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

摘要 为了解决世界范围内精神健康专家短缺的问题，#年每10万人中只有2人 许多低收入和中等收入国家(LMIC)、研究人员和计划实施者正在使用TASK 分享战略，其中包括将精神卫生保健的提供委托给更广泛的 非专科医生，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，对等方)。虽然有证据表明，心理健康策略的任务分担是 在改善对一系列精神障碍的发现和治疗方面，仍然缺乏关键的 了解如何在实际环境中成功实施和扩展任务共享策略。至 为了消除这一差距，拟议的研究试图验证实施以下目标的障碍和促进者 心理健康中的任务分担(Befits-MH)测量，这是一个多维度、多利益相关者的工具 为能够对核心、可修改的障碍和促进者因素进行系统和快速的评估而制定。 我们使用从Impact派生的多层次概念模型开发了BEFITS-MH 实施科学框架，并分析了来自NIMH资助的三个全球“中心”和 对文献中确定的障碍和促进者进行系统回顾。Befit-MH评估前景 来自客户和提供商的，在6个领域：1)角色匹配；2)满意度和激励；3)提供商能力； 4)上下文一致性；5)服务可访问性；6)支持系统。这项研究试图评估 在3个国家正在进行的3项NIMH研究中，BEFITS-MH的心理测量学和语用特性。我们的 具体目标是：目标1：通过改进的Delphi流程最终确定befits-MH工具 并试用该工具对初始内容效度和语用质量(即完成时间)进行评估。目标 2：评价Befit-MH工具的心理测量学特性。根据目前的心理测量学证据 量表标准，我们将评估内部一致性、常模、反应性、结构效度、趋同性 效度、判别效度、已知群体效度和预测效度。该工具将根据以下条件进行验证 三项执行成果：可接受性、适当性和可行性，以及每项成果的进程指标 站点跨越两个时间点的数据收集。目标3：评估语用品质和跨国 BIFFITS的效用-MH。我们将进一步了解实施科学和概念框架 TSMH策略，通过探索各站点的适合-MH量表的结构效度。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隐藏在可修改壁垒和 跨不同背景的促进者，从而促进了对 实施成果。这些发现将在美国国内和全球范围内有用。

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.