Wall Jonathan T, Kaiser Bonnie N, Friis-Healy Elsa A, Ayuku David, Puffer Eve S
1Duke University, Durham, NC USA.
2University of California San Diego, La Jolla, CA USA.
Int J Ment Health Syst. 2020 Feb 20;14:9. doi: 10.1186/s13033-020-00343-0. eCollection 2020.
A key focus of health systems strengthening in low- and middle-income countries is increasing reach and access through task-shifting. As such models become more common, it is critical to understand the experiences of lay providers because they are on the forefront for delivering care services. A greater understanding would improve lay provider support and help them provide high-quality care. This is especially the case for those providing mental health services, as providing psychological care may pose unique stressors. We sought to understand experiences of lay counselors, focusing on identity, motivation, self-efficacy, stress, and burnout. The goal was to understand how taking on a new provider role influences their lives beyond simply assuming a new task, which would in turn help identify actionable steps to improve interventions with task-shifting components.
Semi-structured interviews (n = 20) and focus group discussions (n = 3) were conducted with three lay counselor groups with varying levels of experience delivering a community-based family therapy intervention in Eldoret, Kenya. Thematic analysis was conducted, including intercoder reliability checks. A Stress Map was created to visualize stress profiles using free-listing and pile-sorting data collected during interviews and focus group discussions.
Counselors described high intrinsic motivation to become counselors and high self-efficacy after training. They reported positive experiences in the counselor role, with new skills improving their counseling and personal lives. As challenges arose, including client engagement difficulties and balancing many responsibilities, stress and burnout increased, dampening motivation and self-efficacy. In response, counselors described coping strategies, including seeking peer and supervisor support, that restored their motivation to persevere. At case completion, they again experienced high self-efficacy and a desire to continue.
Findings informed suggestions for ways to incorporate support for lay providers into task-shifting interventions at initiation, during training, and throughout implementation. These include acknowledging and preparing counselors for challenges during training, increasing explicit attention to counselor stress in supervision, fostering peer support among lay providers, and ensuring a fair balance between workload and compensation. Improving and building an evidence base around practices for supporting lay providers will improve the effectiveness and sustainability of lay provider-delivered interventions.
加强低收入和中等收入国家卫生系统的一个关键重点是通过任务转移扩大覆盖范围并提高可及性。随着此类模式变得越来越普遍，了解非专业提供者的经历至关重要，因为他们处于提供护理服务的前沿。更深入的了解将改善对非专业提供者的支持，并帮助他们提供高质量的护理。对于那些提供心理健康服务的人来说尤其如此，因为提供心理护理可能会带来独特的压力源。我们试图了解非专业咨询师的经历，重点关注身份认同、动机、自我效能感、压力和倦怠。目标是了解承担新的提供者角色如何不仅仅是承担一项新任务，还会影响他们的生活，这反过来将有助于确定可采取的行动步骤，以改进包含任务转移成分的干预措施。
对肯尼亚埃尔多雷特三个具有不同社区家庭治疗干预经验水平的非专业咨询师群体进行了半结构化访谈（n = 20）和焦点小组讨论（n = 3）。进行了主题分析，包括编码员间信度检查。使用在访谈和焦点小组讨论期间收集的自由列举和分类数据创建了一个压力图，以直观显示压力概况。
咨询师们表示成为咨询师有很高的内在动机，培训后自我效能感也很高。他们报告了在咨询师角色中的积极经历，新技能改善了他们的咨询工作和个人生活。随着挑战的出现，包括客户参与困难和平衡多项职责，压力和倦怠增加，削弱了动机和自我效能感。作为回应，咨询师们描述了应对策略，包括寻求同行和上级的支持，这些策略恢复了他们坚持下去的动力。在案例结束时，他们再次体验到了很高的自我效能感，并渴望继续下去。
研究结果为在启动、培训期间和整个实施过程中将对非专业提供者的支持纳入任务转移干预措施的方法提供了建议。这些建议包括在培训期间承认并让咨询师为挑战做好准备，在监督中更加明确地关注咨询师的压力，促进非专业提供者之间的同伴支持，以及确保工作量和报酬之间的公平平衡。改进并建立围绕支持非专业提供者实践的证据基础将提高非专业提供者提供的干预措施的有效性和可持续性。
