A brief, task-shifted treatment to improve father depression and child outcomes in Kenya: A pilot effectiveness-implementation trial

在肯尼亚，一项旨在改善父亲抑郁症和儿童结局的简短、任务转移治疗：试点有效性实施试验

• 批准号: 10704666
• 负责人: Ali Giusto
• 金额: $ 19.31万
• 依托单位: NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-15 至 2027-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10704666
• 关键词: Address; Adult; Adverse event; Age; Automobile Driving; Award; Behavior; Behavioral; Caregivers; Case Series; Child; Child Mental Health; Child Rearing; Clinical; Clinical Trials; Communities; Competence; Control Groups; Data; Dedications; Development; Economic Factors; Economics; Educational process of instructing; Effectiveness; Equation; Family; Family member; Fathers; Focus Groups; Future; Gender; Goals; Health; Health Policy; Home; Hospital Referrals; Hybrids; Impairment; Intervention; Interview; Kenya; Knowledge; Learning; Link; Masculine; Mediator; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Mentorship; Meta-Analysis; Methods; Modeling; National Institute of Mental Health; Outcome; Parents; Participant; Partnership Practice; Pathway interactions; Patients; Pattern; Personal Satisfaction; Persons; Poverty; Professional counselor; Provider; Public Health; Publications; Questionnaires; Randomized; Randomized, Controlled Trials; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Reporting; Research; Research Personnel; Resource-limited setting; Services; Stress; Surveys; Testing; Training; Transcript; Waiting Lists; Woman; Work; Youth; acceptability and feasibility; career; caregiver interventions; clinical outcome assessment; depressive symptoms; design; disability; drinking; drinking behavior; effectiveness testing; effectiveness/implementation design; effectiveness/implementation hybrid; effectiveness/implementation trial; efficacious intervention; efficacious treatment; hybrid type 1 design; implementation facilitators; implementation outcomes; implementation science; implementation strategy; implementation/effectiveness; improved; knowledge of results; low and middle-income countries; maladaptive behavior; men; motivational enhancement therapy; peer; pressure; primary outcome; process evaluation; response; retention rate; satisfaction; scale up; secondary outcome; skills; social health determinants; social stigma; symposium

PROJECT SUMMARY Globally, depression is the leading cause of disability world worldwide, yet over 75% of people in low and middle-income countries (LMIC) do not receive treatment. This gap is especially large for men. Treating men is essential to reducing the global burden of depression given its impact on families and children with men’s mental health (MH) predicting poor parenting and child MH. Although treating parent depression has been shown to improve parental MH, parenting, and child MH; men and fathers have been missing MH care and clinical trials. MH care relevant to fathers that address common barriers to MH, such as masculine norms and economic factors, are needed. The goal of the K23 is to expand the candidate’s skillset and prepare her to conduct independent research on scalable interventions for adult MH to improve child MH in low-resource settings. Through a combination of coursework and seminars, scientific conferences, collaborative publications, and mentorship from leading experts, the candidate will develop competency in 1) execution of randomized control trials using implementation science designs; 2) exploration of mechanism of change on MH using mixed methods; 3) understanding social determinant of health (SDH) on implementation. The candidate will apply knowledge and skills gained through training to conduct a pilot randomized control trial (RCT) using an effectiveness-implementation design in Kenya. The candidate will leverage existing partnerships with AMPATH and Moi Teaching and Referral Hospital (MTRH) in Kenya. She will also build on collaborative preliminary work with AMPATH/MTRH that showed promising proof-of-concept for ‘Learn, Act, Engage, Dedicate’ (LEAD), a 5-session task-shifted behavioral activation intervention with motivational interviewing and masculinity discussion strategies for fathers in Kenya. Proof-of-concept findings with nine fathers and families were promising with high participant satisfaction and improvements in father depression, parenting, and child MH. This supports pursuit of a pilot RCT, proposed here, using an effectiveness- implementation Hybrid Type I design to explore preliminary effectiveness and its implementation. Specifically, the candidate will conduct a pilot RCT with fathers randomized to either LEAD or a waitlist control group to (Aim1) explore change in fathers’ MH; (Aim 2) explore drivers of change in father MH, father parenting, and child MH (or non-response); and (Aim 3) explore the feasibility and acceptability of implementing a task-shifted MH treatment for fathers in a low-resource setting. Results will inform the development of an R01 proposal for a Hybrid trial to assess clinical outcomes of father and child MH and the impact of implementation strategies. Together, the training, research, and partnerships in the proposed award will support testing of a scalable MH treatment delivered by peer-father counselors with potential for engaging men and improving father and child MH in a low-resource setting, contributing to the NIMH’s goal of maximizing public health impact of research.

项目摘要 在全球范围内，抑郁症是全球残疾的主要原因，但超过75%的人处于低， 中等收入国家（LMIC）没有得到治疗。这一差距对男性来说尤其大。对待男人 鉴于抑郁症对家庭和儿童的影响， 心理健康（MH）预测不良养育和儿童MH。虽然治疗父母抑郁症一直是 显示改善父母的MH，养育和儿童MH;男性和父亲一直缺少MH护理， 临床试验与父亲相关的精神卫生保健，解决精神卫生的常见障碍，如男性规范， 经济因素是必要的。K23的目标是扩大候选人的技能，并为她做好准备， 对成人MH进行可扩展的干预措施进行独立研究，以改善低资源地区的儿童MH 设置.通过课程和研讨会，科学会议，合作 出版物，并从领先的专家指导，候选人将发展能力1）执行 采用实施科学设计的随机对照试验; 2）探索MH的变化机制 （3）了解健康的社会决定因素（SDH）对实施的影响。 候选人将应用通过培训获得的知识和技能进行试点随机 对照试验（RCT）在肯尼亚使用有效性实施设计。候选人将利用现有的 与肯尼亚的AMPATH和Moi教学和转诊医院建立了伙伴关系。她还将建立在 与AMPATH/MTRH合作的初步工作显示，“学习，行动， 参与，奉献“（LEAD），一项5节任务转移行为激活干预， 在肯尼亚为父亲提供的访谈和男子气概讨论策略。九项概念验证发现 父亲和家庭有希望与高参与者满意度和改善父亲抑郁症， 育儿和儿童MH。这支持了在此提出的试点RCT的实施，使用有效性- 实施混合I型设计，探索初步的有效性及其实施。具体地说， 候选人将进行一项试验性随机对照试验，将父亲随机分为LEAD组或候补对照组， （目的1）探索父亲MH的变化;（目的2）探索父亲MH变化的驱动因素，父亲养育， 儿童MH（或无反应）;以及（目标3）探讨实施任务转移的可行性和可接受性 在低资源环境中为父亲提供MH治疗。结果将为R 01提案的制定提供信息， 混合试验，以评估父亲和儿童MH的临床结果和实施策略的影响。 在拟议的奖励中，培训、研究和伙伴关系将共同支持可扩展MH的测试 由同龄父亲顾问提供的治疗，有可能吸引男性并改善父亲和孩子的关系 MH在一个低资源的设置，有助于NIMH的目标，最大限度地提高研究的公共卫生影响。