Aligning facility leadership and climate to advance mental health services integration in Malawi

摘要 任务分担的心理健康干预措施在低收入和中等收入国家是有效的，但它们仍然存在。 未得到充分利用，心理健康治疗差距仍然很大。创新的执行战略 成功地将循证心理健康治疗纳入中低收入国家的医疗保健。 许多执行工作的一个共同组成部分是“倡导者”战略， 授权一名现场工作人员作为实施倡导者，负责集中其 同事在推行循证治疗模式方面的努力。然而，越来越多的研究， 包括我们自己在马拉维和其他地方的工作，强调了冠军的成功受到强烈影响， 通过他们的直线经理和其他链上组织领导的支持，谁是关键的力量， 协调本组织的环境和优先事项，以支持执行工作。 影响领导参与以改变组织氛围和调整优先事项的方法 在组织和工业心理学领域已经发展了几十年，但只是相对而言， 最近应用于实施科学健康研究，主要用于高收入国家的实施 国家领导力和组织变革的实施（LOCI）是最近开发的 多层次的领导力辅导实施战略，已证明在改变 组织氛围，调整优先事项，并加强美国精神卫生治疗模式的整合 挪威和挪威，但尚未在低收入国家环境中进行调整或测试。LOCI具有显著的 有可能通过调整领导优先事项来解决我们目前研究中发现的差距，以支持 促进心理健康整合的冠军。 本提案的目的是测试补充标准的影响和可持续性 支持实施方法与LOCI领导调整战略，以实现成功 将以证据为基础的、任务分担的精神健康治疗模式纳入一般医疗保健。我们 将使用随机分组试验来评估适应性领导调整策略对以下方面的影响： 将循证心理健康治疗方案整合到多种医疗护理环境中（NCD， 艾滋病毒和结核病护理），评估近端（气候），主要实施（采用，覆盖范围，忠诚度）， 下游患者心理健康、成本效益结果以及结束后的可持续性 领导力调整活动。此外，我们将利用研究项目的结构进一步 加强马拉维心理健康研究人员和决策者的能力。 领导力调整策略是成功的心理健康的一个未充分研究但必不可少的因素 融合的努力。这个项目将对我们理解领导的作用作出重大贡献 在LMIC中推进基于证据的心理健康整合。

ABSTRACT Task-shared mental health interventions are effective in low- and middle-income countries, yet they remain underutilized and the mental health treatment gap remains substantial. Innovative implementation strategies are needed to successfully integrate evidence-based mental health treatments into medical care in LMICs. A common component of many implementation efforts is a “champion” strategy which identifies and empowers an on-the-ground staff member as the implementation champion, in charge of focusing their colleagues’ efforts on implementation of the evidence-based treatment model. Yet a growing body of research, including our own work in Malawi and elsewhere, highlights that the champion’s success is strongly influenced by the strength of support from their line manager and other up-the-chain organization leaders, who are critical in aligning the organization’s climate and priorities in support of the implementation effort. Approaches to influencing leadership engagement to change organizational climate and align priorities has been developed over decades in the field of organizational and industrial psychology but only relatively recently applied to implementation science health research and primarily to implementation in high-income countries. The Leadership and Organizational Change for Implementation (LOCI) is a recently developed multi-level leadership coaching implementation strategy that has demonstrated effectiveness in changing organizational climate, aligning priorities, and enhancing mental health treatment model integration in the US and Norway, but has not been adapted to or tested in low-income country settings. LOCI has significant potential to address the gaps identified in our current research by aligning leadership priorities to support champions in advancing mental health integration. The objective of the present proposal is to test the impact and sustainability of supplementing the standard champion implementation approach with the LOCI leadership alignment strategy to achieve successful integration of an evidence-based, task-shared mental health treatment model into general medical care. We will use a cluster-randomized trial to evaluate the impact of the adapted leadership alignment strategy on integration of an evidence-based mental health treatment package into multiple medical care settings (NCD, HIV, and TB care), assessing proximal (climate), primary implementation (adoption, reach, fidelity), downstream patient mental health, and cost-effectiveness outcomes as well as sustainability after conclusion of the leadership alignment activities. Additionally, we will use the structure of the research project to further strengthen capacity among mental health researchers and policy makers in Malawi. Leadership alignment strategies are an understudied but essential ingredient for successful mental health integration efforts. This project will make a major contribution to our understanding of the role of leadership alignment in advancing evidence-based mental health integration in LMICs.