Acceptability of a Digital Program for Training Community Health Workers in the Early Detection and Referral of Schizophrenia in Rural India: A Mixed-Methods Pilot Study

Delays in detecting and treating schizophrenia result in elevated disability for patients. This mixed-methods pilot study evaluated the feasibility and acceptability of a digital program for training community health workers on early detection and referral of schizophrenia in primary care in rural India. Using convenience sampling, female community health workers, called ASHAs, enrolled in a large depression care study were invited to complete a supplemental digital training on identifying and responding to schizophrenia. Acceptability of the training was assessed through qualitative focus group discussions and satisfaction questionnaires. Framework analysis was used to code participants’ feedback about the training and generate representative themes. Pre-post changes in knowledge about schizophrenia were also explored. In total, N=20 ASHAs completed the training and participated in focus group discussions. Qualitative data revealed that participants found the training helpful, while they reflected on their limited prior understanding of schizophrenia. Participants emphasized that they had previously observed symptoms of schizophrenia in their communities, yet they did not realize that schizophrenia is a mental health condition that can be treated, and that rehabilitation efforts can be successful. Participants recommended conducting the training with other ASHAs to expand access to this information. Participants’ reported high satisfaction with the training, though showed no significant pre-post improvement in knowledge about schizophrenia. A scalable digital training may help equip community health workers to recognize schizophrenia and link people to care. Further evaluation is needed to assess effects on patient outcomes, and integration of schizophrenia care into primary care. • Scalable ways are needed to increase support for schizophrenia care in rural India. • Digital training for CHWs on schizophrenia was acceptable in rural India. • Participants reported high satisfaction and full program completion. • Training raised awareness of schizophrenia and reduced misconceptions. • Future research is needed to determine impact of training on CHW practice.