Abstract
BACKGROUND: Amid a pan-India digitally driven mental health capacity-building program carried out through National Institute of Mental Health and Neurosciences (NIMHANS) from April 2022 to November 2024, one district stood out, consistently outperforming others across most outcome measures. This study delves into the successful elements of this high-performing model district in South India to uncover the key factors behind its success. METHODS: In November-December 2023, 69 primary care doctors (PCDs) from Udupi district participated in a six-week digital mental health training. The study utilized a mixed-method approach, analyzing changes in knowledge, attitudes, and practice (KAP) scores pre- and post-training, diagnostic and treatment concordance between PCDs and psychiatrists via collaborative video consultations (CVCs) records, and insights from focus group discussion (FGD) conducted with 12 PCDs. RESULTS: About 68.12% of Udupi PCDs attended ≥3 sessions of the training, outperforming both Karnataka state PCDs (22.89%) and PCDs from nine other states (13.24%). Post-training, KAP scores improved significantly (mean difference: 1.89, t: -5.63, p < .001), surpassing the overall program's PCDs (mean difference: 1.68). Diagnostic concordance with psychiatrists ranged from "Very good" to "Good" (Cohen's k: 0.6-1.0), while treatment concordance was "Good" to "Fair" (k: 0.3-0.6). FGDs highlighted key success factors, including participant engagement, the perceived need for psychiatric care at PHCs, positive attitudes toward digital training, and strong administrative support. CONCLUSION: Compared to Karnataka as a whole and other states, Udupi district's standout performance was likely driven by favorable trainee-related factors and adequate administrative support enabled through digital training.