Prism Scale Up Study

摘要：老年心理健康实施科学伙伴关系的扩大部分 (PRISM)项目提出了一种基于证据的体育锻炼干预措施，适用于表现出 痴呆的行为和心理症状(BPSD)。干预将以泰语进行 以循证为基础的社区卫生“任务分担”实施战略 工人(CHW)、护士、初级保健医生和精神健康专家。为了回应常见的 循证干预措施与当地实施之间的技术和文化兼容性问题 考虑到当地实施精神健康服务倡议的政治意愿参差不齐，我们建议 开发和测试创新的实施支助战略(即GTO-泰国模式)，其基础是 以证据为基础的结果模式，将根据泰国的情况进行调整，以确保成功 在泰国实施和扩大老年人心理健康服务。据我们所知，没有 以前的研究审查了GTO-泰国实施支持战略的有效性，以交付 亚洲老年BPSD患者的临床干预。 拟议的评估研究将采用Hyprid 3型设计进行随机对照试验，以 比较实施文化适应的GTO模式(GTO-泰语)的干预部门 实施支持，有一个控制臂，它接收通常自上而下的管理指令 实施政策性举措。我们的具体放大研究目标是：1)量身定做以证据为基础的体格检查 运动干预(EBPEI)，以适应泰国当地的社会、文化和政策背景(第1年)；2)发展 评估实施EBPEI以改善老年人心理健康的准备情况的文化信息工具 在泰国的地方省份(1年)；3)通过一个预案，制定GTO-泰国执行支助模式 实施案例研究和形成性评估(YR 2)；4)评估实施策略和临床 通过混合型3型随机试验测试GTO-泰国实施的有效性的结果 提供EBPEI的支助战略，与现行的标准行政程序相比 提供相同的EBPEI(3-4年)；5)通过工具和绩效制定政策建议 指标(5年)。拟议的扩大研究预计将产生以下方面所需的知识和工具 进一步扩大泰国的精神卫生服务，并将对知识做出重大贡献 在其他NIMH计划中心内的发展将随着LMIC的精神健康创新而规模化。

Abstract: The Scale-Up Component of the Partnership in Implementation Science for Geriatric Mental Health (PRISM) project proposes an evidence-based physical exercise intervention for older adults who exhibit behavioral and psychological symptoms of dementia (BPSD). The intervention will be delivered in Thai communities through an evidence-based implementation strategy of “task sharing” among community health workers (CHWs), nurses, primary care physicians, and mental health specialists. In response to the common problem of technical and cultural compatibility between evidence-based interventions and local implementation contexts as well as the uneven local political will for implementing mental health service initiatives, we propose to develop and test an innovative implementation support strategy (i.e., the GTO-ThAI model), based on the evidence-based Getting-to-Outcome model, which will be adapted to Thai settings, to ensure the success of implementation and scaling up of the mental health service for older adults in Thailand. To our knowledge, no previous study has examined the effectiveness of a GTO-ThAI implementation support strategy for delivering clinical interventions for older adults with BPSD in Asia. The proposed evaluation study will conduct a randomized controlled trial with a Hyprid Type 3 design to compare the intervention arm that implements the culturally-adapted GTO model (GTO-ThAI) to deliver implementation support, with a control arm, which receives usual top-down administrative instruction for implementing a policy initiative. Our specific scale-up study aims are to: 1) tailor an evidence-based physical exercise intervention (EBPEI) to fit with Thai local social, cultural, and policy context (Yr 1); 2) develop culturally-informed tools to assess readiness for implementing EBPEI to improve mental health of older adults in local provinces of Thailand (Yr 1); 3) develop the GTO-ThAI implementation support model through a pre- implementation case study and formative evaluation (Yr 2); 4) evaluate implementation strategies and clinical outcomes through a hybrid Type 3 randomized trial to test effectiveness of the GTO-ThAI implementation support strategy for the delivery of EBPEI, compared with the existing standard administrative procedures for delivering the same EBPEI (Yrs 3-4); 5) develop policy recommendations with tools and performance indicators (Yr 5). The proposed scale-up study is expected to generate knowledge and tools essential for further scale-up of mental health services in Thailand, and will contribute significantly to knowledge development within other NIMH program HUBs on going to scale with mental health innovations in LMICs.