Participatory research to support the development of culturally sensitive mental health and wellbeing services for the Kankuamo people of Colombia

第一阶段：知识对话（1-8个月）A)文献综述-能力方法在土著居民中的应用；(B)将举办五次利益攸关方参与讲习班，旨在增进对坎库莫人的心理健康和生活质量的了解。将有目的地从12个坎库莫社区抽取60名个人（包括传统治疗师、社区长老、保健工作者）。数据收集将使用模块一设计、实施、监测和评估（DIME）方法。DIME的模块1引出了相关的定性信息：1)社区中成年人面临的问题；2)成年人需要经常为自己、家庭和社区承担的关键职能/任务；3)目前由公认的社区专家（即关键线人）提供的解决问题的建议。作为ESRC资助的COSTAR项目（ES/S000976/1）的一部分，我们在乌干达和卢旺达开展了工作，在此基础上，这项工作将包括对能力方法（Sen, 1999）的关注，通过包含一个额外的问题，要求社区成员指出：“美好的生活对你意味着什么？”第二阶段：开发评估工具（9-13个月）A)开发或调整评估工具，用于：i)常见精神障碍，II)基于第一阶段的定性发现的生活质量。这将以DIME方法的模块二为指导，并将利用第一阶段收集的数据。B)测试评估工具-在第二阶段开发的两种评估工具将根据DIME方法的模块三进行测试。数据收集将通过对12个Kankuamo的380个家庭的调查进行，并将由第一阶段的参与者在研究小组成员的陪同下进行。调查将包括常见精神障碍和生活质量的新评估工具，以及国际公认的抑郁症状（即PHQ-9）和生活质量（WHOQoL-BREF）的标准化测量。在调查完成后，将采用有目的抽样的方法，招募参与者的子样本参加焦点小组讨论（12个社区每个10人1次FGD；总N = 120），以提供关于评估工具（包括文化可接受性）的定性反馈。C)评估工具的验证-将对IIB阶段收集的数据进行相关分析，以确定与PHQ9和WHOQoL-BREF相比，新评估工具的结构效度。第三阶段：指南制定（13-20个月）来自所有12个Kankuamo社区的成员（N=120）将被邀请参加为期2天的焦点小组、研讨会和互动活动，共同制定制定和提供具有文化敏感性的初级保健社区精神卫生支持指南。这将包括考虑利益相关者的道德和法律义务。第四阶段：制定和评估培训方案（20-30个月）这一阶段将涉及制定、实施和评估一项培训方案，旨在培训社区福利倡导者，以确定坎库莫社区中有精神健康问题的人，并为他们提供适当的、当地可用的支持形式。A)根据第一阶段、第二阶段和第三阶段的调查结果，制定一个为期3天的短期CWA培训计划。B)为参与者提供为期3天的CWA培训计划（N=60）。C)评估：i) CWA培训计划的可接受性（培训后1个月，最多8名CWA学员进行2次FGD）， ii)与CWA互动的社区成员的反馈（最多8名社区成员进行2次FGD）。D)根据第IVC阶段收到的CWA学员和社区成员的反馈，调整CWA培训计划。

Phase 1: Knowledge Dialogue (Months 1-8)A) Literature review - application of capability approach with indigenous populations; B) Five stakeholder engagement workshops aimed at enhancing understanding about the mental health and quality of life of the Kankuamo people will be held. Sixty individuals (including traditional healers, community elders, health workers) will be purposively sampled from across the twelve Kankuamo communities. Data will be collected using Module One the Design, Implementation, Monitoring and Evaluation (DIME) approach. Module 1 of DIME elicits relevant qualitative information about: 1) Problems that adults in the community face; 2) The key function/tasks that adults are required to frequently undertake for themselves, their families, and their communities; 3) The advice that is currently provided by recognised community experts (i.e. key informants) to address the problems. Building on our work in Uganda and Rwanda as part of the ESRC funded COSTAR project (ES/S000976/1), this work will include a focus on the Capability Approach (Sen, 1999) through the inclusion of an additional question that will ask community members to indicate: 'What does a good life mean to you?'. Phase II: Developing Assessment Instruments (Months 9-13)A) Development or adaptation of assessment instruments for: i) common mental disorders, ii) quality of life based on the qualitative findings from Phase I. This will be guided by Module two of the DIME approach and will utilise the data collected in Phase 1.B) Piloting of Assessment Instrument - the two assessment instruments developed in Phase IIA will be piloted according to Module Three of the DIME Approach. Data collection will take place via a survey of 380 households across the 12 Kankuamo and will be undertaken by the participants of phase I, accompanied by members from the research team. The survey will include the novel assessment instruments for common mental disorders and quality of life, as well as internationally recognised standardised measures of depressive symptoms (i.e. PHQ-9) and quality of life (WHOQoL-BREF). Following the completion of the survey, purposive sampling will be used to recruit a subsample of participants into focus groups discussions (1 FGD of 10 people for each of the 12 communities; total N = 120) to provide qualitative feedback about the assessment instruments (including the cultural acceptability). C) Validation of the assessment instruments - Correlational analyses will be conducted on the data collected in Phase IIB to determine the construct validity of the new assessment instruments compared to PHQ9 and WHOQoL-BREF.Phase III: Guideline development (Months 13-20)Members from all 12 Kankuamo communities (N=120) will be invited to a combination of focus groups, workshops and interactive activities over a 2-day period to co-produce guidelines for the development and delivery of culturally sensitive primary care community mental health support. This will include consideration of ethical and legal obligations of stakeholders. Phase IV: Development and evaluation of the training program (Months 20-30)This phase will involve the development, delivery and evaluation of a training program aimed at training Community Wellbeing Advocate (CWA) to identify people experiencing mental health difficulties within the Kankuamo community, and to signpost them to appropriate, locally available, forms of support. A) Develop a short 3-day CWA training program based on the findings from Phase I, Phase II and Phase III. B) Deliver a 3-day CWA training program to participants (N=60). C) Evaluate: i) the acceptability of the CWA training program (two FGD of up to 8 CWA trainees 1-month post-training, ii) feedback from community members who have interacted with the CWA (2 FGD of up to 8 community members).D) Adjust the CWA training programme according to feedback received from the CWA trainees and community members in Phase IVC.