Brooke-Sumner Carrie, Sorsdahl Katherine, Lombard Carl, Petersen-Williams Petal, Myers Bronwyn
Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa.
Alan J Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, South Africa.
BMJ Open. 2018 Apr 9;8(4):e020539. doi: 10.1136/bmjopen-2017-020539.
A large treatment gap for common mental disorders (such as depression) exists in South Africa. Comorbidity with other chronic diseases, including HIV and diseases of lifestyle, is an increasing public health concern globally. Currently, primary health facilities as points of care for those with chronic disease provide limited services for common mental disorders. Assessing organisational readiness for change (ORC) towards adopting health innovations (such as mental health services) using contextually appropriate measures is needed to facilitate implementation of these services. This study aims to investigate the validity of the Texas Christian University Organisational Readiness for Change (TCU-ORC) scale in the South African context. Subsequently, we will develop a shortened version of this scale. This study is nested within Project MIND, a multiyear randomised controlled trial that is testing two different approaches for integrating counselling for common mental disorders into chronic disease care. Although the modified, contextually appropriate ORC measure resulting from the proposed study will be developed in the context of integrating mental health into primary healthcare services, the potential for the tool to be generalised to further understanding barriers to any change being implemented in primary care settings is high.
We will establish internal consistency (Cronbach's alpha coefficients), test-retest reliability (intraclass correlation coefficient) and construct validity of the long-form TCU-ORC questionnaire. Survey data will be collected from 288 clinical, management and operational staff from 24 primary health facilities where the Project MIND trial is implemented. A modified Delphi approach will assess the content validity of the TCU-ORC items and identify areas for potential adaptation and item reduction.
Ethical approval has been granted by the South African Medical Research Council (Protocol ID EC004-2-2015, amendment of 20 August 2017). Results will be submitted to peer-reviewed journals relevant to implementation and health systems strengthening.
南非常见精神障碍（如抑郁症）的治疗缺口很大。与其他慢性病（包括艾滋病毒和生活方式疾病）的共病是全球日益受到关注的公共卫生问题。目前，作为慢性病患者护理点的初级卫生设施为常见精神障碍提供的服务有限。需要采用因地制宜的措施评估组织对采用健康创新（如精神卫生服务）的变革准备情况（ORC），以促进这些服务的实施。本研究旨在调查德克萨斯基督教大学组织变革准备情况（TCU-ORC）量表在南非背景下的有效性。随后，我们将开发该量表的简化版。本研究嵌套于“MIND项目”，这是一项多年期随机对照试验，正在测试将常见精神障碍咨询纳入慢性病护理的两种不同方法。尽管拟议研究得出的经过修改且因地制宜的ORC测量方法将在将精神卫生纳入初级卫生保健服务的背景下制定，但该工具被推广用于进一步了解初级保健环境中实施任何变革的障碍的可能性很高。
我们将确定长版TCU-ORC问卷的内部一致性（克朗巴哈α系数）、重测信度（组内相关系数）和结构效度。将从实施“MIND项目”试验的24个初级卫生设施的288名临床、管理和运营人员收集调查数据。一种改良的德尔菲法将评估TCU-ORC项目的内容效度，并确定可能需要调整和减少项目的领域。
已获得南非医学研究理事会的伦理批准（方案编号EC004-2-2015，2017年8月20日修订）。研究结果将提交给与实施和卫生系统加强相关的同行评审期刊。
