Input of stakeholders on reducing depressive symptoms and improving diabetes outcomes in India: Formative work for the INtegrated DEPrEssioN and Diabetes TreatmENT study
Deepa Rao1, Lauren Lipira2, Shuba Kumar3, Rani Mohanraj3, Subramani Poongothai4, Nikhil Tandon5, GR Sridhar6, Wayne Katon7, KM Venkat Narayan8, Lydia Chwastiak7, Viswanathan Mohan9, Mohammed K Ali10
1 Department of Global Health; Department of Psychiatry and Behavioral Sciences, Health Services University of Washington, Seattle, USA
2 Department of Health Services, University of Washington, Seattle, USA
3 Samarth, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
4 Department of Clinical Trials, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
5 Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
6 Endocrine and Diabetes Centre, Visakhapatnam, Andhra Pradesh, India
7 Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
8 Department of Global Health and Epidemiology; Department of Medicine, Emory University, Atlanta, GA, USA
9 Department of Diabetology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
10 Department of Medicine, Emory University, Atlanta, GA, USA
Harborview Medical Center, 325 9th Ave., Seattle, WA 98104
Source of Support: None, Conflict of Interest: None
Context: Depression and diabetes are highly comorbid, adversely affecting treatment adherence, and resulting in poor outcomes. To improve treatment and outcomes for people dually affected by diabetes and depression in India, we aimed to develop and test an integrated care model.
Aims: In the formative phase of this INtegrated DEPrEssioN and Diabetes TreatmENT (INDEPENDENT) study, we sought stakeholder perspectives to inform culturally-sensitive adaptations of the intervention.
Settings and Design: At our Delhi, Chennai, and Visakhapatnam sites, we conducted focus groups for patients with diabetes and depression and interviewed health-care workers, family members, and patients.
Subjects and Methods: Key informants were asked about experiences with diabetes and depression and for feedback on intervention materials.
Analysis: Qualitative data were analyzed using a grounded theory approach.
Results: Three major themes emerged that have bearing on adaptation of the proposed intervention: importance of family assistance, concerns regarding patient/family understanding of diabetes, and feedback regarding the proposed intervention (e.g., adequate time needed for implementation; training program, and intervention should address stigma).
Conclusions: Based on our findings, the following components would add value when incorporated into the intervention: (1) engaging families in the treatment process, (2) clear/simple written information, (3) clear nonjargon verbal explanations, and (4) coaching to help patients cope with stigma.