# Optimizing a community-based intervention to improve help-seeking for depression care: study protocol for a randomized factorial trial

## TL;DR

This study aims to improve help-seeking behavior for depression care in Nepal by testing a community-based intervention using a randomized trial.

## Contribution

The study introduces a factorial trial design to optimize a community-based depression intervention in a low-income country.

## Key findings

- The study will evaluate the effectiveness of four components of a community-based intervention on promoting help-seeking behavior.
- The Multiphase Optimization Strategy (MOST) framework will be used to determine optimal intervention components for a future full trial.

## Abstract

Depression is a common mental health issue that can be effectively managed in primary and community health care settings. However, there is a significant gap between the number of individuals in need of care and those who actually receive treatment, with the greatest gap in low- and middle-income countries (LMICs). Although efforts have been made in LMICs to improve access to mental health services by addressing supply-side barriers, there has been less attention to demand-side obstacles. On the demand side, factors such as stigma, negative attitudes, and limited awareness of available services lead to underutilization of mental health services. This protocol describes a study of active ingredients of a community-based intervention aimed at enhancing help-seeking for depression care in Nepal, a LMIC with low rates of mental health treatment seeking.

The study will take place in two municipalities in eastern Nepal, utilizing the Multiphase Optimization Strategy (MOST) with a 2 × 3 factorial randomized controlled trial design. Female Community Health Volunteers will be trained to identify individuals with depression using the Community Informant Detection Tool, a proven community-based strategy for proactive case detection, and subsequently implement the Gain Life intervention, which aims to promote help-seeking for depression care. The Gain Life intervention comprises four components: (i) information about depression, (ii) awareness of available services, (iii) stigma reduction by dispelling myths and facts about depression, and (iv) a life transformation story. The study will target the adult population, with eligibility criteria including being 18 years or older, residing in specific municipalities, meeting the CIDT threshold for depression, providing consent, and having proficiency in Nepali. The sample size will be 288, with the primary outcome being help-seeking behaviour.

In this protocol paper, we outline how the MOST framework can optimize a community-based intervention aimed at improving help-seeking for depression care. The findings from this study will guide decisions on whether to proceed with a fully randomized controlled trial or conduct an additional optimization study to finalize the intervention components.

ClinicalTrials.gov NCT06574074. Registered on 27 August 2024.