Advancing mHealth-supported Adoption and Sustainment of an Evidence-based Mental Health Intervention for Youth in a School-based Delivery Setting in Sierra Leone

在塞拉利昂校内分娩环境中推进移动医疗支持的青少年循证心理健康干预措施的采用和维持

• 批准号: 10489910
• 负责人: Alethea Desrosiers
• 金额: $ 74.91万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-05 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10489910
• 关键词: Address; Adolescent; Adoption; Adult; Africa; Behavior; Behavioral; Car Phone; Clinical effectiveness; Cluster randomized trial; Cognitive Therapy; Communication; Data; Development; Education; Educational Background; Effectiveness; Effectiveness of Interventions; Emotional; Employment; Enrollment; Evaluation; Exhibits; Exploration Preparation Implementation and Sustainment; Face; Family; Government; Government Officials; Health; Health Benefit; Hybrids; Image; Infrastructure; Intervention; Investments; Mental Health; Mental Health Services; Mental disorders; Methods; Mobile Health Application; Modeling; Monitor; National Institute of Mental Health; Outcome; Persons; Pilot Projects; Politics; Population; Preparation; Prevalence; Professional counselor; Public Health; Readiness; Recording of previous events; Research; Research Support; Resource-limited setting; Resources; Risk Factors; Schools; Secondary Schools; Services; Sierra Leone; Students; Substance Use Disorder; Supervision; Technology; Time; Training; Training Programs; Training Support; Training and Education; Violence; Visual; Voice; Widespread Disease; Youth; aged; base; behavioral health; burden of illness; compare effectiveness; cost; cost effective; cost effectiveness; cost-effectiveness ratio; daily functioning; dashboard; design; disability-adjusted life years; educational atmosphere; effectiveness implementation design; emotion regulation; evidence base; health care delivery; implementation facilitators; implementation intervention; implementation science; implementation strategy; improved; incremental cost-effectiveness; innovation; intervention delivery; low and middle-income countries; mHealth; organizational climate; programs; relative cost; resilience; scale up; secondary outcome; sustainability framework; teacher; tool; trial design; user centered design; video chat; willingness to pay; Address; Adolescent; Adoption; Adult; Africa; Behavior; Behavioral; Car Phone; Clinical effectiveness; Cluster randomized trial; Cognitive Therapy; Communication; Data; Development; Education; Educational Background; Effectiveness; Effectiveness of Interventions; Emotional; Employment; Enrollment; Evaluation; Exhibits; Exploration Preparation Implementation and Sustainment; Face; Family; Government; Government Officials; Health; Health Benefit; Hybrids; Image; Infrastructure; Intervention; Investments; Mental Health; Mental Health Services; Mental disorders; Methods; Mobile Health Application; Modeling; Monitor; National Institute of Mental Health; Outcome; Persons; Pilot Projects; Politics; Population; Preparation; Prevalence; Professional counselor; Public Health; Readiness; Recording of previous events; Research; Research Support; Resource-limited setting; Resources; Risk Factors; Schools; Secondary Schools; Services; Sierra Leone; Students; Substance Use Disorder; Supervision; Technology; Time; Training; Training Programs; Training Support; Training and Education; Violence; Visual; Voice; Widespread Disease; Youth; aged; base; behavioral health; burden of illness; compare effectiveness; cost; cost effective; cost effectiveness; cost-effectiveness ratio; daily functioning; dashboard; design; disability-adjusted life years; educational atmosphere; effectiveness implementation design; emotion regulation; evidence base; health care delivery; implementation facilitators; implementation intervention; implementation science; implementation strategy; improved; incremental cost-effectiveness; innovation; intervention delivery; low and middle-income countries; mHealth; organizational climate; programs; relative cost; resilience; scale up; secondary outcome; sustainability framework; teacher; tool; trial design; user centered design; video chat; willingness to pay

