Myers Bronwyn, Joska John A, Lund Crick, Levitt Naomi S, Butler Christopher C, Naledi Tracey, Milligan Peter, Stein Dan J, Sorsdahl Katherine
Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa,
Division of Addiction Psychiatry, Psychiatry and Mental Health,
Patient Prefer Adherence. 2018 Sep 18;12:1797-1803. doi: 10.2147/PPA.S176356. eCollection 2018.
To describe patient perceptions of the acceptability of integrating mental health counseling within primary care facilities in the Western Cape province of South Africa and their preferences for the way in which this care is delivered.
Qualitative interviews with 30 purposively selected patients receiving treatment for HIV or diabetes within primary care facilities who screened positive for depression using the Center for Epidemiological Studies Depression Scale or hazardous alcohol use through the Alcohol Use Disorders Identification Test.
Participants articulated high levels of unmet need for mental health services and strong associations between poor mental health and the challenges of living with a chronic disease. Consequently, they considered it acceptable to offer screening and mental health counseling within the context of chronic disease care. They thought counseling would be highly relevant if it helped patients develop adaptive strategies for coping with stress and negative emotions. Irrespective of chronic disease, patients indicated a preference for lay counselors rather than existing clinicians as potential delivery agents, supporting a task-shared approach to mental health counseling delivery in primary care settings. Some expressed concern about the feasibility of using lay counselors already present in facilities to deliver this service, suggesting that additional counselors might be needed.
Findings demonstrate a need for mental health counseling within the context of chronic disease care in South Africa. Task-shared approaches, using lay counselors, seem acceptable to patients - provided counselors are selected to ensure they possess the qualities associated with effective counselors. Findings have informed the design of a task-shared mental health program that is responsive to the preferences of patients with chronic diseases.
描述南非西开普省患者对在初级保健机构中整合心理健康咨询服务的可接受性看法，以及他们对提供这种护理方式的偏好。
对30名在初级保健机构接受艾滋病毒或糖尿病治疗的患者进行定性访谈，这些患者使用流行病学研究中心抑郁量表筛查出抑郁呈阳性，或通过酒精使用障碍识别测试筛查出有危险饮酒行为。
参与者明确表示对心理健康服务的需求未得到充分满足，且心理健康不佳与慢性病生活挑战之间存在紧密关联。因此，他们认为在慢性病护理背景下提供筛查和心理健康咨询是可以接受的。他们认为，如果咨询能帮助患者制定应对压力和负面情绪的适应性策略，那么咨询将具有高度相关性。无论患有何种慢性病，患者都表示倾向于由非专业咨询师而非现有临床医生作为潜在的服务提供者，这支持了在初级保健环境中采用任务分担方式提供心理健康咨询。一些人对利用机构中现有的非专业咨询师提供这项服务的可行性表示担忧，认为可能需要额外的咨询师。
研究结果表明南非在慢性病护理背景下需要心理健康咨询。采用非专业咨询师的任务分担方式似乎为患者所接受——前提是选择的咨询师要确保具备与有效咨询师相关的特质。研究结果为一项响应慢性病患者偏好的任务分担心理健康项目设计提供了参考。
