Optimizing Provider Attitudes and Competence in Learning Mental Health Systems

优化提供者学习心理健康系统的态度和能力

• 批准号: 9508797
• 负责人: Eshetu Girma
• 金额: $ 17.27万
• 依托单位: GEORGE WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-07-01 至 2019-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9508797
• 关键词: Address; African; Asians; Attitude; Behavior; Biological Models; Budgets; Caring; Clinical; Clinical Trials; Collaborations; Communities; Competence; Cost Analysis; Country; Data; Discrimination; Educational Curriculum; Educational workshop; Effectiveness; Ethiopia; Evaluation; Focus Groups; Funding; Future; Goals; Health Personnel; Health Resources; Health care facility; Health system; Healthcare; Income; Institutes; Intervention; Interview; Knowledge; Learning; London; Measures; Medical; Mental Health; Mental Health Services; Mental disorders; Modeling; Monitor; National Institute of Mental Health; Nepal; Outcome; Outcome Measure; Participant; Patient-Focused Outcomes; Patients; Persons; Policies; Primary Health Care; Principal Investigator; Provider; Psychotic Disorders; Public Health; Qualitative Research; Research; Research Design; Research Infrastructure; Research Personnel; Research Technics; Resources; Services; Strategic Planning; Substance abuse problem; Supervision; System; Theory of Change; Trainers Training; Universities; World Health Organization; base; clinical care; college; cost; design; effectiveness trial; evidence base; global health; health administration; implementation research; implementation science; improved; improved outcome; informant; intervention effect; low and middle-income countries; programs; psychosocial; social; social stigma; therapy development; tool

Stigma against persons with mental illness by health care providers contributes to lack of delivery of evidence- based care, long duration of untreated mental illness before initiation of care, and lack of appropriate medical care for persons with mental illness. This is compounded by structural stigma within health systems, which is exemplified by policies and practices that fail to meet needs for mental health budgets, psychiatric supervision of primary care providers, and physical infrastructure for safe and effective care. The purpose of our proposed research is to address the vital need for development of intervention packages to address provider stigma and structural stigma, with a focus on psychotic disorders. The rationale for conducting this study in low-and-middle income countries (LMIC) is because these regions demonstrate the greatest dearth of evidence-based services, and there is a lack of research on how to reduce stigma in a manner that improves patient clinical outcomes in low resource settings. Our goal is to develop an intervention package for Optimizing Provider Attitudes and competence in Learning mental health systems (OPAL). Drawing on the evidence base for addressing provider stigma, OPAL will include facilitated social contact between providers and persons with mental illness. For structural stigma, learning health systems will serve as a model to improve attitudes and clinical care through patient engagement in service design, enhanced provider access to systems data, and promotion of team-based health system administration. To accomplish the objective of developing the OPAL package to reduce provider and structural stigma, we will undertake three aims: (1) develop a draft intervention package through qualitative research including a stakeholder analysis of the package and a pilot training of trainers for consumers, (2) adapt and develop measures to evaluate the package, and (3) strengthen capacity for implementation science in LMIC. This proposed research will take place in Ethiopia and Nepal. These African and Asian settings exemplify LMIC mental health service needs and are participating in implementation research through Emerging Mental Health Systems in Low and Middle Income Countries (EMERALD) and Programme for Improved Mental Health Care (PRIME), which employ the World Health Organization’s (WHO) mental health Global Action Programme (mhGAP). The impact of successful completion of our research aims will be (1) an intervention package that can be added to mhGAP and piloted by WHO, and (2) intervention content and measures to apply for funding to conduct effectiveness trials to evaluate improving provider attitudes and competence as mechanisms to improve patient outcomes.

卫生保健提供者对精神病患者的耻辱导致缺乏循证护理，在开始护理前精神病长期得不到治疗，以及精神病患者得不到适当的医疗服务。卫生系统内部的结构性污名加剧了这一问题，例如，政策和做法未能满足对精神卫生预算、初级保健提供者的精神监督以及安全和有效护理的有形基础设施的需求。我们提议的研究的目的是解决制定干预方案以解决提供者污名和结构性污名的迫切需要，重点是精神障碍。在低收入和中等收入国家(LMIC)进行这项研究的理由是，这些地区表现出最缺乏循证服务，而且缺乏关于如何在低资源环境下以改善患者临床结果的方式减少污名的研究。我们的目标是开发一套干预方案，以优化提供者在学习心理健康系统(Opal)方面的态度和能力。根据解决提供者污名问题的证据基础，Opal将包括促进提供者与精神病患者之间的社会联系。对于结构性污名，学习卫生系统将作为一种模式，通过患者参与服务设计、加强提供者对系统数据的访问以及促进基于团队的卫生系统管理来改善态度和临床护理。为了实现制定Opal一揽子计划以减少提供者和结构性污名的目标，我们将实现三个目标：(1)通过定性研究制定干预一揽子计划草案，包括对一揽子计划进行利益攸关方分析和对消费者培训人员进行试点培训，(2)调整和制定评估一揽子计划的措施，以及(3)加强LMIC的实施科学能力。这项拟议的研究将在埃塞俄比亚和尼泊尔进行。这些非洲和亚洲的环境体现了LMIC的精神卫生服务需求，并通过利用世界卫生组织(WHO)的精神卫生全球行动计划(MhGAP)的新兴中低收入国家精神卫生系统(Emerald)和改善精神卫生保健方案(PRIME)参与实施研究。成功完成我们的研究目标的影响将是(1)可添加到mhGAP中并由世卫组织试行的干预方案，以及(2)干预内容和申请资金进行有效性试验的措施，以评估改善提供者的态度和能力作为改善患者结果的机制。

项目成果

Empowerment training to support service user involvement in mental health system strengthening in rural Ethiopia: a mixed-methods pilot study.

• DOI: 10.1186/s12913-022-08290-x
• 发表时间: 2022-07-08
• 期刊: BMC health services research
• 影响因子: 2.8

Gendering psychosocial care: risks and opportunities for global mental health.

性别社会心理护理：全球心理健康的风险和机遇。

• DOI: 10.1016/s2215-0366(20)30483-1
• 发表时间: 2021
• 期刊: The lancet. Psychiatry
• 作者: Chase,LianaE;Gurung,Dristy;Shrestha,Parbati;Rumba,Sunita
• 通讯作者: Rumba,Sunita

Using participatory action research to pilot a model of service user and caregiver involvement in mental health system strengthening in Ethiopian primary healthcare: a case study.

• DOI: 10.1186/s13033-022-00545-8
• 发表时间: 2022-07-11
• 期刊: INTERNATIONAL JOURNAL OF MENTAL HEALTH SYSTEMS
• 影响因子: 3.6
• 作者: Abayneh, Sisay;Lempp, Heidi;Kohrt, Brandon A.;Alem, Atalay;Hanlon, Charlotte
• 通讯作者: Hanlon, Charlotte

Mental health stigma and discrimination in Ethiopia: evidence synthesis to inform stigma reduction interventions.

• DOI: 10.1186/s13033-022-00540-z
• 发表时间: 2022-06-23
• 期刊: INTERNATIONAL JOURNAL OF MENTAL HEALTH SYSTEMS
• 影响因子: 3.6
• 作者: Girma, Eshetu;Ketema, Bezawit;Mulatu, Tesfahun;Kohrt, Brandon A.;Wahid, Syed Shabab;Heim, Eva;Gronholm, Petra C.;Hanlon, Charlotte;Thornicroft, Graham
• 通讯作者: Thornicroft, Graham