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Introduction: Cognitive deficits represent a core symptom of schizophrenia and a principal contributor to illness disability, yet evaluating cognition in routine clinical settings is often not feasible as cognitive assessments take longer than a standard doctor's visit. Using smartphones to assess cognition in schizophrenia offers the advantages of convenience in that patients can complete assessments outside of the clinic, temporality in that longitudinal trends can be identified, and contextuality in that cognitive scores can be interpreted with other measures captured by the phone (e.g. sleep). The current study aims to design a battery of cognitive assessments corresponding to the MATRICs Consensus Battery of Cognition (MCCB), in partnership with people living with schizophrenia., Methodology: Focus group discussions (FGDs) and interviews were conducted with people diagnosed with schizophrenia across three sites (Boston, Bhopal, and Bangalore) to help design, refine, and assess the proposed smartphone battery of cognitive tests on the mindLAMP app. Interviews were conducted between December 2023 and March 2024. Inductive thematic analysis was used to analyze data., Results: Participants found the app and its proposed cognitive assessments to be acceptable, helpful, and easy to use. They particularly found the gamified nature of the cognitive tests to be appealing and engaging. However, they also proposed ways to further increase engagement by including more information about each cognitive test, more visual instructions, and more information about scoring. Across all sites, there were many similarities in themes., Discussion & Conclusion: People living with schizophrenia, from different sites in the US and India, appear interested in using smartphone apps to track their cognition. Thematic analysis reinforces the importance of feedback and data sharing, although this presents a challenge, given the novel nature of smartphone-based cognitive measures that have not yet been standardized or validated., Competing Interests: The authors declare no conflicts of interest., (© 2025 The Authors. Published by Elsevier Inc.)

Introduction: Contextually responsive implementation support strategies are needed to enhance the integration of mental health services into primary health care. Technical assistance is widely used as a core "capacity building" strategy, primarily for increasing the motivation and capacity of individuals (e.g., frontline workers) to adopt evidence-based interventions in healthcare settings. This article documents the systematic design of a technical assistance strategy for supporting primary care staff (e.g., nurses) in integrating depression care, from screening to treatment, aligned with a non-communicable disease program across seven health facilities in the Sehore District of Madhya Pradesh, India., Methods: We conducted a mapping exercise of local health facilities with dedicated staff and a literature review to inform the development of the technical assistance strategy., Results: Reporting guidelines guided the structure of the strategy protocol. The evidence-supported strategy, called Remote Coaching Support, is tailored to the local setting. It uses quality improvement methods like the Plan-Do-Act-Study cycle and training materials to help coaches deliver support remotely via video/phone-based calls and WhatsApp messaging with the overall goal of increasing uptake and fidelity of depression screening and referral among primary care staff in alignment with an existing non-communicable diseases program., Conclusion: The development of Remote Coaching Support involved iterative improvements through team meetings and practice-training feedback, though limitations exist due to a lack of systematic implementation standards, especially in this setting. This strategy will be tested in increasing scales to refine its application, with effectiveness and acceptability results to be evaluated in a randomized control trial., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Pedersen, Haney, Singh, Choubey, Bondre, Vorapanya, Bhan, Tugnawat, Patel, Naslund and Ramaswamy.)

