Reducing stigma among healthcare providers to improve mental health services (RESHAPE)

减少医疗保健提供者的耻辱以改善心理健康服务 (RESHAPE)

• 批准号: 10676129
• 负责人: Brandon Alan Kohrt
• 金额: $ 55.44万
• 依托单位: GEORGE WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-01 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10676129
• 关键词: Address; Advocacy; Attitude; Caring; Clinical; Clinical effectiveness; Collaborations; Country; Detection; Diagnosis; Diagnostic; Female; Fogarty International Center; Gender; Health; Health Personnel; Health care facility; Health system; Income; Institution; International; Interview; Label; Learning; Measures; Mediating; Mediator; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Mental health promotion; Mission; Municipalities; National Institute of Mental Health; Nepal; Outcome; Patient-Focused Outcomes; Patients; Persons; Primary Care; Primary Health Care; Psychiatrist; Psychoses; Psychotic Disorders; Public Health; Randomized; Randomized, Controlled Trials; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Recovery; Research; Research Personnel; Role; Services; Strategic Planning; Structure; Training; Training Programs; Woman; Work; World Health Organization; accurate diagnosis; alcohol use disorder; arm; career; career development; cost effective; effectiveness testing; effectiveness/implementation hybrid; evidence base; gender equity; generalized anxiety; health training; implementation framework; implementation outcomes; implementation science; implementation strategy; implementation/effectiveness; improved; low and middle-income countries; men; primary care patient; primary care setting; programs; research study; screening program; secondary outcome; service providers; social stigma

PROJECT SUMMARY/ABSTRACT There continues to be a major gap between the global burden of mental illness and the number of patients receiving adequate treatment. To address this gap in low- and middle-income countries, a key strategy has been the use of primary care health workers to detect and deliver of care for mental illness. The World Health Organization has developed the mental health Gap Action Programme (mhGAP) to train primary care workers to detect mental illness and deliver evidence-supported treatment. However, research to date suggests that implementation strategies for mhGAP are inadequate as evidenced by low detection rates, with multiple studies demonstrating post-training detection at fewer than 10% of persons with mental illness detected. A potential barrier to effective implementation of detection in primary care is stigma among primary care workers against persons with mental illness. Our preliminary work suggests that reducing primary care workers' stigma against persons with mental illness may improve accurate detection of mental illness. We developed a version of mhGAP training that includes a stigma reduction component: “REducing Stigma among HealthcAre ProvidErs” (RESHAPE). In RESHAPE, persons with mental illness (i.e., mental health service users) are trained to share recovery stories, conduct myth-busting sessions, and promote mental health advocacy. Our preliminary studies of RESHAPE suggest that involvement of mental health service users in training primary care workers reduces stigma, and that stigma reduction may mediate improved detection of mental illness. We are proposing a hybrid implementation-effectiveness (Type-3) cluster randomized controlled trial in Nepal comparing mhGAP standard implementation with the RESHAPE implementation strategy. Target conditions will be depression, generalized anxiety, psychotic disorders, and alcohol use disorder. In Aim 1, we will evaluate the impact of the RESHAPE service user engagement on stigma among primary care workers. In Aim 2, we will evaluate the impact of the RESHAPE training on accurate reach of services (i.e., detection) and evaluate stigma as a mediator of differences in accuracy. Building on the same theoretical approaches to stigma in our primary research study, for Aim 3 we will conduct capacity building activities with to promote greater involvement of service users in research. We will also address conduct activities to counter gender- related stigma in mental health research careers. Successful completion of these aims will contribute to the NIMH Strategic Plan employing implementation science to maximize the public health impact of research and involve service users. This research advances the Fogarty International Center's mission for implementation science and commitment to evidence-based stigma reduction. We will build capacity by reducing institutional barriers to gender equity in research. These findings will shed light on the potential role of service users to improve implementation and accuracy of mental illness screening programs in primary care settings.

项目概要/摘要 全球精神疾病负担与患者数量之间仍然存在巨大差距 接受充分的治疗。为了解决低收入和中等收入国家的这一差距，一项关键战略是 利用初级保健卫生工作者来发现和提供精神疾病护理。世界卫生 该组织制定了心理健康差距行动计划（mhGAP）来培训初级保健工作者 检测精神疾病并提供有证据支持的治疗。然而，迄今为止的研究表明 mhGAP 的实施策略不够充分，检出率低，且存在多个问题 研究表明，训练后检测出患有精神疾病的人的比例不到 10%。一个 在初级保健中有效实施检测的潜在障碍是初级保健工作者的耻辱 针对患有精神疾病的人。我们的初步工作表明，减少初级保健工作者的耻辱感 针对精神疾病患者可能会提高精神疾病的准确检测。我们开发了一个版本 mhGAP 培训，其中包括减少耻辱成分：“减少医疗保健中的耻辱 ProvidErs”（RESHAPE）。在 RESHAPE 中，精神疾病患者（即精神健康服务使用者） 接受培训以分享康复故事、举办破除神话的课程以及促进心理健康宣传。我们的 RESHAPE 的初步研究表明，心理健康服务使用者参与初级培训 护理人员减少耻辱感，而耻辱感的减少可能有助于改善精神疾病的检测。我们 正在提议在尼泊尔进行混合实施效果（Type-3）整群随机对照试验 将 mhGAP 标准实施与 RESHAPE 实施策略进行比较。目标条件 包括抑郁症、广泛性焦虑症、精神障碍和酒精使用障碍。在目标 1 中，我们将 评估 RESHAPE 服务用户的参与对初级保健工作者的耻辱感的影响。瞄准 2、我们将评估 RESHAPE 培训对服务准确覆盖范围（即检测）的影响以及 评估耻辱作为准确性差异的中介。基于相同的理论方法 在我们的主要研究中，针对目标 3，我们将开展能力建设活动，以促进 服务使用者更多地参与研究。我们还将开展反性别活动 心理健康研究职业中的相关耻辱。成功完成这些目标将有助于 NIMH 战略计划采用实施科学来最大限度地发挥研究和 涉及服务使用者。这项研究推进了福格蒂国际中心的使命的实施 科学和致力于减少基于证据的耻辱。我们将通过减少机构建设来建设能力 研究中性别平等的障碍。这些发现将揭示服务用户的潜在作用 提高初级保健机构精神疾病筛查计划的实施和准确性。