Reducing stigma among healthcare providers to improve mental health services (RESHAPE)

项目摘要/摘要 精神疾病的全球负担和患者数量之间仍然存在巨大差距 接受适当的治疗。为了解决低收入和中等收入国家的这一差距，一项关键战略 一直使用初级保健卫生工作者来检测和提供精神疾病的护理。《世界卫生》 该组织制定了精神健康差距行动计划(MhGAP)，以培训初级保健工作者 发现精神疾病并提供有证据的治疗。然而，迄今为止的研究表明， MhGAP的实施策略不够充分，发现率低，有多个 研究表明，只有不到10%的精神疾病患者在训练后被发现。一个 在初级保健中有效实施检测的潜在障碍是初级保健工作者中的耻辱 对精神病患者的指控。我们的初步工作表明，减少初级保健工作者的耻辱 对精神病患者的检测可能会提高对精神病的准确检测。我们开发了一个版本 MhGAP培训包括一个减少污名的部分：“减少医疗保健中的污名” 提供者“(重塑)。在重塑中，精神病患者(即精神健康服务使用者)是 接受培训，分享康复故事，进行破解神话的会议，并促进心理健康宣传。我们的 Rehape的初步研究表明，精神卫生服务使用者参与了初级培训 护理人员减少污名，减少污名可能有助于更好地发现精神疾病。我们 正在提议在尼泊尔进行一项混合实施-有效性(类型3)整群随机对照试验 将mhGAP标准实施与重塑实施策略进行比较。目标条件 会出现抑郁症、广泛性焦虑症、精神病和酒精使用障碍。在目标1中，我们将 评估重塑服务用户参与度对初级保健工作者污名的影响。在AIM 2、我们将评估重塑培训对服务的准确覆盖(即检测)和 评估污名作为准确性差异的中介。以相同的理论方法为基础 在我们的初步研究研究中，我们将与目标3开展能力建设活动，以促进 让服务用户更多地参与研究。我们还将处理反性别的行为活动- 心理健康研究职业生涯中的相关污名。这些目标的成功实现将有助于 NIMH战略计划采用实施科学来最大限度地提高研究和研究对公众健康的影响 让服务用户参与。这项研究推进了福格蒂国际中心的实施使命 科学和致力于以证据为基础的耻辱减少。我们将通过减少机构建设来建设能力 研究中的性别平等障碍。这些发现将阐明服务用户在以下方面的潜在作用 提高初级保健环境中精神疾病筛查计划的执行率和准确性。

PROJECT SUMMARY/ABSTRACT There continues to be a major gap between the global burden of mental illness and the number of patients receiving adequate treatment. To address this gap in low- and middle-income countries, a key strategy has been the use of primary care health workers to detect and deliver of care for mental illness. The World Health Organization has developed the mental health Gap Action Programme (mhGAP) to train primary care workers to detect mental illness and deliver evidence-supported treatment. However, research to date suggests that implementation strategies for mhGAP are inadequate as evidenced by low detection rates, with multiple studies demonstrating post-training detection at fewer than 10% of persons with mental illness detected. A potential barrier to effective implementation of detection in primary care is stigma among primary care workers against persons with mental illness. Our preliminary work suggests that reducing primary care workers' stigma against persons with mental illness may improve accurate detection of mental illness. We developed a version of mhGAP training that includes a stigma reduction component: “REducing Stigma among HealthcAre ProvidErs” (RESHAPE). In RESHAPE, persons with mental illness (i.e., mental health service users) are trained to share recovery stories, conduct myth-busting sessions, and promote mental health advocacy. Our preliminary studies of RESHAPE suggest that involvement of mental health service users in training primary care workers reduces stigma, and that stigma reduction may mediate improved detection of mental illness. We are proposing a hybrid implementation-effectiveness (Type-3) cluster randomized controlled trial in Nepal comparing mhGAP standard implementation with the RESHAPE implementation strategy. Target conditions will be depression, generalized anxiety, psychotic disorders, and alcohol use disorder. In Aim 1, we will evaluate the impact of the RESHAPE service user engagement on stigma among primary care workers. In Aim 2, we will evaluate the impact of the RESHAPE training on accurate reach of services (i.e., detection) and evaluate stigma as a mediator of differences in accuracy. Building on the same theoretical approaches to stigma in our primary research study, for Aim 3 we will conduct capacity building activities with to promote greater involvement of service users in research. We will also address conduct activities to counter gender- related stigma in mental health research careers. Successful completion of these aims will contribute to the NIMH Strategic Plan employing implementation science to maximize the public health impact of research and involve service users. This research advances the Fogarty International Center's mission for implementation science and commitment to evidence-based stigma reduction. We will build capacity by reducing institutional barriers to gender equity in research. These findings will shed light on the potential role of service users to improve implementation and accuracy of mental illness screening programs in primary care settings.