*2.4. Training Programs*

The training programs in this study were designed to provide instruction to non-specialist health workers to gain the clinical skills and competencies necessary to deliver the Healthy Activity Program (HAP) for treatment of depression [49]. The HAP is an evidence-based brief psychological treatment for depression designed and tested in Goa, India, that has demonstrated effectiveness and cost-effectiveness in primary care settings in India [35], as well as sustained clinical benefits [50]. The success of the HAP for treating depression has also been demonstrated in other lower-resource contexts, including among people receiving treatment for multidrug-resistant tuberculosis [51] and people with severe depression in primary care settings in Nepal [52], and as part of recent efforts to scale up mental health services in Madhya Pradesh [53]. The HAP consists of two manuals covering general counseling skills and treatment specific skills. These manuals are open source and available online (http://www.sangath.in/). These manuals were adapted to the local context of Madhya Pradesh and converted into digital and F2F training programs (i.e., covering the same content using different teaching strategies). In this pilot study, we compared three different training programs: conventional face-to-face (F2F) training; digital training (DGT); and digital training with remote support (DGT+).
