Factors promoting and inhibiting sustained impact of a mental health task-shifting program for HIV providers in Ethiopia.
Factors promoting and inhibiting sustained impact of a mental health task-shifting program for HIV providers in Ethiopia.
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DOI：
10.1017/gmh.2017.21
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Wissow L
中科院分区：
文献类型：
--
作者：
Jerene D;Biru M;Teklu A;Rehman T;Ruff A;Wissow L
将心理健康任务转移到一般医疗保健需要的不仅仅是简短的提供者培训。通才需要长期的支持，以掌握新的技能，并需要改变工作环境，以维持在面对竞争的优先事项的变化。我们研究了促进埃塞俄比亚医院艾滋病提供者心理健康任务转移培训可持续性的计划和背景因素。收敛混合方法的准实验研究。持续影响的衡量标准是，在正式支助结束后16个月，经过培训的/未经培训的提供者在病例发现和管理方面的差异。与可持续性有关的因素进行了审查，通过与训练有素的供应商的访谈。持续影响的程度：经过培训的提供者表现出与标准化筛查者的适度但更好的一致性（更高的灵敏度，相似的特异性）。他们更有可能要求有精神健康问题的病人回来看他们，而不是转诊。促进可持续性的因素（在半结构化访谈中报告）：提供者相信他们学到的治疗方法是有效的。与现场精神卫生工作人员的新互动是持续学习和鼓励的来源。影响可持续性的因素：提供者感到孤立时，心理健康的合作伙伴离开工作在其他地方，未能将心理健康指标纳入行政数据，重新储备工作人员的教育材料，并建立正式的机制，一般心理健康工作人员的互动。一项被视为可行和有效的干预措施以及促进跨专业关系，有助于通才保持新的技能。由于未能解决关键的系统背景问题，随着外部支助的结束，这些技能的使用无法持续。
Task-shifting mental health into general medical care requires more than brief provider training. Generalists need long-term support to master new skills and changes to work context are required to sustain change in the face of competing priorities. We examined program and context factors promoting sustainability of a mental health task-shifting training for hospital-based HIV providers in Ethiopia. Convergent mixed-methods quasi-experimental study. Sustained impact was measured by trained/not-trained provider differences in case detection and management 16 months following the end of formal support. Factors related to sustainability were examined through interviews with trained providers. Extent of sustained impact: Trained providers demonstrated modest but better agreement with standardized screeners (greater sensitivity with similar specificity). They were more likely to request that patients with mental health problems return to see them v. making a referral. Factors promoting sustainability (reported in semi-structured interviews): provider belief that the treatments they had learned were effective. New interactions with on-site mental health staff were a source of ongoing learning and encouragement. Factors diminishing sustainability: providers feelings of isolation when mental health partners left for work elsewhere, failure to incorporate mental health indicators into administrative data, to re-stock staff education materials, and to build formal mechanisms for generalist-mental health staff interaction. An intervention seen as feasible and effective, and promotion of relationships across professional lines, helped generalists sustain new skills. Failure to address key system context issues made use of the skills unsustainable as external supports ended.
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影响因子：
9.7
作者：
Straus, John H.;Sarvet, Barry
通讯作者：
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影响因子：
3.1
作者：
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影响因子：
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作者：
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通讯作者：
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DOI：
10.1186/1748-5908-7-17
发表时间：
2012-03-14
期刊：
Implementation science : IS
影响因子：
--
作者：
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通讯作者：
Charns M
影响因子：
7
作者：
Gadomski, Anne M.;Wissow, Lawrence S.;Kaye, David L.
通讯作者：
Kaye, David L.