Advantages and Challenges of A Village Doctor-Based Cognitive Behavioral Therapy for Late-Life Depression in Rural China: A Qualitative Study

Abstract

BackgroundThe delivery of mental health services in rural China has been notably limited due to lack of qualified mental health professionals among other impeding factors. A village doctor-based cognitive behavioral therapy intervention may be one way of improving accessibility. The purpose of this study was to explore the advantages and challenges of implementing this intervention, as delivered by trained village doctors, to treat late-life depression in rural China.MethodsWe conducted one focus group discussion with 10 village doctors, 10 individual interviews with each of the village doctors, and individual interviews with 19 older adults. The topic guides were advantages and challenges of the intervention program from the perspective of the village doctors and older adults. Interviews were audio-recorded, transcribed, coded using NVivo 8, and analyzed using thematic analysis.ResultsThe village doctors stressed the importance of role-playing and using instructive manuals in the training. Proper supervision was also a key component of the program. The benefits received from the intervention for the village doctors and the elders were positive such that both the doctors and the older adults were willing to implement/receive this intervention. Cultural and political factors (renqing and perceived policy consideration) facilitated the elders’ access to mental health services. Challenges included a lack of real therapy (in contrast to role-playing) demonstrated in the training and lack of a step-by-step manual based on different types of problems encountered. Other impediments to the successful implementation of the intervention included the time constraints of village doctors and the presence of other people when conducting the intervention.ConclusionsThe present study has demonstrated that the intervention program is likely to be an acceptable geriatric depression intervention in rural China if several challenges are appropriately addressed.

Barriers and Facilitators of Engaging Community Health Workers in Non-Communicable Disease (NCD) Prevention and Control in China: A Systematic Review (2006–2016)

“…As shown in Table 1 , of these twenty studies [ 13 , 14 , 15 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ], eleven studies were single-site programs [ 13 , 14 , 18 , 19 , 20 , 24 , 25 , 26 , 28 , 29 , 30 , 31 ]; nine studies discussed multi-site programs [ 15 , 21 , 22 , 23 , 27 , 31 , 32 , 33 , 34 ]; while two of them did not mention specific locations of the study sites [ 22 , 25 ]. Among the programs with specific study sites ( n = 18), the majority were located in the east and central parts of China ( n = 11) [ 14 , 18 , 20 , 21 , 23 , 24 , 25 , 26 , …”

“…The title of the CHWs varied in different programs. Ten programs named the CHWs as ‘village doctors’ [ 14 , 18 , 19 , 20 , 22 , 26 , 30 , 31 , 33 , 34 ], while the other ten programs [ 13 , 15 , 21 , 23 , 24 , 25 , 27 , 28 , 29 , 32 ] used ‘health coach’, ‘local health workers’, ‘CHWs’, ‘lay family health promoters’, ‘community health service center staff’, and ‘primary health care providers’.…”

Promises and pitfalls of data sharing in qualitative research

“…For example, in the Data Availability Statement for their qualitative study recently published in PLOS Medicine , Christopoulos et al (2015) stated, “Public availability of data could potentially compromise participant privacy. Participants did not consent to have their full transcripts or excerpts of transcripts made publically [ sic ] available.” Qualitative studies published in PLOS One subsequent to the PLOS policy adoption have made similar claims (Natoli et al, 2015; Tang et al, 2015) (although there have also been notable, and welcome, exceptions (Lo et al, 2016)).…”

Delivery of public health services by community health workers (CHWs) in primary health care settings in China: a systematic review (1996–2016)

“…Most of the studies (18 studies) were related to NCDs covering five major areas of diabetes and/or hypertension [ 28 , 29 , 43 , 44 , 53 – 59 ], cancer (h [ 45 , 46 ]), mental health [ 32 , 33 , 52 , 60 – 65 ], cardiovascular diseases [ 66 – 69 ]; and NCD health education [ 47 , 70 ]. Ten articles were related to reproductive health, including family planning, prenatal care, and postnatal care.…”

“…Most trainings were given by teachers or experts through lectures. In-class and group discussions as well as role-plays were used frequently in CHWs trainings [ 23 , 32 , 35 , 76 ]. Some NCD studies also used web-based trainings combined with video, picture, and text for CHWs [ 28 , 43 , 46 , 64 ].…”