Murphy Jill, Corbett Kitty K, Linh Dang Thuy, Oanh Pham Thi, Nguyen Vu Cong
Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, Suite 2400, 515 W. Hastings Street, Vancouver, BC, V6B 5K3, Canada.
School of Public Health and Health Systems, University of Waterloo, 200 University Ave. West, Waterloo, ON, N2L3G1, Canada.
BMC Health Serv Res. 2018 Aug 16;18(1):641. doi: 10.1186/s12913-018-3416-z.
Although the prevalence of depression in Vietnam is on par with global rates, services for depression are limited. The government of Vietnam has prioritized enhancing depression care through primary healthcare (PHC) and efforts are currently underway to test and scale-up psychosocial interventions throughout the country. With these initiatives in progress, it is important to understand implementation factors that might influence the successful integration of depression services into PHC. As the implementers of these new interventions, primary care providers (PHPs) are well placed to provide important insight into implementation factors affecting the integration of depression services into PHC. This mixed-methods study examines factors at the individual, organizational and structural levels that may act as barriers and facilitators to the integration of depression services into PHC in Vietnam from the perspective of PHPs.
Data collection took place in Hanoi, Vietnam in 2014. We conducted semi-structured interviews with PHPs (n = 30) at commune health centres and outpatient clinics in one rural and one urban district of Hanoi. Theoretical thematic analysis was used to analyse interview data. We administered an online survey to PHPs at n = 150 randomly selected communes across Hanoi. N = 226 PHPs responded to the survey. We used descriptive statistics to describe the study variables acting as barriers and facilitators and used a chi-square test of independence to indicate statistically significant (p < .05) associations between study variables and the profession, location and gender of PHPs.
Individual-level barriers include low level of knowledge and familiarity with depression among PHPs. Organizational barriers include low resource availability in PHC and low managerial discretion. Barriers at the structural level include limited mental health training among all PHPs and the existing programmatic structure of PHC in Vietnam, which sets mental health apart from general services. Facilitators at the individual level include positive attitudes among PHPs towards people with depression and interest in undergoing enhanced training in depression service delivery.
While facilitating factors at the individual level are encouraging, considerable barriers at the structural level must be addressed to ensure the successful integration of depression services into PHC in Vietnam.
尽管越南抑郁症的患病率与全球水平相当，但抑郁症服务却很有限。越南政府已将通过初级卫生保健（PHC）加强抑郁症护理作为优先事项，目前正在全国范围内开展测试和扩大社会心理干预措施的工作。随着这些举措的推进，了解可能影响抑郁症服务成功融入初级卫生保健的实施因素非常重要。作为这些新干预措施的实施者，初级保健提供者（PHPs）能够很好地洞察影响抑郁症服务融入初级卫生保健的实施因素。这项混合方法研究从初级保健提供者的角度，考察了个体、组织和结构层面可能成为越南抑郁症服务融入初级卫生保健的障碍和促进因素的因素。
2014年在越南河内进行了数据收集。我们对河内一个农村和一个城市地区的社区卫生中心和门诊诊所的初级保健提供者（n = 30）进行了半结构化访谈。采用理论主题分析法分析访谈数据。我们对河内随机选取的n = 150个社区的初级保健提供者进行了在线调查。N = 226名初级保健提供者回复了调查。我们使用描述性统计来描述作为障碍和促进因素的研究变量，并使用独立性卡方检验来表明研究变量与初级保健提供者的职业、地点和性别之间具有统计学意义（p <.05）的关联。
个体层面的障碍包括初级保健提供者对抑郁症的知识水平和熟悉程度较低。组织障碍包括初级卫生保健资源可用性低和管理自主权低。结构层面的障碍包括所有初级保健提供者的心理健康培训有限以及越南初级卫生保健的现有项目结构，该结构将心理健康与一般服务分开。个体层面的促进因素包括初级保健提供者对抑郁症患者的积极态度以及对接受抑郁症服务提供强化培训的兴趣。
虽然个体层面的促进因素令人鼓舞，但必须解决结构层面的相当大的障碍，以确保抑郁症服务在越南成功融入初级卫生保健。
