Cavero V, Toyama M, Castro H, Couto M T, Brandt L, Quayle J, Menezes P R, Mohr D C, Araya R, Miranda J J, Diez-Canseco F
CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.
Population Mental Health Research Centre, Universidade de São Paulo, São Paulo, Brazil.
Discov Ment Health. 2022;2(1):12. doi: 10.1007/s44192-022-00015-0. Epub 2022 Jun 3.
Two randomized controlled trials (RCTs) in Brazil and Peru demonstrated the effectiveness of CONEMO, a digital intervention supported by trained nurses or nurse assistants (NAs), to reduce depressive symptoms in people with diabetes and/or hypertension. This paper extends the RCTs findings by reflecting on the conditions needed for its wider implementation in routine care services. A qualitative study using semi-structured interviews and content analysis was conducted with nurses/NAs, clinicians, healthcare administrators, and policymakers. Informants reported that CONEMO would be feasible to implement in their health services, but some conditions could be improved before its scale-up: reducing workloads of healthcare workers; raising mental health awareness among clinicians and administrators; being able to inform, deliver and accompany the intervention; assuring appropriate training and supervision of nurses/NAs; and supporting the use of technology in public health services and by patients, especially older ones. We discuss some suggestions on how to overcome these challenges.
巴西和秘鲁的两项随机对照试验（RCT）证明了CONEMO的有效性，这是一种由经过培训的护士或护士助理（NA）提供支持的数字干预措施，可减轻糖尿病和/或高血压患者的抑郁症状。本文通过思考在常规护理服务中更广泛实施该措施所需的条件，扩展了随机对照试验的结果。我们对护士/护理助理、临床医生、医疗保健管理人员和政策制定者进行了一项采用半结构化访谈和内容分析的定性研究。受访者表示，CONEMO在他们的医疗服务中实施是可行的，但在扩大规模之前，一些条件可以得到改善：减轻医护人员的工作量；提高临床医生和管理人员对心理健康的认识；能够对干预措施进行告知、提供和跟进；确保对护士/护理助理进行适当的培训和监督；以及支持公共卫生服务机构和患者，特别是老年患者使用技术。我们讨论了一些关于如何克服这些挑战的建议。
