A mixed-methods sequential explanatory study to examine the implementation landscape for evidence-based transdiagnostic approaches for mental disorders in primary healthcare in Ukraine.

一项混合方法序贯解释性研究，旨在检验乌克兰初级医疗保健中精神障碍循证跨诊断方法的实施情况。

• 批准号: 10295238
• 负责人: Alona Mazhnaia
• 金额: $ 8.91万
• 依托单位: KYEVO-MOGYLYANSKA AKADEMIYA, NATSIONALNY UNIVERSYTET
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-25 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10295238
• 关键词: Address; Adopted; Adoption; Advocacy; Alcohols; Anxiety; Attitude; Behavioral; Caring; Characteristics; Cognitive; Communities; Consensus; Cost Analysis; Country; Data; Disease; Education; Effectiveness; Elements; European; Gatekeeping; Group Interviews; Health; Health Care Reform; Health Knowledge, Attitudes, Practice; Health Personnel; Health Policy; Health Services Accessibility; Health system; Healthcare; Healthcare Systems; Human Resources; Infrastructure; International; Knowledge; Medical; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Methods; Morbidity - disease rate; National Health Services; National Institute of Mental Health; Nurses; Opioid; Patient Rights; Perception; Population; Positioning Attribute; Practical, Robust Implementation and Sustainability Model; Primary Health Care; Provider; Psychiatric therapeutic procedure; Psychosocial Assessment and Care; Public Health; Public Health Schools; Research; Resources; Sampling; Service provision; Services; Substance Use Disorder; Surveys; System; Training; Trauma; Ukraine; Veterans; Waiting Lists; anxiety management; base; care delivery; community setting; comorbidity; coping; cost; disability; displaced person; evidence base; experience; health service use; health training; implementation determinants; implementation outcomes; implementation strategy; implementation study; improved; low and middle-income countries; medical specialties; mental health center; mortality; post intervention; prevent; programs; response; scale up; service delivery; skills; suicide mortality

Project Summary This project will explore primary healthcare providers (PHCPs) knowledge, attitudes, mental disorders treatment practices (KAP), and implementation landscape for scaling-up mental health evidence-based transdiagnostic treatment approaches in Ukraine. An estimated third of people in Ukraine have at least one- lifetime experience of mental disorder. The most common are depression, anxiety, and substance use disorder, which are frequently comorbid. Ukraine's suicide mortality rate is higher than in the U.S. and most Eastern European countries. These contribute to one of the worst European region country health profiles, with high morbidity, mortality, and disability rates. Due to the Soviet legacies and ineffective approaches during independence, barriers to Ukraine's mental health services include historical and cultural negative connotations of mental health services, lack of current evidence-based mental health training for healthcare providers, and siloed care delivery systems. In the context of lagging mental health and successful primary healthcare reform, PHCPs, given skills and resources, can offer mental health services using evidence-based approaches simultaneously addressing several common disorders and substantially decrease the mental health treatment gap. This five years mixed-methods sequential explanatory study within the Practical, Robust Implementation and Sustainability Model (PRISM) include the following Specific Aims: 1)To examine knowledge, attitudes, and treatment practices for common mental disorders among PHCPs in Ukraine; 2) To assess acceptability, appropriateness, feasibility, adoption, and cost of Common Elements Treatment Approach (CETA) when implemented by PHCPs; 3) To explore stakeholders' perceptions of implementation and sustainability infrastructure for primary healthcare-based mental health services provision. First, I will partner with the National Health Service in Ukraine (NHSU), a national purchasing entity for state medical guarantees program, to create a sampling frame of PHCPs and distribute the KAP (target N=800) (Aim 1). Second, in partnership with the Center for Mental Health and Psychosocial Support (CMHPS), I will assess implementation outcomes among PHCPs trained in CETA (N=50) (Aim 2). Third, based on the findings from Aim 1 & 2, I will conduct consensus panels with stakeholders (N=40-50) to understand different perspectives, their interactions and develop implementation strategies for mental health services scale-up within primary healthcare (Aim 3). This proposal leverages a partnership with the NHSU and builds on previous CETA research in Ukraine conducted by CMHPS and Johns Hopkins Bloomberg School of Public Health (JHBSPH). This study will yield critical evidence for increasing access to mental health services in Ukraine, a necessary component of improving the country's health profile. It will generate evidence for implementation strategies for scaling-up and sustaining mental health evidence-based approaches within primary healthcare worldwide.

项目摘要 本项目将探讨初级保健提供者（PHCP）的知识，态度，精神障碍， 治疗实践（KAP）和实施前景，以扩大基于证据的精神卫生 乌克兰的跨诊断治疗方法。据估计，乌克兰三分之一的人至少有一个- 精神障碍的终生经历。最常见的是抑郁、焦虑和物质使用 常与之共病。乌克兰的自杀死亡率高于美国， 东欧国家。这些导致了欧洲地区国家健康状况最差的国家之一， 高发病率、死亡率和残疾率。由于苏联的遗产和无效的方法， 独立，乌克兰精神卫生服务的障碍包括历史和文化的负面影响， 精神卫生服务的内涵，目前缺乏基于证据的精神卫生培训， 提供者和孤立的护理提供系统。在落后的心理健康和成功的小学背景下， 医疗保健改革，PHCP，给予技能和资源，可以提供精神卫生服务， 同时解决几种常见疾病的方法，并大大减少了精神疾病的发生。 医疗差距。这五年的混合方法序贯解释性研究， 实施和可持续性模型（PRISM）包括以下具体目标：1）检查 乌克兰PHCP对常见精神障碍的认识、态度和治疗实践; 2） 评估共同要素治疗的可接受性、适当性、可行性、采用性和成本 方法（CETA）由PHCP实施时; 3）探索利益相关者对实施的看法 提供基于初级保健的精神卫生服务的可持续性基础设施。首先我会 与乌克兰国家卫生服务局（NHSU）合作，NHSU是国家医疗采购实体， 保证程序，以创建PHCP的采样帧并分发KAP（目标N=800）（目标1）。 第二，与心理健康和心理社会支持中心（CMHPS）合作，我将评估 在接受CETA培训的PHCP中的实施成果（N=50）（目标2）。第三，根据调查结果， 目标1和2，我将与利益相关者（N=40-50）进行共识小组讨论，以了解不同的观点， 它们之间的相互作用，并制定在小学内扩大精神卫生服务的实施战略 保健（目标3）。该提案利用了与NHSU的伙伴关系，并以之前的CETA为基础 CMHPS和约翰霍普金斯彭博公共卫生学院（JHBSPH）在乌克兰进行的研究。 这项研究将为增加乌克兰获得精神卫生服务的机会提供关键证据，这是一项必要的研究。 这是改善国家健康状况的一部分。它将为实施战略提供证据， 在全球初级保健中扩大和维持基于证据的精神卫生方法。