Workforce shortages represent a major bottleneck to delivering depression care, particularly in lower resource settings. This pilot study aimed to assess the acceptability and feasibility of a digital training program on developing knowledge and skills in the delivery of a brief behavioral activation intervention for depression among non-specialist providers (NSPs) in Gujarat, India. Participating NSPs, such as community health workers and other frontline providers without specialized training in mental health care, were provided access to a digital program covering the core skills and content necessary to deliver the Healthy Activity Program, an evidence-based behavioral activation intervention for depression. NSPs completed knowledge assessments before and after the digital training, followed by focus group discussions to gather their feedback about the program content and delivery format. Of 43 NSPs enrolled in this study, 67% (n = 29) were community health workers called Accredited Social Health Activists and 33% (n = 14) were frontline mid-level health providers called Community Health Officers. Most participants (n = 39; 91%) completed the full course. Knowledge assessment scores showed improvement from pre-training (mean = 29.96; 95% CI: 27.12-32.81) to post-training (mean = 34.62; 95% CI: 31.05-38.19; p = 0.0448). Focus group discussions revealed that participants appreciated the digital mode of training despite facing technical challenges while completing the course. This study further supports the feasibility and acceptability of digital approaches for training frontline providers to deliver brief psychological interventions for depression. With adequate resources and proper execution, digital training holds potential to serve as a key tool to build capacity of NSPs and expand the mental health workforce in India., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Brahmbhatt et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: There is scarce knowledge on the use of structured positive psychology interventions for reducing work-stress and improving wellbeing of rural community health workers in India, particularly the Accredited Social Health Activists (ASHAs) who are village-level (resident women, incentivised) lay health workers. This trial will test the effectiveness of a 'character-strengths' based coaching intervention compared to routine supervision on wellbeing ('authentic happiness') of ASHAs., Methods: This protocol is for a single-blind, parallel group randomized controlled trial comparing the effectiveness of a five-day residential workshop focusing on the use of character-strengths and subsequent 8- to 10-week remote telephonic coaching (weekly) to individually support ASHAs to improve their wellbeing, against routine health system support. The arms are intervention added to routine ASHA supervision (weekly, by the ASHA supervisor), and routine supervision alone (control arm). The target sample comprises 330 rural ASHAs in Madhya Pradesh, India. The primary outcome of mean Authentic Happiness Inventory (AHI) scores will be compared between arms at 3-month follow-up. Secondary outcomes will include an assessment of ASHA's self-reported affect, self-efficacy, flourishing, burnout, motivation, physical health symptoms, quality of life, and routine work performance indicators, and the consequent patient-level outcomes [e.g., service satisfaction and depression remission rates after receiving brief psychological treatment by trained ASHAs]. We will also evaluate the costs of developing and delivering the intervention., Discussion: This trial will determine whether a character-strengths based coaching intervention is an effective and scalable approach for reducing work-stress and improving wellbeing of rural ASHAs in low-resource settings., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Background: Upwards of ninety percent of individuals living with depression in India do not have access to evidence-based treatments, especially in rural areas. Integrating these treatments into primary care is essential for bridging this care gap. This trial aims to evaluate whether a remote coaching implementation support strategy, referred to as Enhanced Implementation Support, is superior to routine support, referred to as Routine Implementation Support, in supporting the delivery of collaborative depression care in rural primary care centers., Methods: Employing a cluster-randomized hybrid type-III implementation trial design, 14 primary care facilities in Sehore district, Madhya Pradesh, will implement a collaborative depression care package based on the WHO's mhGAP program. Facilities will be randomized to either Enhanced Implementation Support or the Routine Implementation Support control condition. Enhanced Implementation Support consists of remote coaching and technical assistance, supplemented with in-person visits, and guided by the Plan-Do-Study-Act implementation cycles. The primary implementation outcome is the proportion of outpatients screened for depression by facility staff, with secondary outcomes including the proportions of outpatients who screen positive for depression, are referred to the medical officer, and initiate treatment. Secondary patient outcomes include proportion of patients who achieve reduction in depression symptom severity at 3-month follow up. Acceptability, feasibility, and fidelity of the depression care package will be assessed through routine observations collected during field visits, facility audits, and qualitative exit interviews with facility staff. Costs of delivering the Enhanced Implementation Support strategy will also be estimated., Discussion: This trial can inform efforts to integrate depression care in rural primary care facilities in a low-resource setting, and illuminate whether external coaching support is superior relative to existing implementation support for achieving these goals., Trial Registration: NCT05264792., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Bondre, Singh, Tugnawat, Chandke, Khan, Shrivastava, Lu, Ramaswamy, Patel, Bhan and Naslund.)

