Department of Psychiatry, Indiana University School of Medicine, 410 West 10th Street, Indianapolis, IN, 46202, USA.
Department of Health Policy and Management, Indiana University Fairbanks School of Public Health, 1050 Wishard Blvd, Indianapolis, IN, 46202, USA.
BMC Health Serv Res. 2024 Nov 27;24(1):1477. doi: 10.1186/s12913-024-11962-5.
Social determinants of health have been shown to influence individual mental health and overall well-being. Additionally, populations that experience stigma and/or discrimination because of race, class, gender, or another identity group experience disproportionately higher rates of mental health disorders than populations that do not experience such marginalization. One way to address upstream social determinants that influence mental health is through systems change initiatives. In 2019, Indiana implemented a statewide Regional Prevention System (RPS) focused on systems change to promote mental health and prevent substance misuse.
We developed a semi-structured interview guide to collect insights about the RPS implementation and sustainability. Potential participants were identified based on their role as an active regional coordinator (n = 9). We conducted qualitative interviews with all 9 regional coordinators in Indiana. Interview recordings were transcribed and coded using an a priori coding framework based on constructs from the Theory of Innovation Implementation and the Consolidated Framework for Implementation Research.
Insights about the RPS implementation process are presented across four domains: innovation, system-level, organization-level, and sustainability. In terms of implementation barriers, coordinators encountered hesitancy and distrust from community members, which they had to overcome to gain buy-in. They also described stigma, including community and individual social norms towards mental health and substance misuse, as barriers that challenged efforts to engage community members in the RPS. Facilitators of implementation included having established community infrastructure and external partnerships. In communities without existing infrastructure to support prevention efforts, particularly rural communities, the implementation process took longer but community members welcomed the additional support and valued the new communication platforms created by the RPS. On sustainability, coordinators provided examples of communities that were able to obtain grant funding in support of prevention initiatives launched through the RPS.
The process of implementing and sustaining prevention efforts through the RPS varied across communities. Prioritizing the delivery of systems-change efforts in underserved communities that are ready for change, rather than statewide efforts, may offer a better strategy for addressing disparities in the social determinants of health that influence mental health and substance misuse.
健康的社会决定因素已被证明会影响个人的心理健康和整体幸福感。此外，由于种族、阶级、性别或其他身份群体而遭受污名化和/或歧视的人群比没有经历这种边缘化的人群更容易出现心理健康障碍。解决影响心理健康的上游社会决定因素的一种方法是通过系统变革倡议。2019 年，印第安纳州实施了一项全州范围的区域预防系统（RPS），专注于系统变革，以促进心理健康和预防药物滥用。
我们制定了一份半结构化访谈指南，以收集有关 RPS 实施和可持续性的见解。根据他们作为活跃区域协调员的角色（n=9）确定潜在参与者。我们在印第安纳州对所有 9 名区域协调员进行了定性访谈。访谈录音根据创新实施理论和实施研究综合框架中的构建进行了转录和编码。
关于 RPS 实施过程的见解在四个领域呈现：创新、系统层面、组织层面和可持续性。在实施障碍方面，协调员遇到了社区成员的犹豫和不信任，他们必须克服这些障碍才能获得支持。他们还描述了障碍，包括社区和个人对心理健康和药物滥用的社会规范，这些障碍挑战了让社区成员参与 RPS 的努力。实施的促进因素包括现有的社区基础设施和外部伙伴关系。在没有支持预防工作的现有基础设施的社区，特别是农村社区，实施过程需要更长的时间，但社区成员欢迎额外的支持，并重视 RPS 创建的新沟通平台。关于可持续性，协调员提供了一些社区的例子，这些社区能够获得赠款资金支持通过 RPS 启动的预防计划。
通过 RPS 实施和维持预防工作的过程在各个社区有所不同。优先考虑在准备好变革的服务不足社区中提供系统变革工作，而不是全州范围内的努力，可能是解决影响心理健康和药物滥用的健康社会决定因素差异的更好策略。
