title: Advantages and Challenges of A Village Doctor-Based Cognitive Behavioral Therapy for Late-Life Depression in Rural China: A Qualitative Study.
abstract: BACKGROUND
  The delivery of mental health services in rural China has been notably limited due to lack of qualified mental health professionals among other impeding factors. A village doctor-based cognitive behavioral therapy intervention may be one way of improving accessibility. The purpose of this study was to explore the advantages and challenges of implementing this intervention, as delivered by trained village doctors, to treat late-life depression in rural China.
  
  
  METHODS
  We conducted one focus group discussion with 10 village doctors, 10 individual interviews with each of the village doctors, and individual interviews with 19 older adults. The topic guides were advantages and challenges of the intervention program from the perspective of the village doctors and older adults. Interviews were audio-recorded, transcribed, coded using NVivo 8, and analyzed using thematic analysis.
  
  
  RESULTS
  The village doctors stressed the importance of role-playing and using instructive manuals in the training. Proper supervision was also a key component of the program. The benefits received from the intervention for the village doctors and the elders were positive such that both the doctors and the older adults were willing to implement/receive this intervention. Cultural and political factors (renqing and perceived policy consideration) facilitated the elders' access to mental health services. Challenges included a lack of real therapy (in contrast to role-playing) demonstrated in the training and lack of a step-by-step manual based on different types of problems encountered. Other impediments to the successful implementation of the intervention included the time constraints of village doctors and the presence of other people when conducting the intervention.
  
  
  CONCLUSIONS
  The present study has demonstrated that the intervention program is likely to be an acceptable geriatric depression intervention in rural China if several challenges are appropriately addressed.
authors.affiliation: Center for Behavioral Health, Beijing Normal University, Beijing, China; School of Social Development and Public Policy, Beijing Normal University, Beijing, China.
authors.forename: Xinfeng
authors.initials: X
authors.lastname: Tang
authors.affiliation: Faculty of Humanities and Social Science, City University of Macau, Macau, China.
authors.forename: Fahui
authors.initials: F
authors.lastname: Yang
authors.affiliation: Department of Social Work, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Tan
authors.initials: T
authors.lastname: Tang
authors.affiliation: Mental Health Education Center of College Student, Sichuan Normal University, Chengdu, China.
authors.forename: Xuemei
authors.initials: X
authors.lastname: Yang
authors.affiliation: Center for Behavioral Health, Beijing Normal University, Beijing, China; School of Social Development and Public Policy, Beijing Normal University, Beijing, China; China Institute of Health, Beijing Normal University, Beijing, China.
authors.forename: Weijun
authors.initials: W
authors.lastname: Zhang
authors.affiliation: Center for Behavioral Health, Beijing Normal University, Beijing, China; School of Social Development and Public Policy, Beijing Normal University, Beijing, China.
authors.forename: Xiaohua
authors.initials: X
authors.lastname: Wang
authors.affiliation: Mianzhu Ankang Hospital, Deyang, China.
authors.forename: Li
authors.initials: L
authors.lastname: Ji
authors.affiliation: Mianzhu Maternal and Child Health Hospital, Mianzhu County, Sichuan Province, China.
authors.forename: Yun
authors.initials: Y
authors.lastname: Xiao
authors.affiliation: Center for Behavioral Health, Beijing Normal University, Beijing, China; School of Social Development and Public Policy, Beijing Normal University, Beijing, China.
authors.forename: Kun
authors.initials: K
authors.lastname: Ma
authors.affiliation: Center for Behavioral Health, Beijing Normal University, Beijing, China; School of Social Development and Public Policy, Beijing Normal University, Beijing, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Center for Behavioral Health, Beijing Normal University, Beijing, China; School of Social Development and Public Policy, Beijing Normal University, Beijing, China.
authors.forename: Xianglei
authors.initials: X
authors.lastname: Kong
authors.affiliation: School of Psychology, Beijing Normal University, Beijing, China; Department of Clinical Psychology, Capital Medical University, Beijing, China.
authors.forename: Jianping
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Psychiatry and Clinical Psychology, Beijing Anding Hospital, Capital Medical University, Beijing, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Liu
authors.affiliation: Center for Mental Health, Southwestern University Of Finance And Economics, Chengdu, China.
authors.forename: Qian
authors.initials: Q
authors.lastname: Xu
authors.affiliation: Center for Behavioral Health, Beijing Normal University, Beijing, China; School of Social Development and Public Policy, Beijing Normal University, Beijing, China; China Institute of Health, Beijing Normal University, Beijing, China.
authors.forename: Donghua
authors.initials: D
authors.lastname: Tian
authors.affiliation: Center for Behavioral Health, Beijing Normal University, Beijing, China; School of Social Development and Public Policy, Beijing Normal University, Beijing, China; China Institute of Health, Beijing Normal University, Beijing, China.
authors.forename: Zhiyong
authors.initials: Z
authors.lastname: Qu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002681:China; D015928:Cognitive Behavioral Therapy / Q000191:economics / Q000193:education / Q000379:methods*; D003150:Community Health Workers / Q000191:economics / Q000193:education / Q000523:psychology; D003863:Depression / Q000628:therapy*; D004282:Documentation; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D007858:Learning; D008297:Male; D008875:Middle Aged; D011057:Politics; D017410:Practice Guidelines as Topic; D012424:Rural Population / Q000706:statistics & numerical data*; D016896:Treatment Outcome