Introduction: Burnout, low motivation, and poor job satisfaction among community health workers (CHWs) have negative impacts on health workers and on patients. This study aimed to characterize levels of burnout, motivation, and job satisfaction in CHWs in Madhya Pradesh, India and to determine the relation between these levels and participant characteristics. This study can inform efforts to promote wellbeing and address stress in this population., Methods: In this cross-sectional study, we recruited participants via simple random sampling without replacement. We administered two validated questionnaires, the Copenhagen Burnout Inventory and a Motivation and Job Satisfaction Assessment, to CHWs who had enrolled in a training program to deliver a brief psychological intervention for depression. We calculated mean scores for each questionnaire item, examined the reliability of the measures, and analyzed associations between participant demographic characteristics and questionnaire scores., Results: 339 CHWs completed the questionnaires. The personal burnout domain had the highest mean burnout score (41.08, 95% CI 39.52-42.64, scale 0-100) and 33% of participants reported moderate or greater levels of personal burnout. Items that reflected physical exhaustion had the highest item-test correlations. The organization commitment domain had the highest mean motivation score (mean 3.34, 95% CI 3.28 - 3.40, scale 1-4). Items describing pride in CHWs' work had the highest item-test correlations. Several pairwise comparisons showed that higher education levels were associated with higher motivation levels (degree or higher vs. 8 th standard [p=0.0044] and 10 th standard [p=0.048], and 12 th standard vs. 8 th standard [p= 0.012]). Cronbach's alpha was 0.82 for the burnout questionnaire and 0.86 for the motivation and job satisfaction questionnaire., Conclusion: CHWs report experiencing burnout and feeling physically tired and worn out. A sense of pride in their work appears to contribute to motivation. These findings can inform efforts to address burnout and implement effective task-sharing programs in low-resource settings., Competing Interests: Competing Interests: There are no competing interests for any author.

Despite having a higher burden of health problems, transgender persons face challenges in accessing healthcare in India. Most studies on healthcare access of transgender persons in India focus only on HIV related care, mental healthcare, gender affirmative services or on the ethno-cultural communities or transgender women. This study fills this gap by focusing on diverse gender identities within the transgender community with a specific focus on experiences in accessing general or routine healthcare services. A qualitative descriptive approach was used in this study. 23 in-depth interviews and 6 focus group discussions were conducted virtually and in-person with a total of 63 transgender persons in different regions of India between May and September 2021. The study used a community-based participatory research approach and was informed by the intersectionality approach. Thematic analysis was conducted to analyze the data. Four key themes emerged: (i) intersectional challenges in accessing healthcare start outside of the health system, continue through cisgender-binary-normative health systems that exclude transgender persons; and at the interface with individuals such as health professionals, support staff and bystanders; (ii) the experiences negatively impact transgender persons at an individual level; (iii) in response, transgender persons navigate these challenges across each of the levels: individual, health system level and from outside of the health system. This is a first of its kind qualitative participatory study focusing on routine healthcare services of transgender persons in India. The findings indicate the need to move conversations on trans-inclusion in healthcare from HIV and gender affirmative services to routine comprehensive healthcare services considering the higher burden of health problems in the community and the impact of poor access on their lives and well-being., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: Aqsa Shaikh and Anant Bhan are currently serving as Section Editors on PLOS Global Public Health. This does not alter our adherence to PLOS ONE policies on sharing data and materials., (Copyright: © 2024 Raghuram et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Measurement-based peer supervision is one strategy to assure the quality of psychological treatments delivered by non-mental health specialist providers. In this formative study, we aimed to 1) describe the development and 2) examine the acceptability and feasibility of PEERS (Promoting Effective mental healthcare through peER Supervision)-a novel smartphone app that aims to facilitate registering and scheduling patients, collecting patient outcomes, rating therapy quality and assessing supervision quality-among frontline treatment providers delivering behavioral activation treatment for depression. The PEERS prototype was developed and tested in 2021, and version 1 was launched in 2022. To date, 215 treatment providers (98% female; ages 30-35) in Madhya Pradesh and Goa, India, have been trained to use PEERS and 65.58% have completed the supplemental, virtual PEERS course. Focus group discussions with 98 providers were examined according to four themes-training and education, app effectiveness, user experience and adherence and data privacy and safety. This yielded commonly endorsed facilitators (e.g., collaborative learning through group supervision, the convenience of consolidated patient data), barriers (e.g., difficulties with new technologies) and suggested changes (e.g., esthetic improvements, suicide risk assessment prompt). The PEERS app has the potential to scale measurement-based peer supervision to facilitate quality assurance of psychological treatments across contexts., Competing Interests: The authors have no conflicts of interest to disclose., (© The Author(s) 2024.)

