1. Evaluation of the six Delivering HOPE India NGO partners programme of BMSF. (Oct 2014 –Dec 2018)
NGO partners supported by Bristol-Myers Squibb Foundation have been engaged in several activities as part of their mandate to rid the country of Hepatitis Some of these programmes have specifically targeted high risk groups like sanitation workers, doctors and nurses, staff working at blood banks, sex workers, injection drug users etc. Others have focussed on communities, schools and colleges, pregnant women and children. Samarth is undertaking an external evaluation of the Hepatitis programmes of 6 such NGO partners, namely, MAMTA-New Delhi, United Way-Mumbai, AmeriCares-Mumbai, HOPE-Lucknow, AIIDR-Ahmedabad and the Liver Foundation of West Bengal.
Qualitative Consultants for following projects
2. A cross-cultural study of the experience of recovery by people with schizophrenia in Australia and India -
PI : Dr Srinivasan Tirupati, Psychiatric Rehabilitation Service, Hunter New England Local Health District (2017 November – September 2018)
This study seeks to explore and describe the experience of recovery from schizophrenia. Persons with schizophrenia are faced with the experience of the illness and recovery from it, with the two experiences occurring simultaneously as well as sequentially. Knowledge about the experience of the illness is necessary to give a better understanding of the experience of recovery from it. Recovery occurs in clinical, functional, social, and 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 or 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 seeksto understand how culture influences the experience of recovery from schizophrenia in Australia and India.
3. Validation of a Scale to Measure Societal Conceptions – Societal Rejections in Mental Illness - Feb. 2014- Ongoing
Dr. R. Padmavati, Additional Director of the Schizophrenia Research Foundation (SCARF) in collaboration with Dr. Larry Yang, Assistant Professor of Epidemiology, University of Columbia, USA are carrying out a study that aims to culturally adapt the Societal Conceptions – Societal Rejections (SC-SR) Scale on a sample of chronic mentally ill patients attending the SCARF facility. The study also seeks to understand patients and family members perceptions on how people in the community think about and treat people with mental illness. Dr. Shuba Kumar, has been sub-contracted by SCARF as the qualitative consultant to this study and will undertake both the conduct of qualitative interviews with patients and their family caregivers as well as the analysis of the qualitative data.
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 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.
2.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.
3.Development and Validation of a Questionnaire to Assess Attitudes of Health Care Providers towards Persons with Leprosy (April 2015 – March 2016) Data Set
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.
4.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
5.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.
6. 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.
7. 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.
8. 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.
9. 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.
10. 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
11. 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.
12. 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.
13. 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.
14. 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.
15. 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.
16. 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.
17. 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.
18. 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.
19. 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.
20. 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.
21.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.
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