PDF(Pubmed)
Abstract：
Nonspecialists have increasingly been used to deliver evidence-based, mental health and behavioral interventions in lower resource settings where there is a dearth of specialized providers and a corresponding gap in service delivery. Recent literature acknowledges that nonspecialist-delivered interventions are shown to be effective. However, few studies report on the fidelity (the degree to which an intervention was implemented as intended) and/or competence (general skills of nonspecialists), key concepts that measure quality of evidence-based intervention delivery. This study seeks to understand how both fidelity and competence have been assessed in nonspecialist-delivered, evidence-based interventions with an intended social or psychological behavior-change outcome. Our search results originally yielded 2317 studies, and ultimately, 16 were included in our final analysis. Generally, results from a narrative synthesis indicated that tools used in the studies demonstrated sufficient inter-rater reliability and intra-class correlation components. Included studies used and described a range of fidelity and competence tools. However, the ENhancing Assessment of Common Therapeutic factors tool was the most commonly used tool that measures competence of nonspecialists, and has been adapted to several other settings. The roles of supervisors in mentoring, monitoring, and supervising nonspecialists emerged as a key ingredient for ensuring fidelity. Most studies assessing fidelity were limited by small sample sizes due to low numbers of nonspecialists implementing interventions, however, more advanced statistical methods may not be needed and may actually impede community-based organizations from assessing fidelity data. Our results suggest interventions can share resources, tools, and compare findings regardless with proper supervision. While the two terms \"fidelity\" and \"competence\" are often used interchangeably, their differences are noteworthy. Ultimately, both competency and fidelity are critical for delivering evidence-based interventions, and nonspecialists are most effective when they can be evaluated and mentored on both throughout the course of the intervention.
摘要：
非专业人士越来越多地被用来提供基于证据的，在资源较少的环境中，心理健康和行为干预措施缺乏专业提供者，服务提供也存在相应的差距。最近的文献承认，非专业人员提供的干预措施被证明是有效的。然而,很少有研究报告保真度（干预措施按预期实施的程度）和/或能力（非专业人员的一般技能），衡量循证干预交付质量的关键概念。这项研究旨在了解如何在非专业人员交付的情况下评估保真度和能力，具有预期的社会或心理行为改变结果的循证干预措施。我们的搜索结果最初产生了2317项研究，最终,16个包含在我们的最终分析中。一般来说,叙事综合的结果表明，研究中使用的工具显示出足够的评分者间可靠性和类内相关成分。纳入研究使用并描述了一系列保真度和能力工具。然而,常见治疗因素评估工具是最常用的工具，用于衡量非专业人员的能力，并已适应其他几个设置。主管在指导中的角色，监测,监督非专业人士成为确保保真度的关键因素。大多数评估保真度的研究都受到小样本量的限制，因为实施干预措施的非专业人员数量很少，然而,更先进的统计方法可能不需要，实际上可能会阻碍社区组织评估保真度数据。我们的结果表明干预措施可以共享资源，工具,并在适当的监督下比较调查结果。虽然“保真度”和“能力”这两个术语经常互换使用，他们的差异值得注意。最终,能力和忠诚度对于提供基于证据的干预措施至关重要，当在整个干预过程中可以对非专业人员进行评估和指导时，他们是最有效的。
