Giusto Ali M, Ayuku David, Puffer Eve S
Duke University Department of Psychology and Neuroscience, Duke University, 417 Chapel Drive, Durham, NC, 27708, USA.
Duke Global Health Institute, 310 Trent Dr, Durham, NC, 27710, USA.
Int J Ment Health Syst. 2022 Mar 4;16(1):16. doi: 10.1186/s13033-022-00522-1.
Men's depression, alcohol use, and family problems commonly co-occur to create of cluster of mental health problems. Yet, few treatments exist to address these problems, especially in low and middle-income countries (LMICs). This paper describes the development and initial feasibility and acceptability of a novel task-shifted intervention to address this cluster of men's mental health problems with a focus on engaging and retaining men in treatment.
The intervention, Learn, Engage, Act, Dedicate (LEAD), is based in behavioral activation blended with motivational interviewing and was pilot tested in Kenya. To develop LEAD, we engaged in a community-engaged multi-step, collaborative process with local Kenyan stakeholders. LEAD was piloted with nine fathers reporting problem drinking. To assess initial feasibility and acceptability, recruitment and participation were tracked and descriptive statistics were generated given engagement of men was key for proof of concept. Semi-structured interviews were conducted with participants and analyzed using thematic content analysis.
The development process resulted in a weekly 5-session intervention rooted in behavioral activation, motivational interviewing, and masculinity discussion strategies. These approaches were combined and adapted to fit contextually salient constructs, such as the importance of the man as provider, and streamlined for lay providers. Feasibility and acceptability results were promising with high attendance, acceptability of delivery and intervention content, and perceived intervention helpfulness.
Results describe an acceptable task-shifted treatment that may engage men in care and addresses a cluster of common mental health problems among men in ways that consider social determinants like masculinity. Findings set the stage for a larger trial. Trial registration ISRCTN, ISRCTN130380278. Registered 7 October 2019-Retrospectively registered, http://www.isrctn.com/ISRCTN13038027.
男性的抑郁症、酗酒和家庭问题常常同时出现，形成一系列心理健康问题。然而，针对这些问题的治疗方法很少，尤其是在低收入和中等收入国家（LMICs）。本文描述了一种新型任务转移干预措施的开发、初步可行性和可接受性，该干预措施旨在解决这一系列男性心理健康问题，重点是让男性参与并持续接受治疗。
“学习、参与、行动、奉献”（LEAD）干预措施基于行为激活，并融入动机性访谈，在肯尼亚进行了试点测试。为了开发LEAD，我们与肯尼亚当地利益相关者开展了一个社区参与的多步骤协作过程。LEAD在9名报告有酗酒问题的父亲中进行了试点。为了评估初步可行性和可接受性，对招募和参与情况进行了跟踪，并在男性参与是概念验证的关键的情况下生成了描述性统计数据。对参与者进行了半结构化访谈，并使用主题内容分析进行了分析。
开发过程产生了一个每周进行5次的干预措施，该措施基于行为激活、动机性访谈和男性气质讨论策略。这些方法被结合并调整，以适应与情境相关的突出概念，如男性作为养家糊口者的重要性，并为非专业提供者进行了简化。可行性和可接受性结果令人鼓舞，出席率高，干预措施的实施和内容可接受，且参与者认为干预措施有帮助。
研究结果描述了一种可接受的任务转移治疗方法，该方法可能会让男性参与到护理中，并以考虑男性气质等社会决定因素的方式解决男性群体中一系列常见的心理健康问题。研究结果为更大规模的试验奠定了基础。试验注册号：ISRCTN，ISRCTN130380278。2019年10月7日注册——追溯注册，http://www.isrctn.com/ISRCTN13038027 。
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