A stepped-care programme of brief psychological interventions for adults affected by adversity in Jordan: Lessons from a pilot randomised controlled trial in Jordan

Background

Stepped care frameworks comprise of the use of relatively limited resources to serve the greatest number of people.

Objective

We conducted a pilot randomised controlled trial in Jordan between September 2022 and February 2023 to evaluate the feasibility of a stepped care model of psychological care for distressed adults.

Methods

Participants were randomised to receive a stepped care intervention involving a guided self-help program (Doing What Matters; DWM), and if still met criteria for psychological distress, followed by a more intensive group program (group Problem Management Plus; gPM+) or a guided self-help program alone. Both intervention arms also received enhanced treatment as usual (ETAU) that comprised referral to available community support services. A mixed methods design was used to assess feasibility and acceptability and expected clinical outcomes.

Findings

One hundred and forty-five distressed adults (meeting Kessler Distress Score-10 score of ≥20) were randomised to either the stepped care or the single intervention arm (86% female) on a 1:1 allocation basis. DWM was delivered over five weeks by trained non-specialist helpers, where participants attended on average 2.6 support calls. Those randomised to gPM+ attended on average 3.3 sessions. The study demonstrated feasibility and acceptability for DWM and gPM+ interventions as delivered by trained non-specialists. Although the trial was not powered to detect clinical effectiveness, the stepped care arm relative to the single intervention arm demonstrated significantly lower depression symptoms immediately after and at 3-months following intervention delivery.

Conclusions

The study and trial procedures were acceptable to participants, non-specialists, and programme staff and demonstrated feasibility of implementing such a framework in Jordan.

Clinical implications

These findings informed a fully powered definitive RCT seeking to evaluate the clinical and cost-effectiveness of a stepped model of care in Jordan.

This publication relates to R2HC funded study: Caring for carers: A psychosocial supervision intervention for mental health practitioners