Background: Task sharing may involve training nonspecialist health workers (NSHWs) to deliver brief mental health interventions. This approach is promising for reducing the global mental health treatment gap. However, capacity is limited for training large cadres of frontline workers in low- and middle-income countries, hindering uptake of these interventions at scale., Methods: The ESSENCE (enabling translation of science to service to enhance depression care) project in Madhya Pradesh, India, aims to address these challenges through two sequential randomized controlled trials. First, a training trial will evaluate the effectiveness and cost-effectiveness of digital training, compared with conventional face-to-face training, in achieving clinical competency of NSHWs in delivering an intervention for depression. This initial trial will be followed by an implementation trial aimed at evaluating the effectiveness of a remote enhanced implementation support, compared with routine implementation support, in addressing barriers to delivery of depression care in primary care facilities., Results: This project involved developing and pilot testing a scalable smartphone-based program for training NSHWs to deliver a brief psychological intervention for depression screening. This initial research guided a randomized trial of a digital training approach with NSHWs to evaluate the effectiveness of this approach. This trial will be followed by a cluster-randomized trial to evaluate the effectiveness of remote implementation support in ensuring efficient delivery of depression care in primary care facilities., Next Steps: Findings from these trials may inform sustainable training and implementation support models to integrate depression care into primary care for scale-up in resource-constrained settings., Competing Interests: The authors report no financial relationships with commercial interests.

Background: Community health workers (CHWs) face high levels of stress (both professional and personal) and risk of burnout, highlighting the need for efforts to promote their mental health and well-being. This study seeks to develop a digital stress reduction program for CHWs in rural India., Methods: A stepwise design process was employed to adapt and digitize the evidence-based World Health Organization's Self-Help Plus (SH+) intervention for addressing psychological distress among CHWs in Madhya Pradesh, India. This involved participatory design workshops with CHWs to ensure that the digital stress reduction intervention would be relevant for their needs and the local culture and context. Small groups of CHWs reviewed the adapted program content, allowing the research team to make refinements such as simplifying language, tailoring content to the local setting, and ensuring that program materials are both interesting and relevant. Simultaneously, the research team digitized the content, leveraging a combination of video and graphical content, and uploaded it to the Sangath Learning Management System, a digital platform accessible on a smartphone app., Results: In total, 18 CHWs contributed to the adaptation of the SH+ content and digital intervention development. Participants commented on finding some terms difficult to follow and recommended simplifying the language and providing detailed explanations. Participants offered positive feedback on the adapted content, expressing that they found the examples covered in the material both relatable and relevant to their own personal experiences at home and in the workplace. By combining participants' insights and comments with feedback from content experts, it was possible to finalize a digital Hindi version of the SH+ intervention for CHWs in rural India., Conclusions: This study is timely given the continued detrimental impacts of the COVID-19 pandemic, and offers a promising and potentially scalable digital program to alleviate psychological distress among frontline health workers., Competing Interests: Declaration of competing interest The authors declare no competing interests.

Introduction: Transgender persons in India, who are one of the most vulnerable groups, were particularly impacted by the COVID-19 pandemic. Increased risk of COVID-19, challenges with continuing livelihood, uncertainty, and anxiety around the pandemic over pre-existing social discrimination and exclusion pose risk of a mental health impact as well. To investigate this further, this component of a larger study on experiences in healthcare of transgender persons in India during COVID-19 and looks into the question "How did the COVID-19 pandemic impact the mental health of transgender persons in India"., Methods: 22 In-depth interviews (IDI) and 6 focus group discussions (FGD) were conducted virtually and in-person with persons self-identifying as transgender or belonging to ethnocultural transgender communities from different parts of India. Community based participatory research approach was used by ensuring representation from the community in the research team and through a series of consultative workshops. Purposive sampling with snowballing was used. The IDIs and FGDs were recorded, transcribed verbatim and analyzed using an inductive thematic analysis., Results: Mental health of transgender persons were affected in the following ways. Firstly, COVID-19, its associated fear and suffering combined with pre-existing inaccessibility of healthcare and reduced access to mental health care affected their mental health. Secondly, unique social support needs of transgender persons were disrupted by pandemic linked restrictions. Thirdly, pre-existing vulnerabilities such as precarious employment and underlying stigma were exacerbated. Finally, gender dysphoria was a key mediating factor in the impact of COVID-19 on mental health with a negative and positive impact., Conclusions: The study reiterates the need to make systemic changes to make mental healthcare and general healthcare services trans-inclusive while also recognizing the essential nature of gender affirmative services and the need to continue them even during emergencies and disaster situations. While this brings out how public health emergencies can exacerbate vulnerabilities, it also shows how the lived mental health experience of transgender person is intricately linked to the way work, travel and housing is structured in our society and therefore points to the structural nature of the linkage between mental health and gender., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Raghuram, Parakh, Chidambaranathan, Tugnawat, Pillai, Singh, Singh, Shaikh and Bhan.)

