Wakida Edith K, Obua Celestino, Haberer Jessica E, Bartels Stephen J
Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda.
Office of Research Administration, Mbarara University of Science and Technology, Mbarara, Uganda.
J Multidiscip Healthc. 2023 Feb 11;16:387-396. doi: 10.2147/JMDH.S401495. eCollection 2023.
Uganda adopted the World Health Organization (WHO) model of creating district health management teams (DHMT) comprised of public health officials and administrators to supervise health service delivery at the community level. The purpose of this study was to characterize the perspectives of the DMHT in providing support supervision to primary health-care providers implementing mental health integration using the pre-recorded material. Our aim was to identify barriers to individual uptake and contextual fit, and to solicit solutions for co-designed improvements.
We conducted a qualitative exploratory study using one-on-one interviews informed by the Practical Robust Implementation and Sustainability Model.
Members of the DHMT identified a systemic gap in supporting mental health integration into primary care, and reported limited knowledge in how to supervise mental health integration and lacked data on mental health delivery and outcomes. They recommended training of the DHMT in supervising mental health integration supported by standard outcome reports, pre-recorded instructional material by psychiatrists, checklists to help guide and standardize the process, and use of visual aids illustrating mental disorders and treatments for low-health literacy populations.
Implementing integrated mental health care using the WHO model of DHMTs as external facilitators and supervisors of primary health-care providers is potentially feasible and scalable, provided that substantial reforms occur such as training in how to provide supervision, standard collection of outcome reports, and practical tools to help guide and facilitate the process.
乌干达采用了世界卫生组织（WHO）的模式，创建了由公共卫生官员和管理人员组成的地区卫生管理团队（DHMT），以监督社区层面的卫生服务提供。本研究的目的是描述地区卫生管理团队在使用预先录制的材料为实施精神卫生整合的初级卫生保健提供者提供支持性监督方面的观点。我们的目标是确定个体采用和情境适配的障碍，并征求共同设计改进措施的解决方案。
我们采用基于实用稳健实施与可持续性模型的一对一访谈进行了一项定性探索性研究。
地区卫生管理团队的成员发现了在支持将精神卫生整合到初级保健方面的系统性差距，并报告称在如何监督精神卫生整合方面知识有限，且缺乏关于精神卫生服务提供和结果的数据。他们建议对地区卫生管理团队进行监督精神卫生整合方面的培训，包括提供标准结果报告、精神科医生预先录制的教学材料、有助于指导和规范流程的检查表，以及为低健康素养人群使用说明精神障碍和治疗方法的视觉辅助工具。
以世界卫生组织的地区卫生管理团队模式作为初级卫生保健提供者的外部促进者和监督者来实施综合精神卫生保健可能是可行且可扩展的，但前提是要进行重大改革，例如提供监督方面的培训、标准结果报告的收集以及有助于指导和促进该过程的实用工具。
