Reducing mental illness stigma in healthcare settings: Proof of concept for a social contact intervention to address what matters most for primary care providers
Reducing mental illness stigma in healthcare settings: Proof of concept for a social contact intervention to address what matters most for primary care providers
复制标题
DOI：
10.1016/j.socscimed.2020.112852
复制
发表时间：
2020-04-01
影响因子：
5.4
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.;Jordans, Mark J. D.
通过世界卫生组织的心理健康差距行动计划（mhGAP）和相关努力，将心理健康服务纳入初级保健的举措正在进行中。然而，初级保健提供者对精神病患者的污名化是这些方案取得成功的一个障碍。因此，需要采取干预措施，以减少初级卫生保健提供者的耻辱感。我们开发了减少健康提供者之间的污名（RESHAPE），这是一种基于理论的干预措施，借鉴了医学人类学的概念框架“什么最重要”。“RESHAPE解决了三个领域的威胁，最重要的是：生存，社会和专业。在一项概念验证研究中，心理健康服务用户和有抱负的医疗保健提供者（积极纳入心理健康服务的初级医疗保健提供者）接受了培训，以共同促进尼泊尔mhGAP培训中嵌入的RESHAPE干预。在尼泊尔为41名初级保健提供者举办了两次关于RESHAPE反污名化内容的培训。培训评估包括四个焦点小组和25个关键线人访谈。在培训前和4个月和16个月的随访中，对使用常见治疗因素增强评估工具（ENACT）评估的污名化态度和基于角色扮演的临床能力进行了评估。该研究于2016年2月至2017年6月进行。在定性访谈中，初级保健提供者描述了暴力观念（生存威胁）和有效治疗精神疾病（专业威胁）的能力的变化。与精神疾病患者互动的意愿从培训前的54%增加到16个月时的81%。观察到的临床能力从培训前的49%增加到16个月时的93%。这项概念验证研究支持通过解决对医疗保健提供者最重要的问题来减少耻辱感，主要是通过减轻生存和专业威胁。需要作出更多努力来应对社会威胁。这些研究结果支持进一步探索服务用户和理想人物参与mhGAP培训的基础上，“什么是最重要的”概念框架
Initiatives for integration of mental health services into primary care are underway through the World Health Organization's mental health Gap Action Programme (mhGAP) and related endeavors. However, primary healthcare providers' stigma against persons with mental illness is a barrier to success of these programs. Therefore, interventions are needed to reduce stigma among primary healthcare providers. We developed REducing Stigma among HealthcAre ProvidErs (RESHAPE), a theoretically-grounded intervention that draws upon the medical anthropology conceptual framework of "what matters most." RESHAPE addresses three domains of threats to what matters most: survival, social, and professional. In a proof-of-concept study, mental health service users and aspirational healthcare providers (primary healthcare providers actively incorporating mental health services) were trained to co-facilitate the RESHAPE intervention embedded within mhGAP training in Nepal. Two trainings with the RESHAPE anti-stigma component were held with 41 primary healthcare providers in Nepal. Evaluation of the training included four focus groups and 25 key informant interviews. Stigmatizing attitudes and role play-based clinical competency, assessed with the ENhancing Assessment of Common Therapeutic factors tool (ENACT), were evaluated pre-training and followed-up at four and 16 months. The study was conducted from February 2016 through June 2017. In qualitative interviews, primary healthcare providers described changes in perceptions of violence (survival threats) and the ability to treat mental illness effectively (professional threats). Willingness to interact with a person with mental illness increased from 54% pre-training to 81% at 16 months. Observed clinical competency increased from 49% pretraining to 93% at 16-months. This proof-of-concept study supports reducing stigma by addressing what matters most to healthcare providers, predominantly through mitigating survival and professional threats. Additional efforts are needed to address social threats. These findings support further exploration of service user and aspirational figure involvement in mhGAP trainings based on a "what matters most" conceptual framework