Smartphone technology provides us with a more convenient and less intrusive method of detecting changes in behavior and symptoms that typically precede schizophrenia relapse. To take advantage of the aforementioned, this study examines the feasibility of predicting schizophrenia relapse by identifying statistically significant anomalies in patient data gathered through mindLAMP, an open-source smartphone app. Participants, recruited in Boston, MA in the United States, and Bangalore and Bhopal in India, were invited to use mindLAMP for up to a year. The passive data (geolocation, accelerometer, and screen state), active data (surveys), and data quality metrics collected by the app were then retroactively fed into a relapse prediction model that utilizes anomaly detection. Overall, anomalies were 2.12 times more frequent in the month preceding a relapse and 2.78 times more frequent in the month preceding and following a relapse compared to intervals without relapses. The anomaly detection model incorporating passive data proved a better predictor of relapse than a naive model utilizing only survey data. These results demonstrate that relapse prediction models utilizing patient data gathered by a smartphone app can warn the clinician and patient of a potential schizophrenia relapse., (© 2023. The Author(s).)

Introduction: About 3.5 million people are living with schizophrenia in India, with most failing to receive minimally adequate care. Digital mental health applications could potentially decrease this treatment gap; however, these applications should be tailored to meet the needs and overcoming barriers of its end-users to ensure their adoption and sustained usage. Few studies in India have explored the perspectives of target stakeholders to understand how digital tools could be viable for supporting care. Therefore, this study explores the perceived needs and barriers of patients with schizophrenia, caregivers and clinicians in using digital mental health applications., Methods: Focus group discussions (FGDs) were conducted with patients having schizophrenia attending outpatient clinics at a government tertiary hospital, and their caregivers, and mental health clinicians in Bhopal, Madhya Pradesh, India. FGDs were audio-recorded and coded. Framework analysis was employed to guide the analysis, involving deductive and inductive generation of themes, data triangulation and comparison of perspectives between participant groups., Results: Six FGDs were conducted with individuals with schizophrenia (n ​= ​11), their caregivers (n ​= ​14), and mental health clinicians (n ​= ​19). Four a priori themes were established: a) Prior experiences with health applications; b) Content of a mental health application; c) Involvement of caregivers in mental health application usage and d) Supporting doctors' work through mental health applications. Additionally, two themes were generated inductively: a) Qualities of a mental health application and b) Data privacy and confidentiality., Conclusion: Exploration of stakeholder perspectives on the content, features, and uses of mental health applications is crucial to yield initial insights about the use of these digital programs in India. This study generated a multitude of suggestions on app functionality and components, which can guide ongoing efforts to develop and deliver digital mental health applications for patients living with schizophrenia in low-resource settings, with limited access to mental health services., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 The Authors.)

Background: Workforce shortages pose major obstacles to the timely detection and treatment of schizophrenia, particularly in low-income and middle-income countries. The SARATHA (Schizophrenia Assessment, Referral, and Awareness Training for Health Auxiliaries) project involves the systematic development, iterative refinement, and pilot testing of a digital program for training community health workers in the early detection and referral of schizophrenia in primary care settings in rural India., Methods: SARATHA is a three-phase study. Phase 1 involves consulting with experts and clinicians, and drawing from existing evidence to inform the development of a curriculum for training community health workers. Phase 2 consists of designing and digitizing the training content for delivery on a smartphone app. Design workshops and focus group discussions will be conducted to seek input from community health workers and service users living with schizophrenia to guide revisions and refinements to the program content. Lastly, Phase 3 entails piloting the training program with a target sample of 20 community health workers to assess feasibility and acceptability. Preliminary effectiveness will be explored, as measured by community health workers' changes in knowledge about schizophrenia and the program content after completing the training., Discussion: If successful, this digital training program will offer a potentially scalable approach for building capacity of frontline community health workers towards reducing delays in early detection of schizophrenia in primary care settings in rural India. This study can inform efforts to improve treatment outcomes for persons living with schizophrenia in low-resource settings.

