Pushing the bench: A mixed methods study of barriers to and facilitators of identification and referral into depression care by professional nurses in KwaZulu-Natal, South Africa
Pushing the bench: A mixed methods study of barriers to and facilitators of identification and referral into depression care by professional nurses in KwaZulu-Natal, South Africa
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DOI：
10.1016/j.ssmmh.2021.100009
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发表时间：
2021-12-01
期刊：
影响因子：
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通讯作者：
Petersen, Inge
中科院分区：
文献类型：
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作者：
Kemp, Christopher G.;Mntambo, Ntokozo;Petersen, Inge
目标：将心理健康和慢性病服务纳入初级保健可以缩小资源匮乏地区的心理健康治疗差距并改善相关健康结果。护士对抑郁症患者的识别和转诊率较低，限制了综合心理保健的有效性；在南非和类似环境中，识别和转介的障碍和促进因素仍然不明确。本研究探讨了南非夸祖鲁-纳塔尔省护士识别和转诊抑郁症状患者的障碍和促进因素，作为南非夸祖鲁-纳塔尔省综合心理健康服务提供的一部分。设计：结合定性和定量数据的三角测量混合方法研究。方法：数据收集、分析和解释以实施研究综合框架 (CFIR) 为指导。参与者是南非夸祖鲁-纳塔尔省阿马朱巴十个初级卫生保健机构的专业护士。定性数据收集涉及针对高推荐护士和低推荐护士的特定 CFIR 结构的半结构化访谈。演绎和归纳编码用于导出与障碍和促进因素相关的主要主题。定量数据收集涉及结构化调查问卷，评估访谈中探讨的决定因素。采用定性比较分析来确定高转介和低转介的必要或充分条件。结果：对 22 名护士进行了访谈。主要主题与培训、监督和能力不足有关；情绪负担；人力和物力资源有限；感知患者对综合服务的需求；和干预的可接受性。六十八名护士完成了问卷调查。定量结果证实并扩展了定性研究结果。自我评估能力低一直是提供适当服务的障碍。结论：为了在人员严重短缺和服务提供者负担过重的情况下促进综合护理的成功，需要采取包括直接培训、结构化监督和常规行为健康筛查工具在内的实施策略。还需要采取干预措施来提高患者的心理健康素养以及对护士的情感支持。
Objective: Integration of mental health and chronic disease services in primary care could reduce the mental health treatment gap and improve associated health outcomes in low-resource settings. Low rates of nurse identification and referral of patients with depression limit the effectiveness of integrated mental health care; the barriers to and facilitators of identification and referral in South Africa and comparable settings remain undefined. This study explored barriers to and facilitators of nurse identification and referral of patients with depressive symptoms as part of integrated mental health service delivery in KwaZulu-Natal, South Africa.Design: Triangulation mixed methods study incorporating qualitative and quantitative data.Methods: Data collection, analysis, and interpretation were guided by the Consolidated Framework for Implementation Research (CFIR). Participants were professional nurses at ten primary health care facilities in Amajuba, KwaZulu-Natal, South Africa. Qualitative data collection involved semi-structured interviews targeting specific CFIR constructs with high-and low-referring nurses. Deductive and inductive coding were used to derive primary themes related to barriers and facilitators. Quantitative data collection involved a structured questionnaire assessing determinants explored in the interviews. Qualitative comparative analysis was used to identify the necessary or sufficient conditions for high and low nurse referral.Results: Twenty-two nurses were interviewed. Primary themes related to insufficient training, supervision, and competency; emotional burden; limited human and physical resources; perceived patient need for integrated services; and intervention acceptability. Sixty-eight nurses completed questionnaires. Quantitative results confirmed and expanded upon the qualitative findings. Low self-assessed competency was a consistent barrier to appropriate service delivery.Conclusions: To promote the success of integrated care in a context of severe staff shortages and over-burdened providers, implementation strategies including direct training, structured supervision, and routine behavioral health screening tools are warranted. Interventions to improve mental health literacy of patients as well as emotional support for nurses are also needed.