Validation of a Pragmatic Implementation Measure for Task Sharing in Mental Health Services

摘要 为了解决全世界心理健康专家短缺的问题， 许多低收入和中等收入国家（LMIC）、研究人员和项目实施者正在使用任务 共享战略，其中涉及将提供精神卫生保健委托给更广泛的干部， 非专业人员，如初级保健医生，社区卫生工作者，非专业志愿者和服务 用户本身（即，peers）。虽然有证据表明，心理健康战略的任务分担是 有效地改善检测和治疗一系列精神障碍，仍然缺乏关键的 了解如何在现实世界中成功实施和扩大任务分担战略。到 为了解决这一差距，拟议的研究旨在验证实施的障碍和促进因素， 心理健康任务分担（BeFITS-MH）措施，一个多维度，多利益相关者的工具，我们 开发该工具是为了系统和快速地评估核心的、可改变的障碍和促进因素。 我们开发了BeFITS-MH使用多层次的概念模型，我们来自有影响力的 实施科学框架，并分析了来自三个NIMH资助的全球“中心”的定性数据， 对文献中确定的障碍和促进因素进行系统综述。BeFITS-MH评估前景 从服务对象和服务提供者的角度分析了6个领域：1）角色匹配; 2）满意度和动机; 3）服务提供者能力; 4)情境一致性; 5）服务可及性; 6）支持系统。本研究旨在评估 BeFITS-MH在3个国家的3项正在进行的NIMH研究中的心理测量和实用特性。我们 具体目标是：目标1：通过修改后的德尔菲流程完成BeFITS-MH工具， 并试用该工具来评估初始内容有效性和实用质量（即，完成时间）。目的 2：评价BeFITS-MH工具的心理测量学性质。根据目前的心理学证据 量表的标准，我们将评估内部一致性，规范，反应，结构效度，收敛 效度、判别效度、已知组效度和预测效度。该工具将根据 三个实施成果：可接受性、适当性和可行性，以及每个成果的过程指标 研究中心在两个时间点收集数据。目标3：评估务实品质和跨国 BeFITS-MH的效用。我们将进一步了解实施科学和概念框架， TSMH策略通过探索BeFITS-MH量表在各研究中心的结构有效性。这项研究将 促进NIMH战略计划目标4："加强NIMH支持的公共卫生影响" 研究。"这项研究还将有助于确定可修改的障碍背后的核心潜在变量， 不同背景下的促进者，从而推进因果关系的概念化， 执行成果。研究结果将在美国和全球范围内有用。

ABSTRACT To address the shortage of mental health specialists worldwide, with as few as 2 per 100,000 population in many low- and middle-income countries (LMICs), researchers and program implementers are using task sharing strategies, which involve delegating the provision of mental health care to a broader cadre of nonspecialists such as primary care physicians, community health workers, lay volunteers, and the service users themselves (i.e., peers). While evidence demonstrates that task sharing for mental health strategies is effective in improving detection and treatment for a range of mental disorders, there remains a lack of critical knowledge on how to successfully implement and scale up task-sharing strategies in real-world settings. To address this gap, the proposed study seeks to validate the Barriers and Facilitators in Implementation of Task Sharing in Mental Health (BeFITS-MH) measure, a multi-dimensional, multi-stakeholder tool we developed to enable the systematic and rapid assessment of core, modifiable barriers and facilitators factors. We developed BeFITS-MH using a multi-level conceptual model that we derived from influential implementation science frameworks, and analyzed qualitative data from three NIMH-funded global “hubs” and a systematic review of barriers and facilitators identified in the literature. BeFITS-MH assesses perspectives from clients and providers, on 6 domains: 1) role fit; 2) satisfaction and motivation; 3) provider competence; 4) contextual congruence; 5) service accessibility; and 6) support systems. This study seeks to evaluate the psychometric and pragmatic properties of BeFITS-MH in 3 ongoing NIMH studies across 3 countries. Our Specific Aims are: Aim 1: Finalize the BeFITS-MH tool by finalizing the tool via a modified Delphi process and piloting the tool to evaluate the initial content validity and pragmatic qualities (i.e., time to complete). Aim 2: Evaluate the psychometric properties of BeFITS-MH tool. Following current Psychometric Evidence Scale criteria, we will evaluate internal consistency, norms, responsiveness, structural validity, convergent validity, discriminant validity, known-groups validity, and predictive validity. The tool will be validated against three implementation outcomes: acceptability, appropriateness, and feasibility, and process indicators at each site across two timepoints of data collection. Aim 3: Assess the pragmatic qualities and cross-national utility of BeFITS-MH. We will further understanding of implementation science and conceptual frameworks for TSMH strategies by exploring structural validity of the BeFITS-MH scales across sites. This research will contribute to NIMH Strategic Plan Objective 4: “Strengthen the Public Health Impact of NIMH-Supported Research.” This study will also enable identification of core latent variables underlying modifiable barriers and facilitators across diverse contexts, thus advancing conceptualization of causal relationships among implementation outcomes. Findings will be useful within the U.S. and globally.