Researchers in Nepal are testing a new program called BECOME that trains community health workers to help people manage both mental health problems (like depression and anxiety) and physical diseases (like diabetes and high blood pressure) at the same time. This matters because these conditions often happen together and make each other worse, especially in countries with fewer healthcare resources. The study will follow 700 people over the next few years to see if this combined approach actually works and can be used in other places. The program teaches stress-reduction techniques, helps people stay active, and uses motivational coaching—all delivered by trained local health workers instead of doctors.

The Quick Take

  • What they studied: Whether training community health workers to deliver a combined behavioral program (stress reduction, activity coaching, and motivational support) can help people with both mental health conditions and chronic diseases like diabetes or high blood pressure.
  • Who participated: 700 adults aged 40 and older in Nepal who have at least one mental health condition (depression or anxiety) and at least one chronic disease (like diabetes or hypertension). The study is happening across 20 different communities in two provinces.
  • Key finding: This is a study protocol—the actual results won’t be available until early 2027. Researchers are currently recruiting participants and will measure whether the BECOME program reduces depression, anxiety, and improves disease management better than standard care.
  • What it means for you: If successful, this approach could make healthcare more accessible and affordable in countries with limited medical resources by using trained community members instead of specialists. However, wait for the actual results before making any decisions based on this research.

The Research Details

This is a stepped-wedge cluster randomized controlled trial, which is a fancy way of saying researchers will gradually introduce the BECOME program to different communities over time while comparing results to communities receiving standard care. Think of it like rolling out a new program in waves—some communities start the program first, then others join later, allowing researchers to measure the impact at each stage.

The study takes place in Nepal across 20 geographic areas (clusters) with 700 participants total. Community health workers in these areas will be trained to deliver three main components: evidence-based stress reduction (teaching relaxation and coping skills), behavioral activation (helping people become more physically active and engaged), and motivational interviewing (a coaching technique that helps people commit to healthy changes).

Participants will be compared to a control group receiving enhanced usual care (better than normal care, but without the BECOME program). Researchers will measure mental health symptoms, disease control, lifestyle factors, and track how well the program is actually being delivered and accepted by communities.

Most research on behavioral interventions happens in wealthy countries with lots of doctors and specialists. This study is important because it tests whether these proven techniques can work in real-world settings in low- and middle-income countries where resources are limited. By using community health workers instead of expensive specialists, the approach could be more affordable and sustainable. The study also measures not just whether it works, but how it works, who uses it, and what it costs—information needed to actually expand the program to other regions.

This is a well-designed study with several strengths: it uses a randomized controlled trial design (the gold standard for testing interventions), involves a large sample size (700 people), measures multiple outcomes (mental health, physical disease, behavior changes), and includes implementation science methods to understand real-world feasibility. The study also plans to gather qualitative feedback from patients, health workers, and system leaders. However, this is a protocol paper—the actual results haven’t been collected yet, so we cannot assess the quality of the findings. The study is registered on ClinicalTrials.gov, which increases transparency and credibility.

What the Results Show

Results are not yet available. This paper describes the study plan, not the outcomes. Participant recruitment began in July 2024 and is ongoing. The researchers expect to complete data collection for the main mental health outcomes by January 2027. The primary outcome being measured is change in severity of common mental health conditions (depression and anxiety). Secondary outcomes include improvements in blood pressure and blood sugar control, changes in lifestyle behaviors (diet, activity, smoking), and measures of how well the program was implemented and accepted.

Beyond mental health improvement, researchers will examine whether the program helps people better manage their physical diseases, whether it changes health behaviors (like exercise and diet), and whether it’s cost-effective. They’ll also look at whether the program reaches the people who need it most, whether health workers can deliver it well, and whether communities accept and continue using it. These ‘implementation outcomes’ are just as important as clinical outcomes for understanding whether the program can actually be expanded to other areas.

Individual components of BECOME (stress reduction, behavioral activation, and motivational interviewing) have been proven effective in research studies, mostly in wealthy countries. However, combining all three approaches and delivering them through community health workers in low-resource settings is relatively new. This study will show whether the combined approach works better than single interventions and whether it’s practical to deliver in real-world community settings in Nepal. The integrated approach addresses the fact that depression, anxiety, diabetes, and high blood pressure often occur together and share common causes (stress, inactivity, poor diet), so treating them together may be more effective than treating them separately.

Since this is a protocol paper, we cannot yet assess limitations in the actual results. However, potential limitations to watch for include: the study only includes people aged 40 and older in Nepal, so results may not apply to younger people or other countries; the study measures outcomes only until early 2027, so long-term effects are unknown; and the success depends on community health workers being properly trained and supported, which may vary across different areas.

The Bottom Line

This research is still in progress, so no clinical recommendations can be made yet. However, the study design is sound and addresses an important gap in healthcare delivery for people with both mental and physical health conditions in resource-limited settings. Once results are available in 2027, they may support training community health workers to deliver combined behavioral interventions. For now, people with depression, anxiety, diabetes, or high blood pressure should continue following their doctor’s advice and seek professional mental health care when needed.

This research is most relevant to: healthcare systems in low- and middle-income countries looking for affordable ways to address mental health and chronic disease together; community health workers and their trainers; people with both mental health conditions and chronic diseases; and public health policymakers. People in wealthy countries with good access to specialists may find it less directly applicable, though the findings could still inform integrated care approaches. This study is not a clinical trial you can join unless you live in the study areas in Nepal.

The study is currently recruiting participants (as of early 2025) and expects to complete data collection by January 2027. Preliminary findings should be available in 2027, with full results and analysis likely following in 2027-2028. If the program proves effective, it would take additional time (likely 1-3 years) to train health workers and implement it in new areas. People should not expect immediate changes from this research—it’s foundational work to determine if and how the approach should be expanded.

Want to Apply This Research?

  • Once BECOME results are available, users could track: (1) mood symptoms (depression/anxiety severity) using simple daily mood ratings (1-10 scale), (2) physical activity minutes per day, (3) medication adherence for chronic diseases, and (4) stress levels using brief check-ins. These align with the program’s focus on mental health, behavioral activation, and disease management.
  • If the BECOME program becomes available, users could use an app to: receive daily stress-reduction exercises (breathing techniques, guided relaxation), get reminders and motivation for physical activity, track progress toward health goals, and access motivational coaching content. The app could also help users remember to take medications and track disease-related measurements (blood pressure, blood sugar if applicable).
  • A long-term tracking approach would involve weekly check-ins on mood and stress, daily activity logging, monthly reviews of disease control (blood pressure/blood sugar readings), and quarterly assessments of overall progress. The app could provide visual progress charts and send encouraging notifications, mimicking the motivational interviewing component of the BECOME program.

This paper describes a research study protocol, not completed results. No clinical recommendations should be made based on this protocol. If you have depression, anxiety, diabetes, high blood pressure, or other chronic conditions, please consult with your healthcare provider for personalized medical advice. Do not delay or replace professional medical treatment based on this research summary. The BECOME program is still being tested and is not yet available for general use outside the study areas in Nepal. Results from this study will help inform future healthcare approaches but should be interpreted by qualified healthcare professionals in context with other available evidence.