Ndlovu Jacqueline N, Ouizzane Soukaina, Leku Marx R, Okware Kenneth K, Sentongo Hafsa, Nyangwen Bathsheba, Upadhaya Nawaraj, Skovdal Morten, Augustinavicius Jura L, Tol Wietse A
Global Health Section, University of Copenhagen, Copenhagen, Denmark.
Department of Epidemiology, Biostatistics, and Occupational Health, School of Population and Global Health, McGill University, Montreal, QC, Canada.
Implement Res Pract. 2024 Dec 5;5:26334895241288574. doi: 10.1177/26334895241288574. eCollection 2024 Jan-Dec.
There is a growing need for mental health and psychosocial support (MHPSS) interventions that can feasibly be provided to larger groups of people, particularly in humanitarian settings. However, scaling up mental health interventions is notoriously difficult. There are therefore growing calls for integrating mental health outside traditional health structures, both to increase reach and to address social determinants of mental health. The objective of this study is to explore barriers and facilitators of Self-Help Plus (SH+), an MHPSS innovation implemented through multisectoral integration. We explore delivery and uptake at the scale of SH+ and aim to understand intervention adaptation needs when integrating SH+ within other health and non-health sectors in Uganda.
We conducted a qualitative study using in-depth interviews in two phases: first for a needs and resource assessment, and second for a process evaluation. We conducted 50 in-depth interviews with BRAC Uganda and MoH partner staff, intervention facilitators, and target impact group members between July and December 2022. A thematic network analysis process was used to identify barriers and facilitators of SH+ delivery and uptake at scale in Uganda.
We identified five major factors that should be considered when scaling through multisectoral integration, namely: (1) adaptivity, (2) funding mechanisms, (3) social capital, (4) participation, and (5) sustainability. Within these factors, there were varying degrees to which a factor was a facilitator or barrier, depending on participants' perceptions of the intervention.
Our findings suggest that multisectoral integration of SH+ into sectors both inside and outside of health may be a viable means to scale SH+ and increase reach. However, funding, partnerships, co-creation, and adaptability need to be further explored to facilitate better and more sustainable integration.
对心理健康和社会心理支持（MHPSS）干预措施的需求日益增长，这些干预措施需要能够切实地提供给更多人群，尤其是在人道主义环境中。然而，扩大心理健康干预措施的规模非常困难。因此，越来越多的人呼吁在传统卫生结构之外整合心理健康服务，以扩大覆盖面并解决心理健康的社会决定因素。本研究的目的是探讨“自助增强”（SH+）的障碍和促进因素，SH+是一种通过多部门整合实施的MHPSS创新措施。我们在SH+的规模上探讨其实施和接受情况，旨在了解在乌干达将SH+整合到其他卫生和非卫生部门时的干预措施调整需求。
我们进行了一项定性研究，分两个阶段进行深入访谈：第一阶段进行需求和资源评估，第二阶段进行过程评估。2022年7月至12月期间，我们对乌干达BRAC和卫生部的合作伙伴工作人员、干预措施促进者以及目标影响群体成员进行了50次深入访谈。采用主题网络分析方法来确定在乌干达大规模实施和接受SH+的障碍和促进因素。
我们确定了通过多部门整合进行扩大规模时应考虑的五个主要因素，即：（1）适应性，（2）资金机制，（3）社会资本，（4）参与度，以及（5）可持续性。在这些因素中，根据参与者对干预措施的看法，一个因素作为促进因素或障碍的程度各不相同。
我们的研究结果表明，将SH+多部门整合到卫生部门内外的其他部门可能是扩大SH+规模和覆盖面的可行手段。然而，需要进一步探索资金、伙伴关系、共同创造和适应性，以促进更好、更可持续的整合。