Background: Despite significant advancements in healthcare technology, digital health solutions - especially those for serious mental illnesses - continue to fall short of their potential across both clinical practice and efficacy. The utility and impact of medicine, including digital medicine, hinges on relationships, trust, and engagement, particularly in the field of mental health. This paper details results from Phase 1 of a two-part study that seeks to engage people with schizophrenia, their family members, and clinicians in co-designing a digital mental health platform for use across different cultures and contexts in the United States and India., Methods: Each site interviewed a mix of clinicians, patients, and their family members in focus groups ( n = 20) of two to six participants. Open-ended questions and discussions inquired about their own smartphone use and, after a demonstration of the mindLAMP platform, specific feedback on the app's utility, design, and functionality., Results: Our results based on thematic analysis indicate three common themes: increased use and interest in technology during coronavirus disease 2019 (COVID-19), concerns over how data are used and shared, and a desire for concurrent human interaction to support app engagement., Conclusion: People with schizophrenia, their family members, and clinicians are open to integrating technology into treatment to better understand their condition and help inform treatment. However, app engagement is dependent on technology that is complementary - not substitutive - of therapeutic care from a clinician., Competing Interests: None., (© The Author(s) 2021.)

Background: Predicting and preventing relapse presents a crucial opportunity and first step to improve outcomes and reduce the care gap for persons living with schizophrenia. Using commercially available smartphones and smartwatches, technology now affords opportunities to capture real-time and longitudinal profiles of patients' symptoms, cognition, physiology and social patterns. This novel data makes it possible to explore relationships between behaviours, physiology and symptoms, which may yield personalised relapse signals., Aims: Smartphone Health Assessment for Relapse Prevention (SHARP), an international mental health research study supported by the Wellcome Trust, will inform the development of a scalable and sharable digital health solution to monitor personal risk of relapse. The resulting technology will be studied toward predicting and preventing relapse among individuals diagnosed with serious mental illness., Method: SHARP is a two-phase study with research sites in Boston, Massachusetts, and Bangalore and Bhopal, India. During phase 1, focus groups will be conducted at each study site to collect feedback on the design and features available on mindLAMP, a digital health platform. Individuals with serious mental illness will use mindLAMP for the duration of a year during phase 2., Results: The results of the research outlined in this protocol will guide the development of technology and digital tools to help address pervasive challenges in global mental health., Conclusions: The digital tools developed as a result of this study, and participants' experiences using them, may offer insight into opportunities to expand digital mental health resources and optimize their utilisation around the world.

Introduction : Task sharing holds promise for scaling up depression care in countries such as India, yet requires training large numbers of non-specialist health workers. This pilot trial evaluated the feasibility and acceptability of a digital program for training non-specialist health workers to deliver a brief psychological treatment for depression. Methods : Participants were non-specialist health workers recruited from primary care facilities in Sehore, a rural district in Madhya Pradesh, India. A three-arm randomized controlled trial design was used, comparing digital training alone (DGT) to digital training with remote support (DGT+), and conventional face-to-face training. The primary outcome was the feasibility and acceptability of digital training programs. Preliminary effectiveness was explored as changes in competency outcomes, assessed using a self-reported measure covering the specific knowledge and skills required to deliver the brief psychological treatment for depression. Outcomes were collected at pre-training and post-training. Results : Of 42 non-specialist health workers randomized to the training programs, 36 including 10 (72%) in face-to-face, 12 (86%) in DGT, and 14 (100%) in DGT+ arms started the training. Among these participants, 27 (64%) completed the training, with 8 (57%) in face-to-face, 8 (57%) in DGT, and 11 (79%) in DGT+. The addition of remote telephone support appeared to improve completion rates for DGT+ participants. The competency outcome improved across all groups, with no significant between-group differences. However, face-to-face and DGT+ participants showed greater improvement compared to DGT alone. There were numerous technical challenges with the digital training program such as poor connectivity, smartphone app not loading, and difficulty navigating the course content-issues that were further emphasized in follow-up focus group discussions with participants. Feedback and recommendations collected from participants informed further modifications and refinements to the training programs in preparation for a forthcoming large-scale effectiveness trial. Conclusions : This study adds to mounting efforts aimed at leveraging digital technology to increase the availability of evidence-based mental health services in primary care settings in low-resource settings.