Aligning facility leadership and climate to advance mental health services integration in Malawi

协调设施领导和氛围，促进马拉维的精神卫生服务一体化

• 批准号: 10651946
• 负责人: Kazione Kulisewa
• 金额: $ 98.17万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-06-01 至 2028-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10651946
• 关键词: Address; Adoption; Attention; Attitude; Caring; Charge; Climate; Clinic; Cluster randomized trial; Country; Data; Disease; Effectiveness; Ensure; Evidence based treatment; Feedback; Funding; Goals; Grant; HIV; Health Services Research; Health Status; Health system; Income; Industrial Psychology; Leadership; Malawi; Manuscripts; Medical; Mental Depression; Mental Health; Mental Health Services; Modeling; Mood Disorders; National Institute of Mental Health; Norway; Organizational Change; Outcome Measure; Patients; Play; Policies; Policy Maker; Process; Provider; Randomized; Research; Research Methodology; Research Personnel; Research Project Grants; Research Proposals; Resource-limited setting; Rewards; Role; Structure; Supervision; Testing; Work; Writing; arm; clinical care; cost effectiveness; effective intervention; effectiveness outcome; empowerment; evidence base; health care settings; health science research; implementation efforts; implementation science; implementation strategy; innovation; leadership development; low and middle-income countries; low income country; member; organizational climate; programs; projectin; randomized trial; success; symposium; tool

ABSTRACT Task-shared mental health interventions are effective in low- and middle-income countries, yet they remain underutilized and the mental health treatment gap remains substantial. Innovative implementation strategies are needed to successfully integrate evidence-based mental health treatments into medical care in LMICs. A common component of many implementation efforts is a “champion” strategy which identifies and empowers an on-the-ground staff member as the implementation champion, in charge of focusing their colleagues’ efforts on implementation of the evidence-based treatment model. Yet a growing body of research, including our own work in Malawi and elsewhere, highlights that the champion’s success is strongly influenced by the strength of support from their line manager and other up-the-chain organization leaders, who are critical in aligning the organization’s climate and priorities in support of the implementation effort. Approaches to influencing leadership engagement to change organizational climate and align priorities has been developed over decades in the field of organizational and industrial psychology but only relatively recently applied to implementation science health research and primarily to implementation in high-income countries. The Leadership and Organizational Change for Implementation (LOCI) is a recently developed multi-level leadership coaching implementation strategy that has demonstrated effectiveness in changing organizational climate, aligning priorities, and enhancing mental health treatment model integration in the US and Norway, but has not been adapted to or tested in low-income country settings. LOCI has significant potential to address the gaps identified in our current research by aligning leadership priorities to support champions in advancing mental health integration. The objective of the present proposal is to test the impact and sustainability of supplementing the standard champion implementation approach with the LOCI leadership alignment strategy to achieve successful integration of an evidence-based, task-shared mental health treatment model into general medical care. We will use a cluster-randomized trial to evaluate the impact of the adapted leadership alignment strategy on integration of an evidence-based mental health treatment package into multiple medical care settings (NCD, HIV, and TB care), assessing proximal (climate), primary implementation (adoption, reach, fidelity), downstream patient mental health, and cost-effectiveness outcomes as well as sustainability after conclusion of the leadership alignment activities. Additionally, we will use the structure of the research project to further strengthen capacity among mental health researchers and policy makers in Malawi. Leadership alignment strategies are an understudied but essential ingredient for successful mental health integration efforts. This project will make a major contribution to our understanding of the role of leadership alignment in advancing evidence-based mental health integration in LMICs.

抽象的 任务共享的心理健康干预措施在低收入和中等收入国家有效，但它们仍然存在 未被充分利用，心理健康治疗差距仍然很大。创新的实施策略 需要成功地将基于证据的心理健康治疗纳入LMIC的医疗服务。 许多实施工作的共同组成部分是“冠军”策略，该战略识别和 授权在地面工作人员担任实施冠军，负责专注 同事在实施基于证据的治疗模型方面的努力。然而，越来越多的研究， 包括我们自己在马拉维和其他地方的工作，重点是冠军的成功受到了强烈影响 通过其线路经理和其他链链组织领导者的支持力量，这是至关重要的 为了使组织的气候和优先事项保持一致，以支持实施工作。 影响领导力参与以改变组织环境并保持优先级的方法 数十年来在组织和工业心理学领域开发，但仅相对 最近应用于实施科学健康研究，主要用于高收入的实施 国家。实施的领导和组织变革（LOCI）是最近开发的 多级领导力教练实施策略，该战略在改变方面有效 组织环境，保持优先级和增强美国心理健康治疗模型的整合 和挪威，但没有在低收入国家环境中适应或测试。基因座具有重要意义 通过调整领导优先级以支持我们当前研究中确定的差距的潜力 拥护心理健康融合的拥护者。 本提案的目的是测试补充标准的影响和可持续性 冠军实施方法采用基因座领导策略来取得成功 将基于循证的，任务共享的心理健康治疗模型整合到一般医疗中。我们 将使用集群随机试验来评估适应性的领导力对准策略对 将基于证据的心理健康治疗方案整合到多个医疗机构中（NCD， 艾滋病毒和结核病护理），评估近端（气候），主要实施（采用，覆盖范围，保真度）， 下游患者的心理健康，成本效益结果以及结论后的可持续性 领导力对齐活动。此外，我们将使用研究项目的结构来进一步 加强马拉维心理健康研究人员和政策制定者的能力。 领导力对准策略是成功的心理健康的理解但必不可少的 整合工作。该项目将为我们理解领导作用做出重大贡献 在LMIC中推进基于证据的心理健康融合方面的一致性。