The development and tailoring of a peer support program for patients with diabetes mellitus and depression in a primary health care setting in Central Uganda
The development and tailoring of a peer support program for patients with diabetes mellitus and depression in a primary health care setting in Central Uganda
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DOI：
10.1186/s12913-020-05301-7
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发表时间：
2020-05-19
影响因子：
2.8
通讯作者：
Wagner, Glenn
中科院分区：
文献类型：
--
作者：
Akena, Dickens;Okello, Elialilia S.;Wagner, Glenn
背景约20-40%的糖尿病患者在病程中伴有抑郁障碍。尽管糖尿病患者的DD负担很高，但在撒哈拉以南非洲（SSA）的大多数初级卫生保健诊所很少发现和充分治疗。在资源有限的SSA中，建议使用同伴支持来提供精神卫生保健的组成部分，尽管其可接受性尚未得到充分研究。方法我们进行了定性访谈（QI），以评估的经验，从DD的痛苦的糖尿病患者的看法，提供同行支持的可接受性，共病糖尿病和DD患者。然后，我们训练他们为新诊断为DD的DM患者提供同伴支持。我们确定了成功实施同伴支持的挑战和潜在障碍，并为这些障碍提供了解决方案。结果参与者报告说，要成为同龄人，他们需要年龄成熟，坚持去诊所/预约，并且不患有任何活跃的身体或共病的精神或药物滥用障碍。与会者预计，提供同行支持的主要障碍将是高损耗率的结果，糖尿病患者在访问医疗保健设施，由于财政限制的困难。解决这一障碍的一个潜在方案是在返回医院的日期同时举行同伴支持会议。同行报告说，干预的内容应主要是关于糖尿病是一种慢性疾病，需要坚持终身治疗的事实。大家一致认为病人可以接受朋辈的支持。结论我们的研究表明，同伴支持计划是一种可接受的手段，提供辅助护理，以支持治疗的依从性和管理，特别是在设置有严重的人员短缺和心理教育可能不会定期交付。
Background About 20-40% of patients with diabetes mellitus (DM) suffer from depressive disorders (DD) during the course of their illness. Despite the high burden of DD among patients with DM, it is rarely identified and adequately treated at the majority of primary health care clinics in sub-Saharan Africa (SSA). The use of peer support to deliver components of mental health care have been suggested in resource constrained SSA, even though its acceptability have not been fully examined. Methods We conducted qualitative interviews (QI) to assess the perceptions of DM patients with an experience of suffering from a DD about the acceptability of delivering peer support to patients with comorbid DM and DD. We then trained them to deliver peer support to DM patients who were newly diagnosed with DD. We identified challenges and potential barriers to a successful implementation of peer support, and generated solutions to these barriers. Results Participants reported that for one to be a peer, they need to be mature in age, consistently attend the clinics/keep appointments, and not to be suffering from any active physical or co-morbid mental or substance abuse disorder. Participants anticipated that the major barrier to the delivery of peer support would be high attrition rates as a result of the difficulty by DM patients in accessing the health care facility due to financial constraints. A potential solution to this barrier was having peer support sessions coinciding with the return date to hospital. Peers reported that the content of the intervention should mainly be about the fact that DM was a chronic medical condition for which there was need to adhere to lifelong treatment. There was consensus that peer support would be acceptable to the patients. Conclusion Our study indicates that a peer support program is an acceptable means of delivering adjunct care to support treatment adherence and management, especially in settings where there are severe staff shortages and psycho-education may not be routinely delivered.