Identifying the health systems changes necessary to sustain and scale up the integration of mental health services into primary care in Lagos, Nigeria

确定尼日利亚拉各斯维持和扩大将精神卫生服务纳入初级保健所需的卫生系统变革

• 批准号: MR/T021845/1
• 负责人: Abiodun Adewuya
• 金额: $ 24.81万
• 依托单位: Lagos State University
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2020
• 资助国家: 英国
• 起止时间: 2020 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FT021845%2F1
• 关键词: Identifying; health; systems; changes; necessary

STATEMENT OF THE PROBLEM: Despite the huge burden of mental health problems, about 85% of people with severe mental illness in sub-Saharan Africa (SSA) do not receive any form of treatment. Integrating mental health services into primary health care (PHC) has been advocated as the most viable means of closing this treatment gap. The linear model of intervention development, efficacy testing and implementation led to problems with sustainability over time and in real world setting. As there are policy and ethical implications of developing effective heath programmes without sustainability and scale-up, an understanding of the factors and processes that influences sustainability and scale up of an evidence-based intervention is needed for proactive planning OVERALL AIM: This feasibility study aims to identify the strategies to facilitate the health system changes necessary to sustain and scale up mental health services in primary care in Lagos, Nigeria. SPECIFIC QUESTIONS TO BE ADRESSED BY THE PROJECT 1) what is the state of implementation of the MeHPriC Project and what are the factors that are currently underlying its implementation?; 2) What are the dynamic interactions between the different components of the programme as regards contexts (inner and outer), implementation processes, implementation actors and intervention outputs and outcomes?; 3) How do these components influence the sustainability of the programme; and 4) What strategies may be required to facilitate the changes necessary for sustainability and scale-upMETHODOLOGY There are 5 phases of the study. 1. In Phase 1, We will review policy documents and conduct in-depth interviews with selected policy makers to develop hypotheses, assess whether the target indicators for the project are met, identify how they are met, identify the key contextual facilitators and constraints and the way they affect the outcome. 2. In Phase 2, we will conduct a quantitative survey amongst the stakeholders including policy makers and administrators, programme managers, PHC health workers and recipients of care. They will complete scales to assess organisational readiness to change, sustainability and perceived intervention acceptability and feasibility 3. In Phase 3, we will conduct a brief evaluation of the implementation and through in-depth interviews, we will examine the stakeholders' perception about the health systems constraints to delivering, scaling up and sustaining the intervention. We will also observe selected PHC facilities to enable us to understand the factors that act as facilitators or barriers to sustenance of the intervention delivery. 4. In Phase 4, we will conduct a Theory of Change (ToC) workshop that will draw mainly on the results from the analysis of the earlier phases in combination with scientific knowledge and programme experience to identify health system changes that will improve sustainability in the delivery of the intervention.5. In Phase 5, we will analysis and present the project report to the funders and the stakeholders RESEARCH IMPACT:1. The individual care recipients will benefit from sustained level of evidence-based interventions leading to better outcomes and improved quality of life. 2. This study will enhance the health workers knowledge, motivation and attitude in providing effective mental health interventions in a sustainable way. 3. The programme implementers will be able to identify and include sustainability components to their design and implementation of complex interventions. 4. Evidence generated in this study will be shared with the WHO team to inform potential strategies for a sustainability and scalability of mental health interventions in LMICs. 5. The project will inform Policy makers on methods of sustaining beneficial interventions thereby maximizing the judicious use of funds

问题概述：尽管精神健康问题负担沉重，但撒哈拉以南非洲地区约85%的严重精神疾病患者没有接受任何形式的治疗。将精神卫生服务纳入初级卫生保健（PHC）一直被提倡为缩小这一治疗差距的最可行手段。干预措施开发、有效性测试和实施的线性模型导致了随着时间和现实世界环境的可持续性问题。由于制定有效的卫生规划存在政策和伦理问题，而缺乏可持续性和扩大规模，因此需要了解影响循证干预的可持续性和扩大规模的因素和过程，以便进行积极规划。总体目标：本可行性研究旨在确定促进卫生系统变革的战略，以维持和扩大尼日利亚拉各斯初级保健中的精神卫生服务。项目需要解决的具体问题1)mehprice项目的实施情况如何，目前实施的基础因素是什么？2)在环境（内部和外部）、实施过程、实施参与者和干预产出和结果方面，方案的不同组成部分之间的动态相互作用是什么？3)这些组成部分如何影响方案的可持续性；4)需要什么策略来促进可持续性和规模扩大所必需的变化。1. 在第一阶段，我们将审查政策文件，并与选定的政策制定者进行深入访谈，以制定假设，评估项目的目标指标是否得到满足，确定如何实现这些指标，确定关键的背景因素和制约因素以及它们影响结果的方式。2. 在第二阶段，我们将对包括决策者和行政人员、规划管理人员、初级保健工作者和护理接受者在内的利益攸关方进行定量调查。他们将完成评估组织变革的准备程度、可持续性和感知干预的可接受性和可行性的量表。在第三阶段，我们将对实施情况进行简要评估，并通过深入访谈，审查利益攸关方对卫生系统在提供、扩大和维持干预措施方面的制约因素的看法。我们还将观察选定的初级保健设施，使我们能够了解促进或阻碍维持干预措施提供的因素。4. 在第四阶段，我们将开展一个变革理论（ToC）讲习班，该讲习班将主要利用对早期阶段的分析结果，结合科学知识和规划经验，以确定将提高干预措施交付可持续性的卫生系统变化。在第五阶段，我们将分析并向资助者和利益相关者提交项目报告。个体护理接受者将受益于持续水平的循证干预措施，从而获得更好的结果和改善的生活质量。2. 本研究将提高卫生工作者的知识、动机和态度，以可持续的方式提供有效的精神卫生干预。3. 方案执行者将能够在其复杂干预措施的设计和执行中确定并包括可持续性组成部分。4. 本研究产生的证据将与世卫组织小组分享，以便为中低收入国家精神卫生干预措施的可持续性和可扩展性的潜在战略提供信息。5. 该项目将使决策者了解维持有益干预措施的方法，从而最大限度地明智地使用资金

项目成果

Predicting the risk of future depression among school-attending adolescents in Nigeria using a model developed in Brazil.

• DOI: 10.1016/j.psychres.2020.113511
• 发表时间: 2020-12
• 期刊: Psychiatry research
• 影响因子: 11.3
• 作者: Brathwaite R;Rocha TB;Kieling C;Kohrt BA;Mondelli V;Adewuya AO;Fisher HL
• 通讯作者: Fisher HL

Epidemiology of depression in primary care: Findings from the Mental Health in Primary Care (MeHPriC) project, Lagos, Nigeria.

初级保健中抑郁症的流行病学：初级保健中的心理健康 (MeHPriC) 项目的调查结果，尼日利亚拉各斯。

• DOI: 10.1177/0091217421996089
• 发表时间: 2022
• 期刊: International journal of psychiatry in medicine
• 影响因子: 2
• 作者: Adewuya AO