Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa (Petersen, Grant, Gigaba, Van Rensburg, Luvuno, Bhana); Department of Global Health (Kemp, Rao, Wagenaar, Sherr, Barnabas), Department of Psychiatry and Behavioral Sciences (Rao), Department of Epidemiology (Wagenaar), University of Washington, Seattle; Norwich Medical School, University of East Anglia, Norwich, Norfolk, United Kingdom (Bachmann); School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa (Mntambo, Gigaba); Center for Global Mental Health Research, National Institute of Mental Health, Bethesda, Maryland (Amarreh); Knowledge Translation Unit, University of Cape Town, Cape Town, South Africa, and King's Global Health Institute, King's College London, London (Fairall); Mental Health and Substance Abuse Directorate, KwaZulu-Natal Department of Health, Natalia, Pietermaritzburg, South Africa (Hongo); Health Systems Research Unit, South African Medical Research Council, Durban, South Africa (Bhana).
Psychiatr Serv. 2021 Sep 1;72(9):1065-1075. doi: 10.1176/appi.ps.202000014. Epub 2021 Mar 11.
People with chronic general medical conditions who have comorbid depression experience poorer health outcomes. This problem has received scant attention in low- and middle-income countries. The aim of the ongoing study reported here is to refine and promote the scale-up of an evidence-based task-sharing collaborative care model, the Mental Health Integration (MhINT) program, to treat patients with comorbid depression and chronic disease in primary health care settings in South Africa.
Adopting a learning-health-systems approach, this study uses an onsite, iterative observational implementation science design. Stage 1 comprises assessment of the original MhINT model under real-world conditions in an urban subdistrict in KwaZulu-Natal, South Africa, to inform refinement of the model and its implementation strategies. Stage 2 comprises assessment of the refined model across urban, semiurban, and rural contexts. In both stages, population-level effects are assessed by using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) evaluation framework with various sources of data, including secondary data collection and a patient cohort study (N=550). The Consolidated Framework for Implementation Research is used to understand contextual determinants of implementation success involving quantitative and qualitative interviews (stage 1, N=78; stage 2, N=282).
The study results will help refine intervention components and implementation strategies to enable scale-up of the MhINT model for depression in South Africa.
Next steps include strengthening ongoing engagements with policy makers and managers, providing technical support for implementation, and building the capacity of policy makers and managers in implementation science to promote wider dissemination and sustainment of the intervention.
患有慢性全身性疾病且合并抑郁的人群健康状况较差。这一问题在中低收入国家尚未得到充分关注。本报告介绍的正在进行的研究旨在完善和推广基于证据的任务分担协作式护理模式，即心理健康综合（MhINT）计划，以便在南非的基层医疗环境中治疗患有合并抑郁和慢性疾病的患者。
本研究采用学习型卫生系统方法，采用现场、迭代观测性实施科学设计。第 1 阶段包括在南非夸祖鲁-纳塔尔省的一个城市分区，根据实际情况评估原始 MhINT 模型，为模型的完善和实施策略提供信息。第 2 阶段包括在城市、半城市和农村环境中评估完善后的模型。在两个阶段中，通过使用 RE-AIM（可及性、有效性、采用、实施、维持）评价框架，结合二次数据收集和患者队列研究（N=550）等多种数据源，评估人群层面的效果。实施研究综合框架用于了解涉及定量和定性访谈的实施成功的背景决定因素（第 1 阶段，N=78；第 2 阶段，N=282）。
研究结果将有助于完善干预措施和实施策略，从而使 MhINT 模型在南非得以推广，用于治疗抑郁。
下一步包括加强与决策者和管理者的持续合作，为实施提供技术支持，并在实施科学方面提高决策者和管理者的能力，以促进该干预措施的更广泛传播和维持。
