Measuring implementation in global mental health: validation of a pragmatic implementation science measure in eastern Ukraine using an experimental vignette design
Measuring implementation in global mental health: validation of a pragmatic implementation science measure in eastern Ukraine using an experimental vignette design
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DOI：
10.1186/s12913-019-4097-y
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发表时间：
2019-04-29
影响因子：
2.8
通讯作者：
Murray, L.
中科院分区：
文献类型：
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作者：
Haroz, E. E.;Bolton, P.;Murray, L.
越来越多的证据支持任务转移心理健康干预在低收入和中等收入国家（LMIC）的有效性。然而，这些方案的系统性扩大或可持续性有限，这表明有必要研究执行情况。取得进展的一个障碍是缺乏与当地相关的有效执行措施。我们适应了现有的简短的传播和实施（D&I）措施，其中包括规模的可接受性，适当性，可行性和可访问性，供当地使用，并研究了其有效性和可靠性之间的样本消费者在Ukraine.MethodsLocal定性数据通知适应的措施和发展的小插曲，以测试的可靠性和有效性。参与者是退伍军人和国内流离失所者（IDPs）招募的一部分，一个单独的有效性研究适应心理健康工具。我们检查了内部一致性信度，重测信度，结构和效标效度为每个规模的措施。我们随机分配一半的参与者回答描述现有的当地精神病服务的小插曲，我们知道这些服务并不受欢迎，而另一半则随机分配到描述可能更好地实施精神卫生服务的小插曲。标准的有效性进行了评估，通过比较每个规模的小插曲，并在vignettes.ResultsN=169参加了定性研究和N=153参加了有效性研究中所描述的程序的整体总结评级的分数。定性调查结果表明，该措施增加了几个项目，并指出了在量表和小插曲中处理提供者专业性/能力的重要性。内部一致性的可靠性范围从=0.85的可行性=0.91的适当性。所有量表的测试-静息信度都是可接受的（rho：0.61-0.79）。所有规模表现出实质性和显着差异的平均分数小插曲分配（OR：2.21-5.6）和整体评级（OR：5.1-14.47），支持标准validity.ConclusionsThis研究是一种创新的混合方法的方法来测试在美国以外的环境中实施科学措施。结果支持乌克兰消费者大多数量表的可靠性和有效性。挑战包括由于参与者难以回答有关假设计划的问题而导致的大量数据缺失。
BackgroundThere is mounting evidence supporting the effectiveness of task-shifted mental health interventions in low- and middle-income countries (LMIC). However, there has been limited systematic scale-up or sustainability of these programs, indicating a need to study implementation. One barrier to progress is a lack of locally relevant and valid implementation measures. We adapted an existing brief dissemination and implementation (D&I) measure which includes scales for acceptability, appropriateness, feasibility and accessibility for local use and studied its validity and reliability among a sample of consumers in Ukraine.MethodsLocal qualitative data informed adaptation of the measure and development of vignettes to test the reliability and validity. Participants were veterans and internally displaced persons (IDPs) recruited as part of a separate validity study of adapted mental health instruments. We examined internal consistency reliability, test-retest reliability, and construct and criterion validity for each scale on the measure. We randomly assigned half the participants to respond to a vignette depicting existing local psychiatric services which we knew were not well regarded, while the other half was randomized to a vignette describing a potentially more well-implemented mental health service. Criterion validity was assessed by comparing scores on each scale by vignette and by overall summary ratings of the programs described in the vignettes.ResultsN=169 participated in the qualitative study and N=153 participated in the validity study. Qualitative findings suggested the addition of several items to the measure and indicated the importance of addressing professionalism/competency of providers in both the scales and the vignettes. Internal consistency reliabilities ranged from =0.85 for feasibility to =0.91 for appropriateness. Test-rest reliabilities were acceptable to good for all scales (rho: 0.61-0.79). All scales demonstrated substantial and significant differences in average scores by vignette assignment (ORs: 2.21-5.6) and overall ratings (ORs: 5.1-14.47), supporting criterion validity.ConclusionsThis study represents an innovative mixed-methods approach to testing an implementation science measure in contexts outside the United States. Results support the reliability and validity of most scales for consumers in Ukraine. Challenges included large amounts of missing data due to participants' difficulties responding to questions about a hypothetical program.