Feasibility and acceptability of a solution-focused approach to strengthen lay counselling for common mental disorders (DIALOG+) in Pakistan: mixed methods study

Abstract

Background Depression and anxiety are widespread globally, with significant treatment gaps in low-resource settings. In Pakistan, where prevalence is high and specialists are scarce, brief psychological interventions by trained lay counsellors show promise. DIALOG+ is a novel technology-assisted, solution-focused approach for leveraging resource-oriented approaches in routine community mental health treatment. Aims To explore the feasibility and acceptability of using DIALOG+ for community-based treatment of common mental disorders delivered by non-specialist lay counsellors in a low-resource setting (trial registration: ISRCTN14528579). Method An open, uncontrolled trial in community settings in Karachi, Pakistan, was conducted with 40 patients with depression and anxiety visiting two primary care clinics between June 2019 and February 2020. Patients were enrolled for monthly sessions delivered over 6 months by lay counsellors. Subjective quality of life along with symptoms of depression and anxiety were measured at baseline and endline (following the 6-month intervention) on the Manchester Short Assessment of Quality of Life (MANSA) and Aga Khan University Anxiety and Depression Scale (AKUADS). Changes in measures were evaluated before and after the intervention using a t-test analysis. Post-intervention, in-depth interviews were held with patients and lay counsellors to gather insights into their experience of the intervention. Results In total, 146 DIALOG+ sessions were conducted with 40 patients. At the 6-month post-intervention assessment, 33 patients showed improved subjective quality of life and reduced self-reported depression and anxiety scores. Patients reported that the intervention helped strengthen the therapeutic relationship with their lay counsellors, helped them track their progress through therapy and enhanced their self-management of negative emotions and behaviours. Conclusions Structured communication can help strengthen lay counsellors’ ability to improve therapeutic outcomes of people with common mental disorders in resource-constrained community settings. Future clinical trials are recommended to further evaluate the long-term impact of the DIALOG+ intervention on mental health outcomes.

Keywords

• Common mental disorders
• solution-focused approach
• mental health
• community care
• DIALOG+