Combining mHealth and nurse-delivered care to improve the outcomes of people with seriousmental illness in West Africa

将移动医疗与护士提供的护理相结合，改善西非严重精神疾病患者的治疗结果

基本信息

批准号：
10533529
负责人：
Dror Ben-Zeev
金额：
$ 69.6万
依托单位：
UNIVERSITY OF WASHINGTON
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-08-05 至 2027-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10533529
关键词：
Address Africa African Aftercare Age Amination Behavioral Model Biological Bipolar Disorder Caring Cellular Phone Cessation of life Clinical Cluster randomized trial Code Cognitive Collaborations Communities Computer software Country Coupled Data Development Diagnosis Education Elements Enrollment Exclusion Exposure to Faith Healing Fasting Feedback Focus Groups Funding Ghana Grant Health Alliance Health Personnel Healthcare Systems Human Rights Impairment Infrastructure Intervention Interview Investigational Therapies Language Learning Measures Mediating Mediator of activation protein Mental Health Mental Health Services Methodology Mission Modeling Myeloma Proteins Narration National Institute of Mental Health Nurses Outcome Patient-Focused Outcomes Patients Persons Pharmacotherapy Pilot Projects Prayers Prevalence Psychiatric Hospitals Qualitative Methods Quality of Care Quality of life Relationship-Building Research Resort Resources Rewards Safety Sampling Schizophrenia Services Severities Shame Site Specific qualifier value Strategic Planning System Techniques Technology Terminology Testing Training Training Support Treatment outcome United States Visiting Nurse abuse neglect animation clinical practice design digital digital health digital mental health disability effectiveness evaluation evidence base experience field study future implementation global health healing improved improved outcome innovation intervention effect low and middle-income countries mHealth patient safety preservation programs prototype psychiatric symptom psychologic psychological distress psychosocial research clinical testing severe mental illness sex social social stigma theories tool traditional care treatment as usual trial design usability

项目摘要

PROJECT SUMMARY Worldwide, serious mental illnesses (SMI) such as schizophrenia or bipolar disorder are major causes of impairment and disability. In West Africa, the hardships of SMI are compounded by pervasive societal stigma, scarce treatment options, systematic exclusion, neglect, and abuse. People with SMI in West Africa describe the experience as akin to “receiving a death sentence.” West African mental healthcare systems have severely constrained resources that contribute to a large treatment gap. Most people with SMI receive services from traditional and faith healers who do not provide high quality care. Healers often use practices such as chaining, seclusion, and forced fasting that often worsen the negative impacts of SMI. Given the shortage of skilled mental health providers and the prevalence of healers, coupled with the established infrastructure healers have in place (e.g., referral networks, “prayer camps”, community ties) global health leaders have argued that healers and prayer camp settings may be leveraged as conduits for treatment, provided they receive appropriate training and support to provide higher quality care. Our multinational research team has developed M&M: a dual-pronged intervention package comprised of a mobile health program designed to train healers to deliver evidence-based psychosocial interventions while maintaining safety and patient dignity in practice (M- Healer) combined with pharmacotherapy delivered directly to the patients at their prayer camps via visiting nurse (Mobile Nurse). We have successfully completed usability, acceptability, feasibility and preliminary clinical testing of the modular elements of the intervention at prayer camps, with very promising results. We now propose to evaluate the effectiveness of the integrated M&M intervention in a fully-powered trial and share it widely through a new West African Digital Mental Health Alliance (WADMA), a mission centered network designed to jumpstart digital mental health research and cross institutional collaboration though grant funded studies, education, and integration of digital mental health tools in clinical practice. We aim to: 1. Evaluate the effectiveness of the M&M intervention using a stepped-wedge cluster randomized trial design; 2. Examine mediators and moderators of M&M intervention effects; and 3. Use qualitative methods to inform M&M intervention optimization and future implementation. Although focused on West Africa, the dual-pronged model we are testing to address quality of care needs, the outcomes we will measure, and the methodological lessons we will learn will all have translational implications for development and implementation of integrated technology-assisted treatment support packages for paraprofessionals caring for people with SMI in the United States.

项目概要在世界范围内，精神分裂症或双相情感障碍等严重精神疾病 (SMI) 是导致精神分裂症的主要原因。在西非，普遍存在的社会耻辱加剧了 SMI 的困难，西非 SMI 患者的治疗选择稀缺、系统性排斥、忽视和虐待。这种经历类似于“被判死刑”。资源有限，导致大多数 SMI 患者接受的服务有限。不提供高质量护理的传统和信仰治疗师经常使用诸如连锁、鉴于技术人员的短缺，隔离和强制禁食往往会加剧 SMI 的负面影响。心理健康提供者和治疗师的普及率，加上已建立的治疗师基础设施，全球卫生领导人认为，已经到位（例如转诊网络、“祈祷营”、社区联系）治疗师和祈祷营场所可以作为治疗的渠道，只要他们接受我们的跨国研究团队已经开发出适当的培训和支持，以提供更高质量的护理。 M&M：双管齐下的干预方案，包括旨在培训治疗师的移动健康计划提供基于证据的心理社会干预措施，同时在实践中维护安全和患者尊严（M- 治疗师）与药物治疗相结合，通过拜访直接向患者的祈祷营提供治疗我们已经成功地完成了可用性、可接受性、可行性和初步工作。我们对祈祷营干预措施的模块化要素进行了临床测试，取得了非常有希望的结果。现在建议在全功率试验中评估综合 M&M 干预的有效性并分享它通过新的西非数字心理健康联盟（WADMA）广泛传播，这是一个以任务为中心的网络旨在通过赠款资助快速启动数字心理健康研究和跨机构合作研究、教育以及数字心理健康工具在临床实践中的整合我们的目标是： 1. 评估使用阶梯楔形整群随机试验设计的 M&M 干预的有效性；2. 检查 M&M 干预效果的中介变量和调节变量；以及 3. 使用定性方法为 M&M 提供信息；尽管重点关注西非，但双管齐下的模式。我们正在测试以满足护理需求的质量、我们将衡量的结果以及方法我们将汲取的经验教训都将对综合发展和实施产生转化影响为美国护理 SMI 患者的专业人员提供技术辅助治疗支持包国家。