PROJECT SUMMARY This study will examine a new implementation strategy for the Youth Readiness Intervention (YRI), an evidence-based mental health intervention. The strategy will (a) leverage a delivery setting (schools) and workforce (teachers) used effectively in low- and middle- income countries; and (b) innovate with technology and mHealth tools to enhance mental health service delivery quality. The YRI will be implemented as an extracurricular resilience-building afterschool activity in Sierra Leone. Teachers will deliver the YRI and receive either mobile phone-supported supervision or standard in-person supervision. Mobile-based supervision will integrate WhatsApp, a free cross-platform messaging and voice service used widely throughout Africa, with a new mHealth app. The mHealth app was recently designed to support fidelity monitoring of Sierra Leonean lay workers delivering the evidence-based Family Strengthening Intervention (R21MH124071). The mHealth app will support supervision through key features, including voice activated content, fillable forms (i.e., YRI fidelity checklist), visual dashboards to monitor fidelity, and training videos to support school-based YRI delivery. The Exploration, Preparation, Implementation, Sustainment (EPIS) framework, a broad multilevel, context- sensitive implementation science model, will guide the study. A hybrid type 3 implementation-effectiveness design will allow for evaluation of both mobile phone-based supervision as a new implementation strategy, and clinical effectiveness of the YRI on youth mental and behavioral health as secondary outcomes. Aim 1 (Exploration and Preparation) will investigate barriers and facilitators to successful YRI implementation aided by mobile-based tools in Sierra Leone’s secondary schools. A mixed methods evaluation with teachers, principals, and government ministry officials will inform co-development of an implementation blueprint prior to YRI delivery. User-centered design methods will be used to adapt the mHealth supervision app and incorporate WhatsApp to create an integrated user model of mobile phone-based supervision. Aim 2 (Implementation) will examine the feasibility, acceptability, cost, and fidelity to the YRI delivered by teachers receiving mobile-based supervision compared with those receiving standard supervision via a mixed methods approach. Aim 3 (Impact of Delivery Approach on YRI Effectiveness) will compare the effectiveness of the YRI in improving mental health, emotion regulation and daily functioning in youth (aged 14-24) when delivered in school settings by teachers who receive either mobile-based supervision (N=480 youth) or those who receive standard supervision (N=480 youth). Aim 4 (Sustainment) will (a) investigate mechanisms of adoption and sustainment of the YRI delivered by teachers through a mixed methods evaluation with teachers, youth, and principals; and (b) conduct a cost-effectiveness and return on investment analysis to evaluate relative costs vs. benefits of the YRI from a broad societal perspective, including educational outcomes.

项目摘要 这项研究将研究青年准备干预（YRI）的新实施策略，这是一个 基于证据的心理健康干预。该策略将（a）利用交货环境（学校）和 劳动力（教师）在低收入和中等收入国家有效使用； （b）技术创新 和MHealth工具以增强心理健康服务的质量。 YRI将被实施 塞拉利昂的课外弹性建设后的课后活动。老师将交付YRI并接受 手机支持的监督或标准面对面监督。基于移动的监督将 综合WhatsApp，一种免费的跨平台消息和语音服务，在整个非洲广泛使用， 新的MHealth应用程序。 MHealth应用程序最近旨在支持塞拉利昂莱恩的保真度监测 提供基于证据的家庭加强干预措施的工人（R21MH124071）。 MHealth应用程序 将通过关键功能（包括语音激活内容，可填充表格（即Yri Fidelity）来支持监督 清单），视觉仪表板以监视保真度和培训视频，以支持基于学校的YRI交付。 探索，准备，实施，维持框架（EPIS）框架，广泛的多层次，上下文 - 敏感的实施科学模型将指导研究。混合3型实施效应 设计将允许将两个基于手机的监督作为一种新的实施策略进行评估，并且 YRI对青年心理和行为健康的临床有效性作为次要结果。 AIM 1（探索和准备）将调查成功YRI的障碍和促进者 实施在塞拉利昂的中学的基于移动工具的帮助下。混合方法评估 与教师，校长和政府部官员一起，将向共同开发实施 YRI交付之前的蓝图​​。以用户为中心的设计方法将用于调整MHealth的监督 应用并合并WhatsApp，以创建基于手机的监督的集成用户模型。目标2 （实施）将检查教师提供的YRI的可行性，可接受性，成本和忠诚 与那些通过混合方法接收标准监督相比，接受基于移动的监督 方法。 AIM 3（交付方法对YRI有效性的影响）将比较YRI的有效性 在改善心理健康，情绪调节和日常功能方面（14-24岁） 受到基于移动的监督（n = 480名青年）或接受的教师的学校环境 标准监督（n = 480名青年）。目标4（维持）将（a）调查采用机制和 通过与教师，青年和年轻人的混合方法评估来维持教师交付的YRI 校长； （b）进行成本效益和投资回报分析以评估相对成本与。 从广义的社会角度来看，YRI的好处，包括教育成果。