Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.
Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.
Glob Health Action. 2022 Dec 31;15(1):2080344. doi: 10.1080/16549716.2022.2080344.
Effective interventions exist for heavy drinking and depression but to date there has been limited translation into routine practice in global health systems. This evidence-to-practice gap is particularly evident in low- and middle-income countries. The international SCALA project (Scale-up of Prevention and Management of Alcohol Use Disorders and Comorbid Depression in Latin America) sought to test the impact of multilevel implementation strategies on rates of primary health care-based measurement of alcohol consumption and identification of depression in Colombia, Mexico, and Peru.
To describe the process of development and cultural adaptation of the clinical intervention and training package.
We drew on Barrero and Castro's four-stage cultural adaption model: 1) information gathering, 2) preliminary adaption, 3) preliminary adaption tests, and 4) adaption refinement. The Tailored Implementation in Chronic Diseases checklist helped us identify potential factors that could affect implementation, with local stakeholder groups established to support the tailoring process, as per the Institute for Healthcare Improvement's Going to Scale Framework.
In Stage 1, international best practice guidelines for preventing heavy drinking and depression, and intelligence on the local implementation context, were synthesised to provide an outline clinical intervention and training package. In Stage 2, feedback was gathered from local stakeholders and materials refined accordingly. These materials were piloted with local trainers in Stage 3, leading to further refinements including developing additional tools to support delivery in busy primary care settings. Stage 4 comprised further adaptions in response to real-world implementation, a period that coincided with the onset of the COVID-19 pandemic, including translating the intervention and training package for online delivery, and higher priority for depression screening in the clinical pathway.
Our experience highlights the importance of meaningful engagement with local communities, alongside the need for continuous tailoring and adaptation, and collaborative decision-making.
尽管已有针对重度饮酒和抑郁的有效干预措施，但迄今为止，这些措施在全球卫生系统中尚未得到广泛应用。在中低收入国家，这一从证据到实践的差距尤为明显。国际 SCALA 项目（拉丁美洲扩大预防和管理酒精使用障碍及共病抑郁项目）旨在检验多层次实施策略对哥伦比亚、墨西哥和秘鲁基层医疗中酒精使用测量和抑郁识别率的影响。
描述临床干预和培训包的开发及文化调适过程。
我们借鉴了 Barrera 和 Castro 的四阶段文化调适模型：1）信息收集，2）初步调适，3）初步调适测试，4）调适完善。根据美国卫生保健改进研究所的“按规模实施”框架，我们利用“慢性病定制实施清单”确定可能影响实施的潜在因素，并成立了当地利益相关者团体来支持定制过程。
在第 1 阶段，我们综合了预防重度饮酒和抑郁的国际最佳实践指南和当地实施情况的信息，以提供一个概述性的临床干预和培训包。在第 2 阶段，我们从当地利益相关者那里收集反馈，并相应地改进材料。在第 3 阶段，这些材料在当地培训师中进行了试点，进一步的改进包括开发额外的工具，以支持在繁忙的基层医疗环境中实施。第 4 阶段包括根据实际实施情况进行进一步调适，恰逢 COVID-19 大流行开始，包括将干预和培训包翻译成在线交付，以及在临床路径中更优先考虑抑郁筛查。
我们的经验强调了与当地社区进行有意义的合作的重要性，同时需要不断调整和适应，以及协作决策。
