Combining mHealth and nurse-delivered care to improve the outcomes of people with seriousmental illness in West Africa

项目总结 在世界范围内，严重的精神疾病(SMI)，如精神分裂症或双相情感障碍是 损害和残疾。在西非，SMI的苦难因普遍存在的社会耻辱而雪上加霜， 缺乏治疗选择、系统性排斥、忽视和滥用。西非的SMI患者描述说 这种经历就像是“被判死刑”。西非的精神卫生保健系统已经严重 有限的资源造成了巨大的治疗缺口。大多数患有SMI的人都会从 不提供高质量护理的传统和信仰治疗师。治疗师经常使用诸如链条之类的做法， 隐居和强制禁食，这往往会加剧SMI的负面影响。考虑到熟练工人的短缺 心理健康提供者和治疗师的普及率，再加上治疗师已经建立的基础设施 现有的(例如，转诊网络、“祈祷营”、社区联系)全球卫生领导人认为 治疗师和祈祷营的设置可以被用作治疗的渠道，前提是他们得到 适当的培训和支持，以提供更高质量的护理。我们的跨国研究团队已经开发出 M&M：由流动健康计划组成的双管齐下的干预方案，旨在培训治疗师 提供循证心理社会干预，同时在实践中维护安全和患者尊严(M- 治疗师)与药物治疗相结合，通过探访直接提供给祈祷营的患者 护士(流动护士)。我们已经成功地完成了可用性、可接受性、可行性和初步 在祈祷营地对干预的模块要素进行了临床测试，取得了非常有希望的结果。我们 现在建议在全面试验和分享中评估综合M&M干预的有效性 它通过一个新的西非数字精神健康联盟(WADMA)广泛开展，这是一个以使命为中心的网络 旨在通过赠款资助启动数字心理健康研究和跨机构合作 研究、教育和整合临床实践中的数字心理健康工具。我们的目标是：1.评估 阶梯-楔形整群随机试验设计对M&M干预效果的影响 M&M干预效果的中介者和调解者；3.使用定性方法告知M&M 干预的优化和未来的实施。尽管专注于西非，但双管齐下的模式 我们正在进行测试，以满足护理质量需求、我们将衡量的结果以及方法 我们将吸取的经验教训都将对发展和实施一体化 为护理美国SMI患者的辅助专业人员提供的技术辅助治疗支持包 各州。

PROJECT SUMMARY Worldwide, serious mental illnesses (SMI) such as schizophrenia or bipolar disorder are major causes of impairment and disability. In West Africa, the hardships of SMI are compounded by pervasive societal stigma, scarce treatment options, systematic exclusion, neglect, and abuse. People with SMI in West Africa describe the experience as akin to “receiving a death sentence.” West African mental healthcare systems have severely constrained resources that contribute to a large treatment gap. Most people with SMI receive services from traditional and faith healers who do not provide high quality care. Healers often use practices such as chaining, seclusion, and forced fasting that often worsen the negative impacts of SMI. Given the shortage of skilled mental health providers and the prevalence of healers, coupled with the established infrastructure healers have in place (e.g., referral networks, “prayer camps”, community ties) global health leaders have argued that healers and prayer camp settings may be leveraged as conduits for treatment, provided they receive appropriate training and support to provide higher quality care. Our multinational research team has developed M&M: a dual-pronged intervention package comprised of a mobile health program designed to train healers to deliver evidence-based psychosocial interventions while maintaining safety and patient dignity in practice (M- Healer) combined with pharmacotherapy delivered directly to the patients at their prayer camps via visiting nurse (Mobile Nurse). We have successfully completed usability, acceptability, feasibility and preliminary clinical testing of the modular elements of the intervention at prayer camps, with very promising results. We now propose to evaluate the effectiveness of the integrated M&M intervention in a fully-powered trial and share it widely through a new West African Digital Mental Health Alliance (WADMA), a mission centered network designed to jumpstart digital mental health research and cross institutional collaboration though grant funded studies, education, and integration of digital mental health tools in clinical practice. We aim to: 1. Evaluate the effectiveness of the M&M intervention using a stepped-wedge cluster randomized trial design; 2. Examine mediators and moderators of M&M intervention effects; and 3. Use qualitative methods to inform M&M intervention optimization and future implementation. Although focused on West Africa, the dual-pronged model we are testing to address quality of care needs, the outcomes we will measure, and the methodological lessons we will learn will all have translational implications for development and implementation of integrated technology-assisted treatment support packages for paraprofessionals caring for people with SMI in the United States.