Readiness for Change Scale: Adaptation and Validation for Mental Health Task-Sharing

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Readiness for Change Scale: Adaptation and Validation for Mental Health Task-Sharing PROJECT SUMMARY: Mental health task-sharing, or the involvement of non-specialist health workers (NSHWs) such as community health workers (CHWs) to make mental health care more available and accessible, has been proven to be efficacious in randomized controlled trials in multiple low-resource settings including low- and middle-income countries. However, in routine care settings, the impact of mental health programs based on task-sharing paradigm greatly depend on its adoption by CHWs and the fidelity with which they implement it which, in-turn, is influenced by their readiness for change (RFC). However, there is dearth of literature assessing the role of RFC as an important predictor of CHW adoption and fidelity within mental health task-sharing. Importantly, research on RFC among CHWs within mental health task-sharing is hindered by the absence of a culturally-adapted, reliable, and valid measurement tool. To address this significant gap in research and knowledge, we build on our previous qualitative work investigating the cultural- and context-specific nuances of RFC among Accredited Social Health Activists (ASHAs), a cadre of female CHWs in India, for engaging in mental health task-sharing. Utilizing our qualitative findings, we aim to adapt the Readiness for Change Scale and translate it into Marathi language by following the World Health Organization's recommendations on scale translation. In addition, we aim to assess the content and construct validity, as well as internal consistency of the translated (Marathi) version of the Readiness for Change Scale among n=330 ASHAs in Rahata sub-district of Ahmednagar district in the state of Maharashtra, India. We will assess content validity through involving an expert panel, and calculate content validity ratios and a content validity index. For evaluating construct (convergent) validity, we will calculate the correlation between the revised scale scores and scores from the General Self-Efficacy Scale. Furthermore, we will use Cronbach's alpha to assess the internal consistency of the revised scale, and factor analysis to identify scale constructs. The outcome of this study—an adapted and validated measure for RFC among CHWs for mental health task-sharing—will build a solid foundation to develop and test an implementation strategy to build RFC among CHWs for mental health task-sharing through NIH's R21 funding mechanism which will be useful for low-resource setting globally, including the United States.