超越电子健康试验的有效性：一项支持有心理困扰医护人员的逐步照护计划的过程评估（RESPOND-HCWs）
Beyond effectiveness in eHealth trials: Process evaluation of a stepped-care programme to support healthcare workers with psychological distress (RESPOND-HCWs).
作者信息
Mediavilla Roberto, García-Vázquez Blanca, McGreevy Kerry R, Underhill James, Bayón Carmen, Bravo-Ortiz María-Fe, Muñoz-Sanjosé Ainoa, Haro Josep Maria, Monistrol-Mula Anna, Nicaise Pablo, Petri-Romão Papoula, McDaid David, Park A-La, Melchior Maria, Vuillermoz Cécile, Turrini Giulia, Compri Beatrice, Purgato Marianna, Roos Rinske, Witteveen Anke B, Sijbrandij Marit, Bryant Richard A, Fuhr Daniela, Ayuso-Mateos José Luis
机构信息
Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, Spain.
Instituto de Investigación Sanitaria del Hospital Universitario La Princesa, Madrid, Spain.
出版信息
Digit Health. 2024 Oct 18;10:20552076241287678. doi: 10.1177/20552076241287678. eCollection 2024 Jan-Dec.
OBJECTIVES
This study presents the process evaluation of an effective stepped-care programme of eHealth interventions (Doing What Matters in Times of Stress [DWM] and Problem Management Plus [PM+]) for healthcare workers (HCWs) with psychological distress (RESPOND-HCWs trial) conducted in Spain. The aim is to analyse the context in which the programme was delivered, assess key implementation outcomes and explore mechanisms of action.
METHODS
We used mixed methods. Quantitative data came from routine randomised control trial monitoring and structured observation, and qualitative data were collected using semi-structured, in-depth interviews with trial participants ( = 12) and decision-makers ( = 7) and a focus group discussion with intervention providers ( = 7). We conducted a descriptive analysis of quantitative data using R software and a thematic analysis of qualitative data using NVivo.
RESULTS
Context analysis revealed implementation barriers, including unrealistic expectations of participants about the programme and mental health-related stigma. The flexibility of interventions and the opportunity for mental health actions were enabling factors. Implementation outcomes showed that the trial was feasible, appropriate and timely, and that the intervention was delivered with minimal protocol deviations and good acceptance among participants. Mechanisms of action included confidence in the positive effect of the intervention, a good therapeutic relationship and specific intervention components.
CONCLUSIONS
These results supplement the outcome evaluation and can help inform large-scale implementation in similar settings. Specific recommendations include increasing mental health awareness and reducing stigma in the implementation setting, including a short orientation session and ensuring flexibility in schedules and peer support.
TRIAL REGISTRATION NUMBER
NCT04980326.
目的
本研究介绍了一项针对西班牙心理困扰医护人员开展的电子健康干预有效分级照护计划（压力时期做重要之事[DWM]和问题管理强化版[PM+]）的过程评估（医护人员应对试验）。目的是分析该计划实施的背景，评估关键实施成果并探索作用机制。
方法
我们采用了混合方法。定量数据来自常规随机对照试验监测和结构化观察，定性数据通过对试验参与者（n = 12）和决策者（n = 7）进行半结构化深度访谈以及与干预提供者（n = 7）进行焦点小组讨论收集。我们使用R软件对定量数据进行描述性分析，使用NVivo对定性数据进行主题分析。
结果
背景分析揭示了实施障碍，包括参与者对该计划不切实际的期望以及与心理健康相关的污名化。干预措施的灵活性和开展心理健康行动的机会是促成因素。实施成果表明该试验可行、恰当且及时，干预实施时方案偏差最小，参与者接受度良好。作用机制包括对干预积极效果的信心、良好的治疗关系以及特定的干预组成部分。
结论
这些结果补充了结果评估，有助于为类似环境下的大规模实施提供参考。具体建议包括在实施环境中提高心理健康意识并减少污名化，包括开展简短的入门培训课程，确保日程安排的灵活性以及同伴支持。
试验注册号
NCT04980326。
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