Grant Merridy, Luvuno Zamasomi, Bhana Arvin, Mntambo Ntokozo, Gigaba Sithabisile, Ntswe Ellen, Petersen Inge
Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
SA Medical Research Council, Health Systems Research Unit, Durban, South Africa.
SSM Ment Health. 2021 Dec;1. doi: 10.1016/j.ssmmh.2021.100023. Epub 2021 Sep 23.
Low demand for mental health services in sub-Saharan Africa is driven by poor mental health literacy, stigma, and poor service availability.
To develop a Community Mental Health Education and Detection (CMED) Tool for adults for use by community health teams in South Africa aligned with their roles of health promotion, screening and linkage to care.
Formative evaluation methods involving four processes: (1) Ongoing engagement with the KwaZulu-Natal Department of Health (KZN DoH) to ensure co-creation of the CMED tool and alignment with routine community health team activities; (2) Adaptation of the CMED tool from the Community Informant Detection Tool (CIDT), used to promote help-seeking of people with mental health problems in Nepal; (3) Review of the CMED vignettes and illustrations by a panel of local and international mental health care experts to establish accuracy and contextual and cultural relevance; (4) Process mapping and focus group discussions (FGDs) with community health teams in one district to establish cultural and contextual appropriateness as well as coherence and compatibility with existing community-based services.
The resulting CMED tool consists of five case vignettes and related illustrations to facilitate psychoeducation and the detection of possible depression, anxiety, psychosis, harmful alcohol use, and drug use by community health teams. Based on prototype matching, it includes two structured questions to guide the community health teams in the detection and referral process. The tool was acceptable, culturally and contextually appropriate, and helpful for the services provided by community health teams. Challenges of working in households and the importance of self-care were highlighted as important considerations when developing training content and piloting the tool.
Extensive consultation with the KZN DoH, community health teams, and the expert mental health panel resulted in developing a tool that was perceived to be culturally sensitive and relevant to the community package of services.
撒哈拉以南非洲地区对心理健康服务的低需求是由心理健康素养差、污名化以及服务可及性差所驱动的。
开发一种针对成年人的社区心理健康教育与检测（CMED）工具，供南非的社区卫生团队使用，以契合其健康促进、筛查及与护理衔接的职责。
形成性评价方法涉及四个过程：（1）与夸祖鲁 - 纳塔尔省卫生部（KZN DoH）持续合作，以确保共同创建CMED工具并使其与社区卫生团队的日常活动保持一致；（2）从社区 informant 检测工具（CIDT）改编CMED工具，该工具用于促进尼泊尔有心理健康问题的人寻求帮助；（3）由一组本地和国际精神卫生保健专家审查CMED案例和插图，以确定其准确性以及背景和文化相关性；（4）与一个地区的社区卫生团队进行流程映射和焦点小组讨论（FGD），以确定文化和背景适宜性以及与现有社区服务的连贯性和兼容性。
最终的CMED工具由五个案例及相关插图组成，以促进社区卫生团队进行心理教育并检测可能存在的抑郁症、焦虑症、精神病、有害饮酒和药物使用情况。基于原型匹配，它包括两个结构化问题，以指导社区卫生团队进行检测和转诊过程。该工具是可接受的，在文化和背景上是适宜的，并且对社区卫生团队提供的服务有帮助。在制定培训内容和试用该工具时，强调了在家庭中工作的挑战以及自我护理的重要性作为重要考虑因素。
与KZN DoH、社区卫生团队和精神卫生专家小组进行广泛协商后，开发出了一种被认为在文化上敏感且与社区服务包相关的工具。
