Pedersen Gloria A, Haney Juliana Restivo, Singh Abhishek, Choubey Shivangi, Bondre Ameya, Vorapanya Vorapat, Bhan Anant, Tugnawat Deepak, Patel Vikram, Naslund John A, Ramaswamy Rohit
Mental Health for All Lab, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States.
Department of Psychology, West Virginia University, Morgantown, WV, United States.
Front Public Health. 2024 Dec 6;12:1439997. doi: 10.3389/fpubh.2024.1439997. eCollection 2024.
Contextually responsive implementation support strategies are needed to enhance the integration of mental health services into primary health care. Technical assistance is widely used as a core "capacity building" strategy, primarily for increasing the motivation and capacity of individuals (e.g., frontline workers) to adopt evidence-based interventions in healthcare settings. This article documents the systematic design of a technical assistance strategy for supporting primary care staff (e.g., nurses) in integrating depression care, from screening to treatment, aligned with a non-communicable disease program across seven health facilities in the Sehore District of Madhya Pradesh, India.
We conducted a mapping exercise of local health facilities with dedicated staff and a literature review to inform the development of the technical assistance strategy.
Reporting guidelines guided the structure of the strategy protocol. The evidence-supported strategy, called Remote Coaching Support, is tailored to the local setting. It uses quality improvement methods like the Plan-Do-Act-Study cycle and training materials to help coaches deliver support remotely via video/phone-based calls and WhatsApp messaging with the overall goal of increasing uptake and fidelity of depression screening and referral among primary care staff in alignment with an existing non-communicable diseases program.
The development of Remote Coaching Support involved iterative improvements through team meetings and practice-training feedback, though limitations exist due to a lack of systematic implementation standards, especially in this setting. This strategy will be tested in increasing scales to refine its application, with effectiveness and acceptability results to be evaluated in a randomized control trial.
需要因地制宜的实施支持策略，以加强精神卫生服务与初级卫生保健的整合。技术援助被广泛用作一项核心“能力建设”策略，主要用于提高个人（如一线工作人员）在医疗环境中采用循证干预措施的积极性和能力。本文记录了一项技术援助策略的系统设计，该策略旨在支持印度中央邦塞霍雷区七个卫生机构的初级保健人员（如护士）整合抑郁症护理，从筛查到治疗，与一项非传染性疾病项目保持一致。
我们对配备了专业工作人员的当地卫生机构进行了摸底调查，并进行了文献综述，以为技术援助策略的制定提供参考。
报告指南指导了策略方案的结构。这项名为“远程辅导支持”的循证策略是根据当地情况量身定制的。它使用诸如计划 - 执行 - 行动 - 研究循环等质量改进方法和培训材料，帮助辅导人员通过视频/电话呼叫以及WhatsApp消息进行远程支持，总体目标是提高初级保健人员对抑郁症筛查和转诊的接受度和依从性，使其与现有的非传染性疾病项目保持一致。
“远程辅导支持”的开发通过团队会议和实践培训反馈进行了反复改进，不过由于缺乏系统的实施标准，尤其是在这种情况下，仍然存在局限性。该策略将在更大范围内进行测试以完善其应用，并将在一项随机对照试验中评估其有效性和可接受性结果。
