Development of an Implementation Facilitation Strategy to Link Mental Health Screening and eHealth Intervention for Clients in Ryan White-Funded Clinics in Chicago.
Development of an Implementation Facilitation Strategy to Link Mental Health Screening and eHealth Intervention for Clients in Ryan White-Funded Clinics in Chicago.
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制定一项实施促进战略，将芝加哥瑞安·怀特资助的诊所的客户的精神健康筛查和电子健康干预联系起来。
DOI：
10.1097/qai.0000000000002980
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发表时间：
2022-07-01
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为了减少抑郁症对PLWH的影响，我们正在实施基于诊所的行为健康筛查和转介到兰花(通过互联网传递优化韧性和应对艾滋病毒)，这是一种基于证据的干预措施。我们使用实施研究综合框架(CFIR)在实施之前确定背景障碍和促进者。16个芝加哥地区瑞安·怀特医疗病例管理(RWMCM)网站。我们与医学病例管理人员和主管进行了一项序贯混合方法研究。参与者完成了一项评估CFIR域名的在线调查，得分从1(强烈不同意)到5(强烈同意)。调查结果提供了有目的的抽样框架和访谈程序。访谈采用快速定性分析进行分析。平均而言，58名受访者(n=58)对团队文化、学习氛围和实施准备情况略有赞同(ms=3.80-3.87)。潜在的障碍包括干预的复杂性(M=3.47)、所需的人力资源(MS=2.71-3.33)以及与现有筛查/转诊系统相比的相对优势(MS=3.09-3.71)。定性结果(n=15)发现，拥有强大的行为健康系统的诊所优势不大，但没有这些服务的诊所优势很大。答复者确定了促进执行的全系统培训和监测战略。RWMCM地点通常是实施干预措施的有利环境。如实施研究逻辑模型所示，障碍将通过部署拟议的影响临床和个人一级结果的战略来解决，包括电子提示(降低复杂性)、作为其他行为健康服务的补充的兰花培训(增加相对优势)以及实施期间的反馈(加强奖励/激励)。
To reduce the impact of depression on PLWH, we are implementing a clinic-based behavioral health screener and referral to ORCHID (Optimizing Resilience and Coping with HIV through Internet Delivery), an evidenced-based intervention. We used the Consolidated Framework for Implementation Research (CFIR) to identify contextual barriers and facilitators in advance of implementation. 16 Chicagoland area Ryan White Medical Case Management (RWMCM) sites. We conducted a sequential mixed-methods study with medical case managers and supervisors. Participants completed an online survey assessing CFIR domains, scored on a 1 (strongly disagree) to 5 (strongly agree) scale. Survey results informed a purposive sampling frame and interview protocol. Interviews were analyzed by rapid qualitative analysis. On average, survey respondents (n=58) slightly agreed with positive views of team culture, learning climate, and implementation readiness (Ms=3.80–3.87). Potential barriers included intervention complexity (M=3.47), needed human resources (Ms=2.71–3.33), and only slight agreement with relative advantage over existing screening/referral systems (Ms=3.09–3.71). Qualitative results (n=15) identified low advantage for clinics with robust behavioral health systems but strong advantage in clinics without these services. Respondents identified system-wide training and monitoring strategies to facilitate implementation. RWMCM sites are a generally favorable context for implementation of the interventions. As illustrated in an implementation research logic model, barriers will be addressed through deploying strategies proposed to impact clinic-and individual-level outcomes, including electronic prompts (reduce complexity), training on ORCHID as a complement to other behavioral health services (increase relative advantage), and feedback during implementation (strengthen rewards/incentives).