Implementation strategy in collaboration with people with lived experience of mental illness to reduce stigma among primary care providers in Nepal (RESHAPE): protocol for a type 3 hybrid implementation effectiveness cluster randomized controlled trial.
Implementation strategy in collaboration with people with lived experience of mental illness to reduce stigma among primary care providers in Nepal (RESHAPE): protocol for a type 3 hybrid implementation effectiveness cluster randomized controlled trial.
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DOI：
10.1186/s13012-022-01202-x
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发表时间：
2022-06-16
影响因子：
7.2
通讯作者：
Jordans, Mark J. D.
中科院分区：
文献类型：
--
作者：
Kohrt, Brandon A.;Turner, Elizabeth L.;Gurung, Dristy;Wang, Xueqi;Neupane, Mani;Luitel, Nagendra P.;Kartha, Muralikrishnan R.;Poudyal, Anubhuti;Singh, Ritika;Rai, Sauharda;Baral, Phanindra Prasad;McCutchan, Sabrina;Gronholm, Petra C.;Hanlon, Charlotte;Lempp, Heidi;Lund, Crick;Thornicroft, Graham;Gautam, Kamal;Jordans, Mark J. D.
关键词：
在低收入和中等收入国家，将心理健康服务纳入初级保健环境的努力越来越多。然而，常用的方法来培训初级保健提供者（PCP）可能无法实现预期的结果，改善服务的提供，证明了培训后的精神疾病的低检测率。造成这一缺陷的一个因素是PCP中的耻辱感。减少污名化的初级保健协调员培训执行战略有可能提高服务质量。在尼泊尔，一项3型混合实施-有效性群集随机对照试验将评估PCP的常规培训实施与培训PCP的替代实施策略（称为减少医疗保健提供者之间的耻辱感（RESHAPE））的比较。在照常执行时，初级保健人员接受了关于世界卫生组织心理健康差距行动方案干预指南的培训，培训由心理健康专家进行。在RESHAPE中，mhGAP-IG培训包括由有精神疾病生活经历的人（PWLE）及其护理人员使用PhotoVoice以及有抱负的人物进行促进的附加组成部分。两组PCP培训的持续时间相同。该研究的共同主要结果是PCP之间的耻辱，在培训后6个月用社会距离量表测量，以及RE-AIM实施科学框架的一个领域。可操作性达到的精神疾病的检测在初级保健设施的准确性，并将确定由精神科医生在3个月后，PCP诊断的病人。污名将被评估为一个中介的影响。将评估成本效益和其他RE-AIM结局。24个城市，集群的单位，将被随机分配到mhGAP-IG实施照常或RESHAPE武器，大约76个卫生设施和216个PCP平均分配到武器之间。估计将招募1100名患者，以评估抑郁症、广泛性焦虑症、精神病或酒精使用障碍的准确诊断。掩蔽将包括PCP、患者和精神科医生。这项研究将促进与PWLE合作培训PCP的污名减少的知识。这种合作的培训方法有可能提高诊断能力。如果成功，这一实施战略可以在资源匮乏的环境中推广，以缩小全球精神疾病治疗差距。ClinicalTrials.gov，NCT 04282915。报名时间：2020年2月25日。在线版本包含补充材料，可通过10.1186/s13012-022-01202-x获得。
There are increasing efforts for the integration of mental health services into primary care settings in low- and middle-income countries. However, commonly used approaches to train primary care providers (PCPs) may not achieve the expected outcomes for improved service delivery, as evidenced by low detection rates of mental illnesses after training. One contributor to this shortcoming is the stigma among PCPs. Implementation strategies for training PCPs that reduce stigma have the potential to improve the quality of services. In Nepal, a type 3 hybrid implementation-effectiveness cluster randomized controlled trial will evaluate the implementation-as-usual training for PCPs compared to an alternative implementation strategy to train PCPs, entitled Reducing Stigma among Healthcare Providers (RESHAPE). In implementation-as-usual, PCPs are trained on the World Health Organization Mental Health Gap Action Program Intervention Guide (mhGAP-IG) with trainings conducted by mental health specialists. In RESHAPE, mhGAP-IG training includes the added component of facilitation by people with lived experience of mental illness (PWLE) and their caregivers using PhotoVoice, as well as aspirational figures. The duration of PCP training is the same in both arms. Co-primary outcomes of the study are stigma among PCPs, as measured with the Social Distance Scale at 6 months post-training, and reach, a domain from the RE-AIM implementation science framework. Reach is operationalized as the accuracy of detection of mental illness in primary care facilities and will be determined by psychiatrists at 3 months after PCPs diagnose the patients. Stigma will be evaluated as a mediator of reach. Cost-effectiveness and other RE-AIM outcomes will be assessed. Twenty-four municipalities, the unit of clustering, will be randomized to either mhGAP-IG implementation-as-usual or RESHAPE arms, with approximately 76 health facilities and 216 PCPs divided equally between arms. An estimated 1100 patients will be enrolled for the evaluation of accurate diagnosis of depression, generalized anxiety disorder, psychosis, or alcohol use disorder. Masking will include PCPs, patients, and psychiatrists. This study will advance the knowledge of stigma reduction for training PCPs in partnership with PWLE. This collaborative approach to training has the potential to improve diagnostic competencies. If successful, this implementation strategy could be scaled up throughout low-resource settings to reduce the global treatment gap for mental illness. ClinicalTrials.gov, NCT04282915. Date of registration: February 25, 2020. The online version contains supplementary material available at 10.1186/s13012-022-01202-x.
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影响因子：
12.7
作者：
Glasgow, RE;Vogt, TM;Boles, SM
通讯作者：
Boles, SM
影响因子：
3.7
作者：
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Prince M
影响因子：
3.1
作者：
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通讯作者：
Adhikari, Bishnu P.
影响因子：
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作者：
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WHO World Mental Health Survey Collaborators
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通讯作者：
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