Aligning facility leadership and climate to advance mental health services integration in Malawi

摘要 任务分担的心理健康干预在低收入和中等收入国家是有效的，但它们仍然 未得到充分利用，心理健康治疗缺口仍然很大。创新实施战略 要成功地将循证精神卫生治疗纳入LMICs的医疗保健中，就需要这样做。 许多实施工作的一个共同组成部分是确定和 授权现场工作人员作为实施倡导者，负责集中他们的 同事们在实施循证治疗模式方面的努力。然而，越来越多的研究表明， 包括我们自己在马拉维和其他地方的工作，突出了冠军的成功受到了强烈的影响 通过他们的直线经理和其他上游组织领导人的支持，他们是关键的 协调本组织的气候和优先事项，以支持执行工作。 影响领导层参与度以改变组织氛围和调整优先事项的方法有 在组织和工业心理学领域经过几十年的发展，但仅相对 最近应用于实施科学健康研究，并主要应用于高收入人群的实施 国家。领导和组织变革实施(LOCI)是最近发展起来的 多层次领导力培训实施战略，在变革中展示了有效性 美国的组织氛围、调整优先事项和加强心理健康治疗模式的整合 和挪威，但尚未在低收入国家环境中适应或测试。基因座具有显著的 通过调整领导优先事项来解决我们当前研究中发现的差距，以支持 推动心理健康融合的领军人物。 本提案的目的是测试补充标准的影响和可持续性 采用现场领导调整战略的冠军实施方法，以实现成功 将循证、任务分担的精神健康治疗模式融入普通医疗。我们 将使用整群随机试验来评估调整后的领导层调整策略对 将基于证据的心理健康治疗包整合到多个医疗环境(NCD， 艾滋病毒和结核病护理)，评估最近的(气候)，初步实施(采用，覆盖范围，保真度)， 下游患者的心理健康、成本-效果结果以及结论后的可持续性 领导力结盟活动。此外，我们将利用研究项目的结构来进一步 加强马拉维精神卫生研究人员和决策者的能力。 领导一致性策略是一个未被充分研究但却是成功心理健康的重要因素。 整合努力。这个项目将对我们理解领导力的作用做出重大贡献。 在LMICs中推进循证精神卫生整合的一致性。

ABSTRACT Task-shared mental health interventions are effective in low- and middle-income countries, yet they remain underutilized and the mental health treatment gap remains substantial. Innovative implementation strategies are needed to successfully integrate evidence-based mental health treatments into medical care in LMICs. A common component of many implementation efforts is a “champion” strategy which identifies and empowers an on-the-ground staff member as the implementation champion, in charge of focusing their colleagues’ efforts on implementation of the evidence-based treatment model. Yet a growing body of research, including our own work in Malawi and elsewhere, highlights that the champion’s success is strongly influenced by the strength of support from their line manager and other up-the-chain organization leaders, who are critical in aligning the organization’s climate and priorities in support of the implementation effort. Approaches to influencing leadership engagement to change organizational climate and align priorities has been developed over decades in the field of organizational and industrial psychology but only relatively recently applied to implementation science health research and primarily to implementation in high-income countries. The Leadership and Organizational Change for Implementation (LOCI) is a recently developed multi-level leadership coaching implementation strategy that has demonstrated effectiveness in changing organizational climate, aligning priorities, and enhancing mental health treatment model integration in the US and Norway, but has not been adapted to or tested in low-income country settings. LOCI has significant potential to address the gaps identified in our current research by aligning leadership priorities to support champions in advancing mental health integration. The objective of the present proposal is to test the impact and sustainability of supplementing the standard champion implementation approach with the LOCI leadership alignment strategy to achieve successful integration of an evidence-based, task-shared mental health treatment model into general medical care. We will use a cluster-randomized trial to evaluate the impact of the adapted leadership alignment strategy on integration of an evidence-based mental health treatment package into multiple medical care settings (NCD, HIV, and TB care), assessing proximal (climate), primary implementation (adoption, reach, fidelity), downstream patient mental health, and cost-effectiveness outcomes as well as sustainability after conclusion of the leadership alignment activities. Additionally, we will use the structure of the research project to further strengthen capacity among mental health researchers and policy makers in Malawi. Leadership alignment strategies are an understudied but essential ingredient for successful mental health integration efforts. This project will make a major contribution to our understanding of the role of leadership alignment in advancing evidence-based mental health integration in LMICs.