Ngongi Leonida Isdory, Akiba Christopher Fittipaldi, Kilonzo Mrema Noel, Minja Anna Agape, Komba Charles Onesphor, Mbaga Mwajabu Rashidi, Msafiri Anna Celestini, Kajula Lusajo Joel, Kaaya Sylvia Florence, Pence Brian Wells, Gaynes Bradley Neil
Muhimbili National Hospital, Dar es Salaam, Tanzania.
RTI International, Research Triangle Park, North Carolina, United States of America.
PLoS One. 2025 May 9;20(5):e0323502. doi: 10.1371/journal.pone.0323502. eCollection 2025.
Attention Deficit Hyperactivity Disorder (ADHD) affects 5% of adolescents globally. ADHD increases the child's risk for adverse outcomes, including school failure, juvenile delinquency, substance abuse, and increased sexual risk behaviors. ADHD can be diagnosed in children using the Kiddie Schedule for Affective Disorders and Schizophrenia (KSADS). Semi-structured or structured diagnostic interviews, such as the KSADS-Present and Lifetime (PL) version by Kaufman and colleagues, are the gold standard in diagnosing psychiatric disorders like ADHD. Nevertheless, KSADS-PL is not used in routine clinical practice in Tanzania. There is no research exploring barriers and facilitators to use of KSADS-PL in resource limited areas including Tanzania. The study aimed to uncover barriers, facilitators and possible solutions related to psychiatric care providers' routine use KSADS-PL at the Muhimbili National Hospital (MNH) in Dar-es-Salaam, Tanzania.
Between July and October 2019, we conducted semi-structured interviews that focused on providers' perceptions of facilitators, barriers, and solutions regarding KSADS-PL integration into routine clinical practice, data were analyzed data using a qualitative thematic approach informed by the Consolidated Framework for Implementation Research (CFIR).
Limited knowledge and lack of training about KSADS-PL represented the most mentioned perceived barrier for providers. Some providers reported inadequacy of both human and material resources, high workload, and limited physical space at the clinic. Facilitators included readiness for KSADS-PL implementation, and providers' desires for uniform and standardized ways of detecting ADHD. Suggested solutions included involving hospital leaders, support for provider training, increasing staff, making KSADS-PL tools readily available, utilizing an online version of the tool, creating departmental standards, maximizing space at the clinic, and reorganizing clinic flow.
Findings suggest a need for innovative implementation science solutions such as multifaceted educational strategies focusing on ongoing trainings and supervisions to increase clinical knowledge, reorganizing clinic flow to increase the quality and duration of patient‑provider interaction, as well as role shifting and other planning strategies that may address barriers like understaffing.
注意缺陷多动障碍（ADHD）影响着全球5%的青少年。ADHD会增加儿童出现不良后果的风险，包括学业失败、青少年犯罪、药物滥用以及性风险行为增加。可以使用儿童情感障碍和精神分裂症量表（KSADS）对儿童进行ADHD诊断。半结构化或结构化诊断访谈，如考夫曼及其同事编制的KSADS现患及终生版（PL），是诊断ADHD等精神疾病的金标准。然而，KSADS - PL在坦桑尼亚的常规临床实践中并未使用。在包括坦桑尼亚在内的资源有限地区，尚无研究探讨使用KSADS - PL的障碍和促进因素。该研究旨在揭示与坦桑尼亚达累斯萨拉姆穆希姆比利国家医院（MNH）精神科护理人员常规使用KSADS - PL相关的障碍、促进因素及可能的解决方案。
2019年7月至10月期间，我们进行了半结构化访谈，重点关注护理人员对将KSADS - PL纳入常规临床实践的促进因素、障碍及解决方案的看法，使用基于实施研究综合框架（CFIR）的定性主题方法对数据进行分析。
护理人员提及最多的感知障碍是对KSADS - PL的知识有限和缺乏培训。一些护理人员报告人力和物力资源不足、工作量大以及诊所空间有限。促进因素包括对实施KSADS - PL的准备情况，以及护理人员对统一和标准化检测ADHD方法的期望。建议的解决方案包括让医院领导参与、支持护理人员培训、增加工作人员、使KSADS - PL工具随时可用、使用该工具的在线版本、制定部门标准、最大化诊所空间以及重新安排诊所流程。
研究结果表明需要创新的实施科学解决方案，如注重持续培训和监督以增加临床知识的多方面教育策略、重新安排诊所流程以提高医患互动的质量和时长，以及角色转变和其他规划策略，这些策略可能解决人员不足等障碍。
