2.5.2. Preliminary Effectiveness Outcome

Competency outcomes were collected before (baseline) and after (end line) the training to determine the preliminary effectiveness of the different training programs. Competency was assessed using a questionnaire consisting of short clinical vignettes followed by multiple-choice questions covering the core skills and competencies needed to deliver the HAP. The measure was based on prior research showing that self-assessment can reliably assess therapist competency following training [24,59,60]. Three equivalent versions of the questionnaire were used to allow repeat testing. The measure focuses on testing knowledge of the HAP treatment as well as applied knowledge of how to deliver the treatment, an essential aspect of provider competence. This questionnaire is scored from 0 to 100, with higher scores reflecting higher levels of knowledge and competency. The questionnaire was translated into Hindi for this study, and modifications were made to fit the local context, such as simplifying complex or technical language and using local terms. Experienced counselors reviewed the Hindi translation to ensure that it was appropriate for administering to non-specialist health workers in the local context in Madhya Pradesh. To avoid "teaching to the test" [61], none of the individuals involved in the development of the HAP training materials had access to the competency assessment questionnaire.
