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

项目摘要 该项目将探索初级卫生保健提供者(PCP)的知识、态度、精神障碍 治疗实践(KAP)，以及扩大心理健康的实施环境--基于证据 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- 终生精神障碍的经历。最常见的是抑郁、焦虑和药物使用。 紊乱，这往往是并存的。乌克兰的自杀死亡率高于美国和大多数国家 东欧国家。这导致了欧洲地区国家健康状况最差的国家之一， 高发病率、高死亡率和高致残率。由于苏联的遗产和无效的方法在 独立，乌克兰精神卫生服务的障碍包括历史和文化上的负面影响 心理健康服务的内涵，目前缺乏循证的医疗心理健康培训 医疗服务提供者和孤立的护理服务系统。在心理健康滞后和初选成功的背景下 医疗保健改革，初级保健医生，在给予技能和资源的情况下，可以利用循证提供精神健康服务 同时解决几种常见障碍并大幅减少精神障碍的方法 健康治疗差距。这五年来，混合方法的顺序解释研究在实用性、健壮性内 实施和可持续发展模式(PRISM)包括以下具体目标：1)审查 乌克兰初级卫生保健人员对常见精神障碍的知识、态度和治疗做法；2) 评估共同要素治疗的可接受性、适当性、可行性、采用率和成本 3)探讨利益攸关方对执行情况的看法 以初级保健为基础的精神卫生服务提供的可持续性基础设施。首先，我会 与乌克兰国家医疗服务机构(NHSU)合作，NHSU是国家医疗保健的国家采购实体 确保方案，以创建初级卫生保健方案的抽样框架并分发KAP(目标N=800)(目标1)。 第二，我将与心理健康和心理社会支持中心(CMHPS)合作，评估 在CETA(N=50)(目标2)培训的初级卫生保健方案中取得的执行结果。第三，基于以下研究结果 目标1和2，我将与利益相关者(N=40-50)进行协商一致的小组讨论，以了解不同的观点， 它们之间的相互作用，并制定在基层扩大精神卫生服务的实施战略 医疗保健(目标3)。该提案利用了与NHSU的合作伙伴关系，并建立在之前CETA的基础上 由CMHPS和约翰霍普金斯大学彭博公共卫生学院(JHBSPH)在乌克兰进行的研究。 这项研究将为乌克兰增加获得精神卫生服务提供关键证据，这是必要的 这是改善该国健康状况的组成部分。它将为以下方面的实施战略提供证据 在世界范围内扩大和维持以精神健康为基础的循证方法。

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.