**5. Conclusions**

The findings and observations from this pilot study offer insights that can inform modifications and improvements to the face-to-face and digital training programs for non-specialist health workers in preparation for a larger fully powered effectiveness trial. A potentially important finding from this pilot study was the apparent motivation for enrollment and starting the training on depression care among non-specialist health workers (*n* = 36 out of *n* = 42) and the motivation to complete this training (*n* = 27 out of *n* = 36), and specifically among ASHAs and ASHA Facilitators. Based on our findings, there seems to be a demand for training in depression care that will be further explored in the forthcoming trial. With digital technologies becoming an increasingly important tool in health systems in many low-resource settings in India, as reflected by efforts to finance the adoption of smartphones among frontline health workers to support care delivery [29], future research can expand on the findings reported here to determine how technology can support the scale up of mental health care. Importantly, it will be necessary to determine how to effectively leverage digital technology to enable supervision and quality assurance for the sustained delivery of high quality psychological treatment for depression, as this will be critical to support task-sharing mental health services in low-resource settings towards addressing the care gap [72].

**Author Contributions:** Prepared the study outline and manuscript proposal, S.S.M. and J.A.N.; wrote the first draft of the manuscript, S.S.M., D.T., and J.A.N.; data collection, S.S.M. and U.J.; data analysis, S.S.M., A.A., R.S. and A.K.; interpretation of the study findings, S.S.M., A.A., A.K., R.S. and J.A.N.; development and field-testing of the digital training program, A.K., R.S., and D.T.; oversaw the project and supervision, A.B., D.T., V.P. and J.A.N.; reviewed drafts of the manuscript and provided critical and intellectual inputs, A.K., U.J., J.L.R., A.S., A.B. and V.P. All authors have read and agreed to the published version of the manuscript.

**Funding:** This work was supported by the National Institute of Mental Health (NIMH), USA (grant no. U19MH113211). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

**Acknowledgments:** We would like to acknowledge Dinesh Chandke, Kamlesh Sharma, and Narendra Verma, for their contribution to participant recruitment and coordination of endpoint assessments. In addition, we acknowledge Deepali Vishwakarma and Pooja Dhurve, for providing technical support and ensuring effective delivery of the training programs to participants. We would also like to acknowledge the contributions of Medha Upadhye, Miriam Sequeira, and Urvita Bhatia for supporting the development of the training program content. We wish to acknowledge our advisors, collaborators, researchers, and clinicians who have supported our efforts with the ESSENCE project, including Zafra Cooper, Sona Dimidjian, Christopher Fairburn, Steven Hollon, Chunling Lu, Lauren Mitchell, Abhijit Nadkarni, Rohit Ramaswamy, Daisy Singla, and Donna Spiegelman. Additionally, we acknowledge our study participants; the non-specialist health workers for their participation, time, and contribution to this study; and our collaborators from National Health Mission, Madhya Pradesh State and National Health Systems Resource Center, Delhi, India for their support.

**Conflicts of Interest:** The authors declare no competing interests.
