Spagnolo Jessica, Champagne François, Leduc Nicole, Piat Myra, Melki Wahid, Charfi Fatma, Laporta Marc
School of Public Health, Institut de recherche en santé publique de l'Université de Montréal (IRSPUM), University of Montreal, 7101 Parc Avenue, Montreal, Quebec, H3N 1X9, Canada.
Douglas Mental Health University Institute (CIUSS Ouest-de-l'Île-de-Montréal), 6875 LaSalle boul., Montreal, Québec, H4H 1R3, Canada.
BMC Health Serv Res. 2017 Jan 17;17(1):38. doi: 10.1186/s12913-017-1992-y.
In low- and middle-income countries (LMICs), addressing the high prevalence of mental disorders is a challenge given the limited number and unequal distribution of specialists, as well as scarce resources allocated to mental health. The Mental Health Gap Action Programme (mhGAP) and its accompanying Intervention Guide (IG), developed by the World Health Organization (WHO), aim to address this challenge by training non-specialists such as general practitioners (GPs) in mental health care. This trial aims to implement and evaluate an adapted version of the mhGAP-IG (version 1.0) offered to GPs in 2 governorates of Tunisia (i.e., Tunis and Sousse), in order to uncover important information regarding implementation process and study design before country-wide implementation and evaluation.
METHODS/DESIGN: First, a systematic review will be conducted to explore types and effectiveness of mental health training programs offered to GPs around the world, with a specific focus on programs implemented and evaluated in LMICs. Second, a cluster randomized controlled trial (RCT) will be conducted to evaluate the effectiveness of the implemented training based on the mhGAP-IG (version 1.0). Third, multiple case study design will be used to explore how contextual factors impact the successful implementation of the training and desired outcomes.
In Tunisia, an important need exists to further develop proximity health services and to address the growing mental health treatment gap. One solution is to train GPs in the detection, treatment, and management of mental health problems, given their strategic role in the healthcare system. This trial thus aims to implement and evaluate an adapted version of a training based on the mhGAP-IG (version 1.0) in Tunis and Sousse before country-wide implementation and evaluation. Several contributions are envisioned: adding to the growing evidence on the mhGAP and its accompanying guide, especially in French-speaking nations; building research capacity in Tunisia and more generally in LMICs by employing rigorous designs; evaluating an adapted version of the mhGAP-IG (version 1.0) on a sample of GPs; generating important information regarding implementation process and study design before country-wide implementation; and complimenting the trial results with implementation analysis, a priority in global mental health.
在低收入和中等收入国家（LMICs），鉴于专科医生数量有限且分布不均，以及分配给心理健康的资源稀缺，应对精神障碍的高患病率是一项挑战。世界卫生组织（WHO）制定的心理健康差距行动规划（mhGAP）及其配套的干预指南（IG）旨在通过培训全科医生（GPs）等非专科医生来应对这一挑战。本试验旨在实施和评估在突尼斯两个省（即突尼斯市和苏塞）向全科医生提供的mhGAP-IG（第1.0版）改编版，以便在全国范围内实施和评估之前，获取有关实施过程和研究设计的重要信息。
方法/设计：首先，将进行系统评价，以探索全球范围内为全科医生提供的心理健康培训项目的类型和效果，特别关注在低收入和中等收入国家实施和评估的项目。其次，将进行整群随机对照试验（RCT），以评估基于mhGAP-IG（第1.0版）实施的培训的效果。第三，将采用多案例研究设计，以探讨背景因素如何影响培训的成功实施和预期结果。
在突尼斯，迫切需要进一步发展近距离医疗服务，并应对日益扩大的心理健康治疗差距。一种解决方案是培训全科医生进行心理健康问题的检测、治疗和管理，因为他们在医疗系统中发挥着战略作用。因此，本试验旨在在全国范围内实施和评估之前，在突尼斯市和苏塞实施和评估基于mhGAP-IG（第1.0版）的培训改编版。预计会有多项贡献：增加关于mhGAP及其配套指南的越来越多的证据，特别是在法语国家；通过采用严格的设计，在突尼斯以及更广泛的低收入和中等收入国家建设研究能力；在全科医生样本上评估mhGAP-IG（第1.0版）的改编版；在全国范围内实施之前，生成有关实施过程和研究设计的重要信息；并用实施分析补充试验结果，这是全球心理健康的一个优先事项。
