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: 10526096
• 负责人: Ali Giusto
• 金额: $ 19.53万
• 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/10526096
• 关键词: Address; Adult; Adverse event; Age; Automobile Driving; Award; Behavioral; Caregivers; Case Series; Child; Child Mental Health; Child Rearing; Clinical; Clinical Trials; Communities; Competence; Control Groups; Data; 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 of activation protein; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Mentorship; Meta-Analysis; Methods; Modeling; National Institute of Mental Health; Only Child; 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; Time; Training; Transcript; Use Effectiveness; Waiting Lists; Woman; Work; acceptability and feasibility; career; caregiver interventions; clinical implementation; depressive symptoms; design; disability; drinking; effectiveness implementation design; effectiveness implementation study; effectiveness implementation trial; effectiveness testing; efficacious intervention; efficacious treatment; hybrid type 1 design; implementation facilitators; implementation outcomes; implementation science; implementation strategy; 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，抑郁症是全球残疾世界的主要原因，但超过75％的人处于低谷和 中等收入国家（LMIC）不接受治疗。对于男人来说，这个差距尤其很大。治疗男人是 鉴于对男人的家庭和儿童的影响，减轻全球抑郁症的负担至关重要 心理健康（MH）预测育儿不良和儿童MH。虽然治疗父母抑郁症已经 证明可以改善父母MH，育儿和孩子MH；男人和父亲一直缺少MH护理和 临床试验。 MH关心与父亲有关，这些父亲涉及对MH的共同障碍，例如男性规范和 需要经济因素。 K23的目标是扩大候选人的技能，并为她做好准备 对成人MH的可扩展干预措施进行独立研究，以改善低资源的儿童MH 设置。通过课程和半小伙子的结合，科学会议，协作 出版物和领先专家的精神职位，候选人将在1）执行 使用实施科学设计的随机对照试验； 2）探索MH变化机制 使用混合方法； 3）了解实施的卫生社会决定者（SDH）。 候选人将运用通过培训获得的知识和技能，以进行随机进行飞行员 使用肯尼亚的有效实施设计对照试验（RCT）。候选人将利用现有的 与肯尼亚的Ampath和MOI教学和转诊医院（MTRH）的合作伙伴关系。她还将建立在 与Ampath/MTRH的协作初步工作，显示了“学习，ACT， 参与，奉献'（LEAD），这是一种5条任务迁移的行为激活干预措施 肯尼亚父亲的访谈和阳刚性讨论策略。概念证明发现有九个 父亲和家庭的参与满意度和父亲抑郁症的改善应许， 育儿和孩子MH。这支持在此处提出的追求飞行员RCT，并使用有效性 - 实施混合I型设计，以探索初步效力及其实施。具体来说， 候选人将与父亲一起进行飞行员RCT，以随机分配到铅或候补名单对照组 （AIM1）探索父亲MH的变化； （AIM 2）探索MH父亲，父亲育儿和 儿童MH（或无响应）； （AIM 3）探索实施任务迁移的可行性和可接受性 MH在低资源环境中对父亲的治疗。结果将为R01提案的开发提供信息 一项评估父亲和儿童MH临床结果以及实施策略的影响的混合试验。 拟议奖励中的培训，研究和合作伙伴共同支持可扩展MH的测试 同伴父亲ComunSeleors提供的治疗有可能吸引男人并改善父亲和孩子 MH在低资源环境中，促进了NIMH最大程度地提高公共健康影响的目标。