Improving integrated depression and non-communicable disease care in Malawi through engaged leadership and supportive implementation climate.
Improving integrated depression and non-communicable disease care in Malawi through engaged leadership and supportive implementation climate.
复制标题
通过参与式领导和支持性实施环境，改善马拉维的抑郁症和非传染性疾病综合护理。
DOI：
10.1186/s12913-023-10344-7
复制
发表时间：
2023-12-14
影响因子：
2.8
通讯作者：
Stockton, Melissa A.
中科院分区：
文献类型：
--
作者：
Sansbury, Griffin M.;Pence, Brian W.;Zimba, Chifundo;Yanguela, Juan;Landrum, Kelsey;Matewere, Maureen;Mbota, Macdonald;Malava, Jullita K.;Tikhiwa, Harriet;Morrison, Abigail M.;Akiba, Christopher F.;Gaynes, Bradley N.;Udedi, Michael;Hosseinipour, Mina C.;Stockton, Melissa A.
关键词：
低收入和中等收入国家往往缺乏获得精神卫生服务的机会，导致人们呼吁将其纳入其他初级保健系统。在撒哈拉以南非洲地区，将抑郁症治疗纳入非传染性疾病 (NCD) 环境中是可行、可接受且有效的。然而，领导力和实施环境的挑战往往阻碍有效的整合和服务质量。本研究的目的是确定离散的领导策略，以帮助克服马拉维非传染性疾病诊所整合抑郁症护理的障碍，并了解诊所领导如何塑造实施氛围。我们对马拉维 10 家非传染性疾病诊所的地区医疗官员、非传染性疾病协调员、一名非传染性疾病提供者以及每家的研究助理进行了 39 次深度访谈（请注意，一名地区医疗官员为两家诊所提供服务）。根据半结构化访谈指南，参与者被问及关于领导力和实施氛围对克服将抑郁症护理纳入现有非传染性疾病服务的障碍的影响的看法。主题分析使用归纳和演绎方法来识别新出现的主题并比较参与者类型。结果揭示了敬业的领导如何促进积极的实施氛围，诊所提高了克服实施障碍的能力。有效的领导者平易近人，参与诊所的日常运营和解决问题。他们在干预期间直接参与和指导，为患者筛查和治疗计划咨询提供帮助。不同级别的领导层利用各自的地位和权力动态来影响提供者对干预措施的态度和看法。领导者的行动是向提供者通报干预来源，并教育他们心理保健的重要性，因为它经常被低估。最后，他们优先考虑干预措施的团队合作和集体所有权，增加提供者的责任。优先考虑领导可见性和开放沟通的培训将有助于马拉维卫生部正在进行的努力，以扩大非传染性疾病诊所内基于证据的抑郁症治疗。在广泛的外部监测可能受到限制的情况下，这被证明是有用的。最终，这些结果可以为成功的战略提供信息，以缩小实施差距，通过改善领导力和实施氛围，实现资源匮乏环境中精神卫生服务的整合。这些发现来自 ClinicalTrials.gov，NCT03711786。注册于 2018 年 10 月 18 日。 https://clinicaltrials.gov/ct2/show/NCT03711786。在线版本包含可在 10.1186/s12913-023-10344-7 获取的补充材料。
Low- and middle-income countries often lack access to mental health services, leading to calls for integration within other primary care systems. In sub-Saharan Africa, integration of depression treatment in non-communicable disease (NCD) settings is feasible, acceptable, and effective. However, leadership and implementation climate challenges often hinder effective integration and quality of services. The aim of this study was to identify discrete leadership strategies that facilitate overcoming barriers to the integration of depression care in NCD clinics in Malawi and to understand how clinic leadership shapes the implementation climate. We conducted 39 in-depth interviews with the District Medical Officer, the NCD coordinator, one NCD provider, and the research assistant from each of the ten Malawian NCD clinics (note one District Medical Officer served two clinics). Based on semi-structured interview guides, participants were asked their perspectives on the impact of leadership and implementation climate on overcoming barriers to integrating depression care into existing NCD services. Thematic analysis used both inductive and deductive approaches to identify emerging themes and compare among participant type. The results revealed how engaged leadership can fuel a positive implementation climate where clinics had heightened capacity to overcome implementation barriers. Effective leaders were approachable and engaged in daily operations of the clinic and problem-solving. They held direct involvement with and mentorship during the intervention, providing assistance in patient screening and consultation with treatment plans. Different levels of leadership utilized their respective standings and power dynamics to influence provider attitudes and perceptions surrounding the intervention. Leaders acted by informing providers about the intervention source and educating them on the importance of mental healthcare, as it was often undervalued. Lastly, they prioritized teamwork and collective ownership for the intervention, increasing provider responsibility. Training that prioritizes leadership visibility and open communication will facilitate ongoing Malawi Ministry of Health efforts to scale up evidence-based depression treatment within NCD clinics. This proves useful where extensive and external monitoring may be limited. Ultimately, these results can inform successful strategies to close implementation gaps to achieve integration of mental health services in low-resource settings through improved leadership and implementation climate. These findings are reported from ClinicalTrials.gov, NCT03711786. Registered on 18/10/2018. https://clinicaltrials.gov/ct2/show/NCT03711786. The online version contains supplementary material available at 10.1186/s12913-023-10344-7.
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DOI：
10.1186/1748-5908-4-50
发表时间：
2009-08-07
期刊：
Implementation science : IS
影响因子：
--
作者：
Damschroder LJ;Aron DC;Keith RE;Kirsh SR;Alexander JA;Lowery JC
通讯作者：
Lowery JC
DOI：
10.1176/appi.ps.202000003
发表时间：
2021-07-01
期刊：
Psychiatric services (Washington, D.C.)
影响因子：
--
作者：
Gaynes BN;Akiba CF;Hosseinipour MC;Kulisewa K;Amberbir A;Udedi M;Zimba CC;Masiye JK;Crampin M;Amarreh I;Pence BW
通讯作者：
Pence BW
影响因子：
7.2
作者：
Aarons, Gregory A.;Glisson, Charles;Landsverk, John A.
通讯作者：
Landsverk, John A.
影响因子：
4.5
作者：
Crabb J;Stewart RC;Kokota D;Masson N;Chabunya S;Krishnadas R
通讯作者：
Krishnadas R
影响因子：
7.2
作者：
Birken, Sarah A.;Lee, Shoou-Yih Daniel;Weiner, Bryan J.
通讯作者：
Weiner, Bryan J.