Designing a Problem Management intervention

I am presently working on a project that aims to study the impact of loneliness on migration and reverse migration among textile factory workers in Bangalore, India. The objective is to design and implement an Cognitive Behavioral Therapy (CBT) inspired intervention that will target the loneliness and depression experienced by migrant women factory workers. Typically these workers are from the states of Chattisgarh, Jharkhand, Bihar, and Orissa. They move to Bangalore, Karnataka to work in the urban textile factories. Often this move can be an arduous process where these women leave their home states and find themselves in an unfamiliar environment and live in hostels with hundreds of other workers. In addition to being in a completely new setting, these women also leave their families and friends behind at home. The economic “symptom” that we observe workers who move to Bangalore soon quit their factory jobs and move back to their home states. This decision can be costly in two ways. First, the migrant workers generally earn more in their factory jobs than they did in their home state which affords them and their families a higher level of consumption. Second, the government has several concurrent schemes that train the factory workers and teach them the skills required to adequately perform their jobs in the factory. This demands a sizable investment from the government and the workers returning to their home states means the cost of training cannot be fully recovered. 

Through preliminary work, we find that loneliness is one of the main reasons why factory workers reverse migrate away from their jobs in the city. Our research therefore aims to collect evidence on the prevalence of loneliness among adolescent factory workers, investigate channels through which potential loneliness mitigating interventions would work, and ultimately recommend scalable mental health interventions that textile factories in the developing world can use to help assimilate migrant workers into their new surroundings. This summer (summer 2022) I focused on designing and piloting one treatment arm of our study, namely the “Problem Management +” (PM+) arm. At its core, the PM+ is a treatment designed to affect loneliness and depression levels in new migrant workers (i.e. who have been at the factory for less than two weeks). We pair the new migrant workers (hereafter referred to as juniors) with migrant workers who have been at the factory for at least seven months (hereafter referred to as seniors). In short we pair juniors with a senior buddy and hence the name of our project: Buddysystem. The  junior and senior buddy jointly attend four training sessions where they learn how to manage problems in a healthy and step-by-step fashion. In particular the pair jointly focuses on problems that the junior might be facing because they are new to their surroundings. Examples of such problems include not knowing how to cook, not knowing how to travel around the city, and being yelled at by their supervisor for not being fast enough at their job. A typical participant/pair is enrolled in our study or “treated” for eight weeks. They undergo four training sessions in these weeks focusing on different aspects of PM+ that we hope will empower young adolescent factory workers and enable them to navigate issues at the factory or hostel in a healthy way. 

The first training session focuses on introducing the project and our aims to the junior and senior pairs. We tell the participants what our study is about and explain to juniors and seniors their roles and expectations as participants in the study. This is also the first time the junior and seniors meet each other and are introduced as “buddies”. Thereafter we teach the pairs some values that can help guide them as they become good friends with each other. The values are: to listen to your buddy, not pressure them into things, putting aside personal value judgments when interacting with your buddy, not directly providing solutions to problems but instead empowering your buddy to come up with their own solutions, and finally keeping your buddy’s secrets. We encourage the pairs to get to know each other at a deeper level and spend time with each other. 

The second training session introduces the concept of Problem Mangement; a systematic way to think through and if possible solve problems that one faces. We begin by explaining to the pairs that they must choose to focus on problems that they can actually control and potentially solve. For example if a junior buddy faces two problems, one where her supervisor yells at her and another where she has had a disagreement with a roommate, it is conceivable that she cannot change the supervisor’s behavior but she has relatively more control in the relationship with her roommate and can aim to resolve the fight. The three main steps of PM+ are explained to the participants. They are, choosing a problem, identifying an achievable solution, and planning one’s actions around implementing a solution. We also teach them some deep breathing techniques that have been shown to help people calmly think through stressful or worrisome situations. 

The third training session walks through the three steps of PM+ in some more detail and we help junior and senior buddies with implementing the three steps for a particular problem that the pair has jointly recognized that the junior buddy is facing as a direct consequence of having newly migrated to the city for work. The fourth and final training session (titled Get Going Keep Going) follows up on the progress that the buddies have made through the eight weeks of being enrolled in our study and most importantly teaches the pairs that they can apply PM+ techniques to all facets of their life, not just problems that they face at or as a result of the factory or hostel. Furthermore, the PM+ steps can be used to carve our time for things that bring the participants happiness and joy like their hobbies or other activities that they feel like they have less time for as they are adjusting to life in the city.

Overall the experience was interesting and challenging at the same time. Implementing the intervention required translating concepts like Cognitive Behavioral Therapy into Hindi and explaining the concepts and the individual steps of PM+ to participants with low levels of education and literacy. This was a difficult and ultimately rewarding process as we were able to roll out the intervention in a pilot in early August 2022 and now we wait to see what the results show us about the impact of the treatment on loneliness, depression, and ultimately our primary outcome of interest, reverse migration.

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About advaitra8

I am pursuing a PhD in Applied Economics at the Wharton School of the University of Pennsylvania. My research interests include development economics, education, and health economics. I also enjoy causal inference, applied Bayesian modeling, machine learning, and networks. I earned an MS in Economics from the New School for Social Research and a BSc. in Economics, Mathematics, and Statistics from St. Joseph's College, Bangalore University.