在乌干达中部的初级卫生保健环境中，为糖尿病合并抑郁症患者开发和定制同伴支持计划。

The development and tailoring of a peer support program for patients with diabetes mellitus and depression in a primary health care setting in Central Uganda.

机构信息

Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda.

University of Washington, Los Angeles, USA.

出版信息

BMC Health Serv Res. 2020 May 19;20(1):436. doi: 10.1186/s12913-020-05301-7.

DOI:10.1186/s12913-020-05301-7

PMID:32430046

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7236139/

Abstract

BACKGROUND

About 20-40% of patients with diabetes mellitus (DM) suffer from depressive disorders (DD) during the course of their illness. Despite the high burden of DD among patients with DM, it is rarely identified and adequately treated at the majority of primary health care clinics in sub-Saharan Africa (SSA). The use of peer support to deliver components of mental health care have been suggested in resource constrained SSA, even though its acceptability have not been fully examined.

METHODS

We conducted qualitative interviews (QI) to assess the perceptions of DM patients with an experience of suffering from a DD about the acceptability of delivering peer support to patients with comorbid DM and DD. We then trained them to deliver peer support to DM patients who were newly diagnosed with DD. We identified challenges and potential barriers to a successful implementation of peer support, and generated solutions to these barriers.

RESULTS

Participants reported that for one to be a peer, they need to be mature in age, consistently attend the clinics/keep appointments, and not to be suffering from any active physical or co-morbid mental or substance abuse disorder. Participants anticipated that the major barrier to the delivery of peer support would be high attrition rates as a result of the difficulty by DM patients in accessing the health care facility due to financial constraints. A potential solution to this barrier was having peer support sessions coinciding with the return date to hospital. Peers reported that the content of the intervention should mainly be about the fact that DM was a chronic medical condition for which there was need to adhere to lifelong treatment. There was consensus that peer support would be acceptable to the patients.

CONCLUSION

Our study indicates that a peer support program is an acceptable means of delivering adjunct care to support treatment adherence and management, especially in settings where there are severe staff shortages and psycho-education may not be routinely delivered.

摘要

背景

约 20-40%的糖尿病（DM）患者在患病过程中会出现抑郁障碍（DD）。尽管 DM 患者的 DD 负担很重，但在撒哈拉以南非洲（SSA）的大多数初级保健诊所，这种疾病很少被发现，也没有得到充分治疗。在资源有限的 SSA，有人建议利用同伴支持来提供心理健康护理的部分内容，尽管其可接受性尚未得到充分检验。

方法

我们进行了定性访谈（QI），以评估经历过 DD 的 DM 患者对向同时患有 DM 和 DD 的患者提供同伴支持的可接受性的看法。然后，我们对他们进行培训，让他们向新诊断出 DD 的 DM 患者提供同伴支持。我们确定了成功实施同伴支持的挑战和潜在障碍，并提出了克服这些障碍的方法。

结果

参与者报告说，要成为同伴，他们需要年龄成熟，定期参加诊所/约会，并且没有任何活跃的身体或共患精神或物质滥用障碍。参与者预计，提供同伴支持的主要障碍将是由于 DM 患者因经济拮据而难以获得医疗保健服务而导致的高流失率。克服这一障碍的一个潜在方法是将同伴支持会议安排在患者返回医院的日期。同伴报告说，干预的内容主要应该是 DM 是一种慢性疾病，需要终身坚持治疗。他们一致认为，同伴支持将受到患者的欢迎。