Getahun Monica, Mathai Muthoni A, Rota Grace, Allen Ammon, Burger Rachel L, Opiyo Elizabeth, Oluoch Dennis, Wangia Josyline, Wambura Raphael, Mbwayo Anne, Muchembre Peter, Obura Raymond R, Neylan Thomas C, Aarons Gregory A, Ongeri Linnet, Meffert Susan M
Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, United States of America.
Department of Psychiatry, University of Nairobi, Nairobi, Kenya.
PLOS Glob Public Health. 2024 Sep 5;4(9):e0002685. doi: 10.1371/journal.pgph.0002685. eCollection 2024.
SMART DAPPER is an implementation science study responding to mental health treatment gaps for depression and trauma-related disorders in Sub-Saharan Africa (SSA). We report on patient experiences in a study using a Sequential, Multiple Assignment Randomized Trial (SMART) design to test first and second line non-specialist treatment using psychotherapy (Interpersonal Psychotherapy [IPT] or medication (fluoxetine [FLX]), integrated within public sector primary care in western Kenya. An embedded qualitative study conducted in-depth interviews (n = 17) and three (n = 3) focus group discussions with participants (May to October 2021). Audio-recorded interviews were transcribed and translated into English; we deductively and inductively analyzed transcripts guided by grounded theoretical approaches and content analysis. We drew on the health belief model and socio-ecological framework to present findings, including perceived severity (motivations for taking part in the intervention), impacts of the intervention at the individual, interpersonal, and community and health systems levels as well as barriers and facilitators. Participants discussed family and marital conflict, loss of a child, loss of income or a job, and traumatic events such as a death or illness. Impacts at the individual level included reduced headaches, improved appetite and weight management, increased energy, improved sleep, better self-efficacy, and improved concentration, which was reported to lead to increased economic opportunities. At the interpersonal level, participants noted a reduction in conflict, better conflict management and resolution, increased harmony with family and community members, and improved relationships with their partners and children. Perceived challenges included balancing the intervention with livelihoods, preference for traditional medicines, actual or anticipated side effects with medication (FLX), mental health stigma, major life events, and perceived inadequate counseling and challenges with providers. The findings demonstrate the potential of the SMART DAPPER intervention for depression and trauma-related disorder treatments and underscore the challenges and barriers that must be addressed when scaling similar interventions. Trial registration: ClinicalTrials.gov identifier: NCT03466346.
SMART DAPPER是一项实施科学研究，旨在应对撒哈拉以南非洲（SSA）抑郁症和创伤相关疾病的心理健康治疗差距。我们报告了一项研究中的患者体验，该研究采用序贯多重分配随机试验（SMART）设计，在肯尼亚西部的公共部门初级保健中，测试使用心理治疗（人际心理治疗[IPT]）或药物治疗（氟西汀[FLX]）的一线和二线非专科治疗。一项嵌入式定性研究在2021年5月至10月期间对参与者进行了深度访谈（n = 17）和三次焦点小组讨论（n = 3）。录音访谈被转录并翻译成英文；我们采用扎根理论方法和内容分析，对转录本进行了演绎和归纳分析。我们利用健康信念模型和社会生态框架来呈现研究结果，包括感知严重性（参与干预的动机）、干预在个人、人际、社区和卫生系统层面的影响，以及障碍和促进因素。参与者讨论了家庭和婚姻冲突、子女死亡、收入或工作损失以及诸如死亡或疾病等创伤性事件。在个人层面的影响包括头痛减轻、食欲和体重管理改善、精力增加、睡眠改善、自我效能提高以及注意力改善，据报告这导致了经济机会增加。在人际层面，参与者指出冲突减少、冲突管理和解决能力提高、与家人和社区成员的和谐度增加以及与伴侣和子女的关系改善。感知到的挑战包括在干预与生计之间取得平衡、对传统药物的偏好、药物（FLX）的实际或预期副作用、心理健康污名、重大生活事件以及对咨询的感知不足和与提供者的挑战。研究结果表明了SMART DAPPER干预对抑郁症和创伤相关疾病治疗的潜力，并强调了扩大类似干预规模时必须解决的挑战和障碍。试验注册：ClinicalTrials.gov标识符：NCT03466346。
