Murray Laura K, Tol Wietse, Jordans Mark, Zangana Goran Sabir, Amin Ahmed Mohammed, Bolton Paul, Bass Judith, Bonilla-Escobar Fransisco Javier, Thornicroft Graham
Associate Scientist, Clinical Psychologist, Johns Hopkins School of Public Health; Dept of Mental Health, Applied Mental Health Research Group (AMHR).
Dr. Ali and Rose Kawi Assistant Professor, Johns Hopkins School of Public Health; Dept of Mental Health.
Intervention (Amstelveen). 2014 Dec;12(Suppl 1):94-112. doi: 10.1097/WTF.0000000000000070.
The burden of mental health problems in (post)conflict low- and middle-income countries (LMIC) is substantial. Despite growing evidence for the effectiveness of selected mental health programs in conflict-affected LMIC and growing policy support, actual uptake and implementation have been slow. A key direction for future research, and a new frontier within science and practice, is Dissemination and Implementation (DI) which directly addresses the movement of evidence-based, effective health care approaches from experimental settings into routine use. This paper outlines some key implementation challenges, and strategies to address these, while implementing evidence-based treatments in conflict-affected LMIC based on the authors' collective experiences. Dissemination and implementation evaluation and research in conflict settings is an essential new research direction. Future DI work in LMIC should include: 1) defining concepts and developing measurement tools, 2) the measurement of DI outcomes for all programming, and 3) the systematic evaluation of specific implementation strategies.
在冲突后低收入和中等收入国家（LMIC），心理健康问题的负担相当沉重。尽管越来越多的证据表明某些心理健康项目在受冲突影响的低收入和中等收入国家有效，且政策支持也不断增加，但实际采用和实施情况却很缓慢。未来研究的一个关键方向以及科学与实践的一个新领域是传播与实施（DI），它直接关注基于证据的有效医疗方法从实验环境到常规使用的转变。本文根据作者的集体经验，概述了在受冲突影响的低收入和中等收入国家实施循证治疗时的一些关键实施挑战以及应对这些挑战的策略。在冲突环境中进行传播与实施评估及研究是一个重要的新研究方向。未来在低收入和中等收入国家开展的传播与实施工作应包括：1）定义概念并开发测量工具；2）对所有项目的传播与实施结果进行测量；3）对具体实施策略进行系统评估。
