Modified strategies for integrating mental health into NCD care in India

BackgroundDespite the growing burden of mental disorders, including substance use disorders (MSUDs) in India, their integration within existing non-communicable disease (NCD) care remains limited. This study documents the process of modification and refinement of implementation strategies. These strategies were originally developed as part of initial models (Model M0, M1, M2, M3…). The strategies aimed to integrate MSUD screening and management within existing NCD care in the Faridabad district of Haryana, India.MethodsThis was a mixed-methods implementation study. Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS) was used to systematically capture changes to the original set of 51 Expert Recommendations for Implementing Change (ERIC) strategies. Modifications were categorised as planned or unplanned, proactive or reactive. They were analysed based on type (substitution, addition, tailoring, or integration). Stakeholders were purposively recruited based on their role in the design, administration, or delivery of care. These included policy makers, state- and district-level health administrators, facility-level healthcare professionals, and patients/service users and caregivers. Data sources included field notes by the project field staff, digital portal, and dashboard, training reports and meetings of the project group at AIIMS, New Delhi. Additional information for the process came from the co-creation meetings. A total of 81 healthcare professionals from 16 public health facilities participated in training. Stakeholder engagement involved co-creation meetings, field-based observations, structured feedback loops, and consensus-based adaptation cycles. Qualitative data were analysed using a rapid thematic approach guided by the CFIR.ResultsNine strategies were modified substantially. These included revising professional roles, creating new clinical teams, facilitating relay of clinical data to providers, promoting network weaving, intervening with patients/consumers to enhance uptake and adherence, use mass media, conduct ongoing training, shadow other experts, and visit other sites. Workforce shortages, logistical constraints, and the absence of mass media channels were main reasons for modifications. Social incentives were introduced to enhance engagement. The refined implementation strategies were integrated into the successive models (Model M1, M2, M3…Mx). This contributed to the final implementation model development (Model Mx).ConclusionThe study highlights the importance of systematic approach and documentation for adapting implementation strategies to real-world conditions. The modified strategies intend to offer a feasible approach to integrated MSUD care in Faridabad district of Haryana. The findings indicate feasibility and system fit. Further evaluation is required to assess effectiveness and scalability.Clinical trial registrationhttps://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=MTEzMTg4&Enc=&userName=, identifier (CTRI/2024/08/072748).