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.

项目摘要在全球范围内，严重的精神疾病（SMI），例如精神分裂症或躁郁症是障碍和残疾。在西非，SMI的艰辛被普遍的社会污名化了，稀缺的治疗选择，系统排除，忽视和虐待。西非有SMI的人描述类似于“接受死刑”的经历。西非心理保健系统严重限制有助于较大治疗差距的资源。大多数有SMI的人都从不提供高质量护理的传统和信仰治疗者。治疗师经常使用诸如链接之类的做法，隔离和强迫禁食通常会担心SMI的负面影响。考虑到熟练的短缺心理健康提供者和治疗师的患病率，再加上已建立的基础设施治疗师全球卫生领导人认为，到位（例如，推荐网络，“祈祷营”，社区关系）辩称治疗者和祈祷营的环境可以作为治疗的导管来利用，只要他们接受适当的培训和支持以提供更高质量的护理。我们的跨国研究团队已经发展 M＆M：一项手机健康计划的双管干预套件，旨在培训治疗者提供基于证据的社会心理干预措施，同时保持安全和患者尊严的实践（m-）治疗师）结合药物疗法直接通过访问来祈祷营地的患者护士（移动护士）。我们已经成功完成了可用性，可接受性，可行性和初步对祷告营地干预的模块化元素的临床测试，结果非常有希望。我们现在提出的建议在全面的试验中评估综合M＆M干预的有效性它通过新的西非数字心理健康联盟（WADMA）广泛，这是一个以任务为中心的网络旨在跳到数字心理健康研究和跨机构合作，尽管赠款资助了数字心理健康工具在临床实践中的研究，教育和整合。我们的目标是：1。评估使用阶梯式北向群集随机试验设计的M＆M干预的有效性； 2。检查 M＆M干预效果的介体和主持人；和3。使用定性方法通知M＆M 干预优化和未来实施。虽然专注于西非，但双管模型我们正在测试以满足护理需求的质量，我们将测量的结果以及方法论我们将学习的教训将对整合的开发和实施具有翻译意义技术辅助治疗支持套件，用于关心联合有SMI的人国家。