Reducing stigma among healthcare providers to improve mental health services (RESHAPE): protocol for a pilot cluster randomized controlled trial of a stigma reduction intervention for training primary healthcare workers in Nepal.
Reducing stigma among healthcare providers to improve mental health services (RESHAPE): protocol for a pilot cluster randomized controlled trial of a stigma reduction intervention for training primary healthcare workers in Nepal.
复制标题
减少医疗保健提供者之间的污名化以改善心理健康服务（RESHAPE）：试验群集群集随机对照试验的方案，用于降低污名的干预措施，以培训尼泊尔的初级医疗保健工人。
DOI：
10.1186/s40814-018-0234-3
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发表时间：
2018
影响因子：
1.7
通讯作者：
Patel V
中科院分区：
文献类型：
--
作者：
Kohrt BA;Jordans MJD;Turner EL;Sikkema KJ;Luitel NP;Rai S;Singla DR;Lamichhane J;Lund C;Patel V
低收入和中等收入国家的非专业卫生保健提供者，包括初级和社区卫生保健工作者，可以有效地治疗精神疾病。然而，在现有卫生系统内扩大精神卫生服务受到诸如对精神疾病患者的污名化等障碍的限制。因此，需要采取干预措施来解决非专业人员的态度和行为问题。为了解决这一差距，减少卫生保健提供者之间的耻辱以改善精神卫生服务（重塑）是一项干预措施，其中增加了与精神卫生服务使用者的社会接触，以培训非专业卫生保健工作者将精神卫生服务纳入初级卫生保健。本协议描述了在尼泊尔奇旺初级保健中心进行的混合方法试点和可行性研究。定性部分将包括关键信息提供者访谈和焦点小组讨论。定量部分由试点集群随机对照试验（c-RCT）组成，该试验将为未来重塑与常规训练（TAU）的有效性研究建立参数。初级卫生保健设施（集群单位，k = 34）将被随机分配到TAU或重塑。干预措施的直接受益者是设施内的初级保健工作者（n = 150）；间接受益者是他们的病人（n = 100）。TAU条件是对初级卫生保健工作者现有的精神卫生培训和监督，通过改善精神卫生保健方案（PRIME）实施精神卫生差距行动方案（mhGAP）。主要目的是通过对初级卫生保健工作者、培训师和精神卫生服务使用者的定性访谈来评估可接受性和可行性。次要目标是收集卫生工作者结果的定量信息，包括心理健康耻辱感（社会距离量表）、临床知识（mhGAP）、临床能力（加强常见治疗因素评估，ENACT）和内隐态度（内隐关联测验，IAT），以及患者结果，包括与耻辱感相关的护理障碍、日常功能和症状。试点和可行性研究将有助于完善建议，以便在资源匮乏的卫生系统的初级卫生保健机构中实施《行动计划》和其他精神卫生服务。试点c-RCT研究结果将为重塑的有效性试验提供信息，以推进非专业提供者培训和监督最佳方法的证据基础。ClinicalTrials.gov识别码，NCT02793271
Non-specialist healthcare providers, including primary and community healthcare workers, in low- and middle-income countries can effectively treat mental illness. However, scaling-up mental health services within existing health systems has been limited by barriers such as stigma against people with mental illness. Therefore, interventions are needed to address attitudes and behaviors among non-specialists. Aimed at addressing this gap, REducing Stigma among HealthcAre Providers to ImprovE mental health services (RESHAPE) is an intervention in which social contact with mental health service users is added to training for non-specialist healthcare workers integrating mental health services into primary healthcare. This protocol describes a mixed methods pilot and feasibility study in primary care centers in Chitwan, Nepal. The qualitative component will include key informant interviews and focus group discussions. The quantitative component consists of a pilot cluster randomized controlled trial (c-RCT), which will establish parameters for a future effectiveness study of RESHAPE compared to training as usual (TAU). Primary healthcare facilities (the cluster unit, k = 34) will be randomized to TAU or RESHAPE. The direct beneficiaries of the intervention are the primary healthcare workers in the facilities (n = 150); indirect beneficiaries are their patients (n = 100). The TAU condition is existing mental health training and supervision for primary healthcare workers delivered through the Programme for Improving Mental healthcarE (PRIME) implementing the mental health Gap Action Programme (mhGAP). The primary objective is to evaluate acceptability and feasibility through qualitative interviews with primary healthcare workers, trainers, and mental health service users. The secondary objective is to collect quantitative information on health worker outcomes including mental health stigma (Social Distance Scale), clinical knowledge (mhGAP), clinical competency (ENhancing Assessment of Common Therapeutic factors, ENACT), and implicit attitudes (Implicit Association Test, IAT), and patient outcomes including stigma-related barriers to care, daily functioning, and symptoms. The pilot and feasibility study will contribute to refining recommendations for implementation of mhGAP and other mental health services in primary healthcare settings in low-resource health systems. The pilot c-RCT findings will inform an effectiveness trial of RESHAPE to advance the evidence-base for optimal approaches to training and supervision for non-specialist providers. ClinicalTrials.gov identifier, NCT02793271