Bitta Mary A, Kariuki Symon M, Omar Anisa, Nasoro Leonard, Njeri Monica, Kiambu Cyprian, Ongeri Linnet, Newton Charles R J C
Clinical Research-Neurosciences, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya.
Department of Psychiatry, University of Oxford, Oxford, UK.
Glob Ment Health (Camb). 2020 May 18;7:e11. doi: 10.1017/gmh.2020.6. eCollection 2020.
Little data exists about the methodology of contextualizing version two of the Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) in resource-poor settings. This paper describes the contextualisation and pilot testing of the guide in Kilifi, Kenya.
Contextualisation was conducted as a collaboration between the KEMRI-Wellcome Trust Research Programme (KWTRP) and Kilifi County Government's Department of Health (KCGH) between 2016 and 2018. It adapted a mixed-method design and involved a situational analysis, stakeholder engagement, local adaptation and pilot testing of the adapted guide. Qualitative data were analysed using content analysis to identify key facilitators and barriers to the implementation process. Pre- and post-training scores of the adapted guide were compared using the Wilcoxon signed-rank test.
Human resource for mental health in Kilifi is strained with limited infrastructure and outdated legislation. Barriers to implementation included few specialists for referral, unreliable drug supply, difficulty in translating the guide to Kiswahili language, lack of clarity of the roles of KWTRP and KCGH in the implementation process and the unwillingness of the biomedical practitioners to collaborate with traditional health practitioners to enhance referrals to hospital. In the adaptation process, stakeholders recommended the exclusion of child and adolescent mental and behavioural problems, as well as dementia modules from the final version of the guide. Pilot testing of the adapted guide showed a significant improvement in the post-training scores: 66.3% (95% CI 62.4-70.8) 76.6% (95% CI 71.6-79.2) ( < 0.001).
The adapted mhGAP-IG version two can be used across coastal Kenya to train primary healthcare providers. However, successful implementation in Kilifi will require a review of new evidence on the burden of disease, improvements in the mental health system and sustained dialogue among stakeholders.
关于在资源匮乏地区将《精神卫生差距行动规划干预指南》第二版（mhGAP - IG）本地化的方法，现有数据很少。本文描述了该指南在肯尼亚基利菲的本地化及试点测试情况。
本地化工作于2016年至2018年间由肯尼亚医学研究协会 - 惠康信托研究计划（KWTRP）与基利菲县政府卫生部（KCGH）合作开展。采用了混合方法设计，包括情景分析、利益相关者参与、本地化调整以及对调整后的指南进行试点测试。使用内容分析法对定性数据进行分析，以确定实施过程中的关键促进因素和障碍。采用Wilcoxon符号秩检验比较调整后指南培训前后的得分。
基利菲的精神卫生人力资源紧张，基础设施有限且立法过时。实施障碍包括可供转诊的专科医生少、药品供应不可靠、难以将指南翻译成斯瓦希里语、KWTRP和KCGH在实施过程中的角色不明确，以及生物医学从业者不愿与传统卫生从业者合作以加强向医院的转诊。在调整过程中，利益相关者建议在指南最终版本中排除儿童和青少年精神及行为问题以及痴呆症模块。调整后指南的试点测试显示培训后得分有显著提高：66.3%（95%置信区间62.4 - 70.8）升至76.6%（95%置信区间71.6 - 79.2）（P < 0.001）。
调整后的mhGAP-IG第二版可用于肯尼亚沿海地区培训初级卫生保健提供者。然而，要在基利菲成功实施，需要审查关于疾病负担的新证据，改善精神卫生系统，并在利益相关者之间持续开展对话。
