Rice. Collaborative project with Mohan’s Diabetes Foundation International Diabetes Federation through the BRiDGES Grant (April 2009- May 2011)
This was a preliminary qualitative study carried out to study the acceptability of brown rice viz-a-viz white rice as a substitute rice staple. It involved doing focus groups discussions with pre-diabetic men and women to understand their perceptions on switching to brown rice as a means of adopting a healthier diet.
18. Understanding Informed Consent in the Medical Settings funded by the CMC –Vellore Research Development Fund (February 2010 – December 2010)
The study sought to understand patient and health care providers’ perceptions on the process of informed consent. It involved doing in-depth interviews with patients following surgery, and with doctors to ascertain how this process was perceived by them - its relevance, need and potential barriers/constraints if any.
19. Diabetes Community Lifestyle Improvement Programme (D Clip). Collaborative project with Mohan’s Diabetes Foundation funded by the International Diabetes Federation through the BRiDGES grant (June 2010- March 2012)
The overall goal of this study was to test a culturally specific, community-based lifestyle intervention programme for the prevention of type 2 diabetes in men and women living in Chennai, India. The qualitative component carried out sought to understand the perceptions of the participants on the programme and their interests in continuing with it.
20. Study on Maternal Nutrition in Three States of India: Bihar, Tamil Nadu and Uttar Pradesh. Collaborative project with Mohan’s Diabetes Foundation and Emory University funded by the Bill and Melinda Gates Foundation (October 2010-February 2011)
The objective of the study was to review current maternal and child health policies and programme implementation experiences in these three states with a view to identifying potential delivery platforms and inform implementation of future maternal health programmes.
21. Pilot study to Asses the Acceptability and Effectiveness Of Central Storage Of Pesticides In Preventing Suicides: A Community controlled trial. Collaborative project with the Voluntary Health Services (VHS) and CMC-Vellore and funded by WHO. (April 2009 – March 2011)
This study assessed the acceptability and effectiveness of a central pesticide storage facility as a programmatic intervention to reduce pesticide related suicides and attempted suicides in selected villages in the state of Tamil Nadu. The study involved the construction of a central pesticide storage facility that was easily accessible to farmers thereby providing a safe storage space for pesticides and reducing access to a lethal means of suicide.
22. Evaluation of the HIV Fellowship Programme at the Government Hospital for Thoracic Medicine (GHTM), Tambaram, Chennai (2007- 2008) funded by International Training and Education Center for Health (I-TECH).
The Fellowship programme aimed to train physicians in HIV/AIDS medicine. These physicians would then move into positions of direct patient contact and care, and in course of time become leaders in the field of HIV/AIDS care, prevention, research and program management. This trained manpower resource would further help to reduce the burden on existing medical doctors at GHTM. Samarth undertook and evaluation of these doctors to understand their satisfaction with the programme, its content and training teams as well as their plans for the future.
23. Formation of Community Based Organizations for High Risk Groups - A Needs Assessment Report: funded by the AIDS Prevention and Control Project - APAC (August-September 2008)
This study aimed to obtain a deeper understanding of various groups at risk for HIV, namely, Aravanis, Female Sex Workers (FSWs) and Men who have Sex with Men (MSMs). The study focused on their perceptions of community based organizations, their ability to run them and problems/barriers envisaged.
24. Testing a Mass Media Campaign on Stigma and Discrimination Faced by HIV+ Persons: funded by the AIDS Prevention and Control Project – APAC (March-April 2008)
The AIDS Prevention and Control Project (APAC) wanted to conduct a mass media campaign aimed at addressing stigma and discrimination faced by HIV+ persons in the state of Tamil Nadu. The campaign was in the form of educational messages that were intended to be aired on radio and television and printed in newspapers so as to have maximum reach. Samarth pre-tested these messages with various categories of people to obtain feedback on its appropriateness and relevance.
25.Effect of Stigma on HIV Care-Seeking Behaviours and Mental Health in Tamil Nadu, India: Collaborative project between Samarth, BRTC-Christian Medical College, Vellore and the University of Washington funded by Puget Sound Partners Grant, USA (October 2007 – September 2008)
This study investigated the relationship between HIV-associated stigma and depression in Tamil Nadu among HIV-positive persons affiliated with support networks and validated a stigma assessment scale for use in clinical settings. The findings from this study have reiterated the need to address stigma related issues during counselling sessions with HIV positive persons.