Reducing stigma among healthcare providers to improve mental health services (RESHAPE)

减少医疗保健提供者的耻辱以改善心理健康服务 (RESHAPE)

基本信息

批准号：
10408221
负责人：
Brandon Alan Kohrt
金额：
$ 8.6万
依托单位：
GEORGE WASHINGTON UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-09-01 至 2024-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10408221
关键词：
Address Advocacy Attitude Caring Clinical Clinical effectiveness Collaborations Country Detection Diagnosis Diagnostic Effectiveness Female Gender Health Health Personnel Health care facility Health system Income International Interview Label Learning Light Measures Mediating Mediator of activation protein Mental Depression Mental Health Mental Health Services Mental disorders Mission Municipalities National Institute of Mental Health Nepal Outcome Patient Care Patient-Focused Outcomes Patients Persons Primary Health Care Psychiatrist Psychoses Psychotic Disorders Public Health Randomized Randomized Controlled Trials Reach, Effectiveness, Adoption, Implementation, and Maintenance Recovery Research Research Personnel Role Services Strategic Planning Structure Training Training Programs Woman Work World Health Organization accurate diagnosis alcohol use disorder arm base career career development cost effective effectiveness implementation study effectiveness testing evidence base gender equity generalized anxiety health training implementation framework implementation outcomes implementation science implementation strategy improved international center low and middle-income countries men primary care setting programs research study screening program secondary outcome service providers social stigma

项目摘要

PROJECT SUMMARY/ABSTRACT There continues to be a major gap between the global burden of mental illness and the number of patients receiving adequate treatment. To address this gap in low- and middle-income countries, a key strategy has been the use of primary care health workers to detect and deliver of care for mental illness. The World Health Organization has developed the mental health Gap Action Programme (mhGAP) to train primary care workers to detect mental illness and deliver evidence-supported treatment. However, research to date suggests that implementation strategies for mhGAP are inadequate as evidenced by low detection rates, with multiple studies demonstrating post-training detection at fewer than 10% of persons with mental illness detected. A potential barrier to effective implementation of detection in primary care is stigma among primary care workers against persons with mental illness. Our preliminary work suggests that reducing primary care workers' stigma against persons with mental illness may improve accurate detection of mental illness. We developed a version of mhGAP training that includes a stigma reduction component: “REducing Stigma among HealthcAre ProvidErs” (RESHAPE). In RESHAPE, persons with mental illness (i.e., mental health service users) are trained to share recovery stories, conduct myth-busting sessions, and promote mental health advocacy. Our preliminary studies of RESHAPE suggest that involvement of mental health service users in training primary care workers reduces stigma, and that stigma reduction may mediate improved detection of mental illness. We are proposing a hybrid implementation-effectiveness (Type-3) cluster randomized controlled trial in Nepal comparing mhGAP standard implementation with the RESHAPE implementation strategy. Target conditions will be depression, generalized anxiety, psychotic disorders, and alcohol use disorder. In Aim 1, we will evaluate the impact of the RESHAPE service user engagement on stigma among primary care workers. In Aim 2, we will evaluate the impact of the RESHAPE training on accurate reach of services (i.e., detection) and evaluate stigma as a mediator of differences in accuracy. Building on the same theoretical approaches to stigma in our primary research study, for Aim 3 we will conduct capacity building activities with to promote greater involvement of service users in research. We will also address conduct activities to counter gender- related stigma in mental health research careers. Successful completion of these aims will contribute to the NIMH Strategic Plan employing implementation science to maximize the public health impact of research and involve service users. This research advances the Fogarty International Center's mission for implementation science and commitment to evidence-based stigma reduction. We will build capacity by reducing institutional barriers to gender equity in research. These findings will shed light on the potential role of service users to improve implementation and accuracy of mental illness screening programs in primary care settings.

项目摘要/摘要全球精神疾病和患者人数之间仍然存在重大差距接受足够的治疗。为了解决低收入和中等收入国家的这一差距，一个关键策略已有我们是使用初级保健卫生工作者来检测和提供精神疾病的护理。世界健康组织已制定了心理健康差距行动计划（MHGAP）来培训初级保健工作者检测精神疾病并提供证据支持的治疗。但是，迄今为止的研究表明 MHGAP的实施策略不足以证明低检测率，多个研究表明，培训后检测的患者不到10％，患有精神疾病的患者。一个初级保健工作者的污名是有效实施初级保健检测的潜在障碍针对患有精神疾病的人。我们的初步工作表明，减少初级保健工作者的污名针对精神疾病的人可能会改善精神疾病的准确检测。我们开发了一个版本 MHGAP培训包括降低污名成分：“减少医疗保健之间的污名提供者”（重塑）。在重塑中，患有精神疾病的人（即心理健康服务用户）是经过培训，可以分享恢复故事，进行神话般的会议并促进心理健康倡导。我们的重塑的初步研究表明，精神卫生服务用户参与培训护理人员减少了污名，污名的降低可能会改善对精神疾病的检测。我们在尼泊尔提出混合实施效应（Type-3）群集随机对照试验将MHGAP标准实施与重塑实施策略进行比较。目标条件在AIM 1中，我们将受到沮丧，普遍的动画，精神病和饮酒障碍。评估重塑服务用户参与对初级保健工作者污名的影响。目标 2，我们将评估重塑培训对准确服务范围（即检测）和评估污名作为准确性差异的中介。以相同的理论方法为基础在我们的主要研究研究中，对于目标3，我们将进行能力建设活动以促进服务用户更多地参与研究。我们还将解决与性别相反的行为活动 - 心理健康研究职业的相关污名。这些目标的成功完成将有助于 NIMH战略计划采用实施科学来最大化研究的公共卫生影响和参与服务用户。这项研究推进了Fogarty国际中心的执行任务科学和对基于证据的污名的承诺。我们将通过降低机构来增强能力研究中性别平等的障碍。这些发现将阐明服务用户的潜在作用提高初级保健环境中精神疾病筛查计划的实施和准确性。