Esponda Georgina Miguel, Hartman Sarah, Qureshi Onaiza, Sadler Euan, Cohen Alex, Kakuma Ritsuko
Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
Clinical Psychology Department, Clark University, Worcester, Massachusetts, MA, USA.
Lancet Psychiatry. 2020 Jan;7(1):78-92. doi: 10.1016/S2215-0366(19)30125-7. Epub 2019 Aug 29.
Integration of services into primary health care for people with common mental disorders is considered a key strategy to improve access to mental health care in low-income and middle-income countries, yet services at the primary care level are largely unavailable. We did a systematic review to understand the barriers and facilitators in the implementation of mental health programmes. We searched five databases and included studies published between Jan 1, 1990, and Sept 1, 2017, that used qualitative methods to assess the implementation of programmes for adults with common mental disorders at primary health-care settings in low-income and middle-income countries. The Critical Appraisal Skills Programme Qualitative Checklist was used to assess the quality of eligible papers. We used the so-called best fit framework approach to synthesise findings according to the Consolidated Framework for Implementation Research. We identified 24 papers for inclusion. These papers described the implementation of nine programmes in 11 countries. Key factors included: the extent to which an organisation is ready for implementation; the attributes, knowledge, and beliefs of providers; complex service user needs; adaptability and perceived advantage of interventions; and the processes of planning and evaluating the implementation. Evidence on implementation of mental health programmes in low-income and middle-income countries is scarce. Synthesising results according to the Consolidated Framework for Implementation Research helped to identify key areas for future action, including investment in primary health-care strengthening, capacity building for health providers, and increased support to address the social needs of service users.
将服务纳入常见精神障碍患者的初级卫生保健被视为低收入和中等收入国家改善精神卫生保健可及性的一项关键战略，但初级保健层面的服务在很大程度上难以获得。我们进行了一项系统综述，以了解精神卫生项目实施过程中的障碍和促进因素。我们检索了五个数据库，并纳入了1990年1月1日至2017年9月1日期间发表的研究，这些研究采用定性方法评估了低收入和中等收入国家初级卫生保健机构中针对患有常见精神障碍的成年人的项目实施情况。使用批判性评估技能计划定性清单来评估合格论文的质量。我们根据实施研究综合框架采用所谓的最佳匹配框架方法来综合研究结果。我们确定了24篇论文以供纳入。这些论文描述了11个国家九个项目的实施情况。关键因素包括：一个组织为实施做好准备的程度；提供者的属性、知识和信念；复杂的服务使用者需求；干预措施的适应性和感知优势；以及规划和评估实施情况的过程。关于低收入和中等收入国家精神卫生项目实施情况的证据很少。根据实施研究综合框架综合结果有助于确定未来行动的关键领域，包括投资加强初级卫生保健、对卫生提供者进行能力建设，以及增加支持以满足服务使用者的社会需求。
