Department of Primary Care & Mental Health, University of Liverpool, Liverpool, UK.
NIHR Applied Research Collaboration North West Coast (ARC NWC), Liverpool, UK.
Int J Equity Health. 2024 Feb 2;23(1):19. doi: 10.1186/s12939-024-02106-6.
Mental health services are scarce in low- and middle-income countries (LMICs), and designing and implementing effective interventions can be difficult. The aim of this international study was to explore the key lessons for developing, implementing, and evaluating community-based mental health and well-being interventions in LMICs, with an additional focus on older adults.
Research and clinical experts in developing and implementing psychosocial community-based interventions in LMICs were interviewed remotely between October 2021 and January 2022. Participants were recruited via existing global health networks and via published literature searches. Participants were asked about their experiences of developing and implementing interventions, and about key barriers and facilitators during the process. Interviews lasted up to 45 min, and data were analysed using combined inductive and deductive thematic analysis.
Sixteen global mental health experts participated. Five themes with different sub-themes were generated: Mechanisms and contexts; Barriers; Facilitators; Public and stakeholder involvement; Looking through an ageing lens. The development and delivery of mental health interventions in LMICs are facilitated through integration into existing health infrastructures and working with existing job roles as delivery agents. Public and stakeholder involvement are crucial at all stages of development through to implementation to focus on meeting local needs and sustaining participant motivation. Logistical barriers of transport, resources, and location need to be addressed, emphasising local sustainability.
This study provides important insights for how the development, implementation, and evaluation of community-based mental health and well-being interventions in LMICs can be optimised, and can complement general guidance into complex interventions developments.
精神卫生服务在中低收入国家（LMICs）十分匮乏，设计和实施有效的干预措施可能颇具难度。本项国际研究旨在探索在 LMICs 中开发、实施和评估以社区为基础的精神卫生和福祉干预措施的关键经验，重点关注老年人。
2021 年 10 月至 2022 年 1 月期间，通过远程方式对在 LMICs 中开发和实施心理社会社区干预措施的研究和临床专家进行了访谈。参与者通过现有的全球卫生网络和已发表的文献检索进行招募。参与者被要求分享他们在开发和实施干预措施方面的经验，以及在这个过程中的主要障碍和促进因素。访谈时长最多 45 分钟，数据采用结合了归纳和演绎主题分析的方法进行分析。
16 名全球精神卫生专家参与了研究。共产生了五个主题，每个主题下还有不同的次主题：机制和背景；障碍；促进因素；公众和利益相关者的参与；从老龄化视角看问题。在 LMICs 中开发和提供精神卫生干预措施需要通过将其整合到现有卫生基础设施中，并与现有工作角色合作作为服务提供方来实现。在从开发到实施的所有阶段，公众和利益相关者的参与至关重要，这有助于关注满足当地需求和维持参与者积极性。需要解决交通、资源和位置等后勤障碍，强调地方可持续性。
本研究为如何优化 LMICs 中以社区为基础的精神卫生和福祉干预措施的开发、实施和评估提供了重要见解，可以补充复杂干预措施开发的一般性指导。
