PDF(Pubmed)
Abstract：
BACKGROUND: Low- and middle-income countries often lack access to mental health services, leading to calls for integration within other primary care systems. In sub-Saharan Africa, integration of depression treatment in non-communicable disease (NCD) settings is feasible, acceptable, and effective. However, leadership and implementation climate challenges often hinder effective integration and quality of services. The aim of this study was to identify discrete leadership strategies that facilitate overcoming barriers to the integration of depression care in NCD clinics in Malawi and to understand how clinic leadership shapes the implementation climate.
METHODS: We conducted 39 in-depth interviews with the District Medical Officer, the NCD coordinator, one NCD provider, and the research assistant from each of the ten Malawian NCD clinics (note one District Medical Officer served two clinics). Based on semi-structured interview guides, participants were asked their perspectives on the impact of leadership and implementation climate on overcoming barriers to integrating depression care into existing NCD services. Thematic analysis used both inductive and deductive approaches to identify emerging themes and compare among participant type.
RESULTS: The results revealed how engaged leadership can fuel a positive implementation climate where clinics had heightened capacity to overcome implementation barriers. Effective leaders were approachable and engaged in daily operations of the clinic and problem-solving. They held direct involvement with and mentorship during the intervention, providing assistance in patient screening and consultation with treatment plans. Different levels of leadership utilized their respective standings and power dynamics to influence provider attitudes and perceptions surrounding the intervention. Leaders acted by informing providers about the intervention source and educating them on the importance of mental healthcare, as it was often undervalued. Lastly, they prioritized teamwork and collective ownership for the intervention, increasing provider responsibility.
CONCLUSIONS: Training that prioritizes leadership visibility and open communication will facilitate ongoing Malawi Ministry of Health efforts to scale up evidence-based depression treatment within NCD clinics. This proves useful where extensive and external monitoring may be limited. Ultimately, these results can inform successful strategies to close implementation gaps to achieve integration of mental health services in low-resource settings through improved leadership and implementation climate.
BACKGROUND: These findings are reported from ClinicalTrials.gov, NCT03711786. Registered on 18/10/2018. https://clinicaltrials.gov/ct2/show/NCT03711786 .
METHODS: We conducted 39 in-depth interviews with the District Medical Officer, the NCD coordinator, one NCD provider, and the research assistant from each of the ten Malawian NCD clinics (note one District Medical Officer served two clinics). Based on semi-structured interview guides, participants were asked their perspectives on the impact of leadership and implementation climate on overcoming barriers to integrating depression care into existing NCD services. Thematic analysis used both inductive and deductive approaches to identify emerging themes and compare among participant type.
RESULTS: The results revealed how engaged leadership can fuel a positive implementation climate where clinics had heightened capacity to overcome implementation barriers. Effective leaders were approachable and engaged in daily operations of the clinic and problem-solving. They held direct involvement with and mentorship during the intervention, providing assistance in patient screening and consultation with treatment plans. Different levels of leadership utilized their respective standings and power dynamics to influence provider attitudes and perceptions surrounding the intervention. Leaders acted by informing providers about the intervention source and educating them on the importance of mental healthcare, as it was often undervalued. Lastly, they prioritized teamwork and collective ownership for the intervention, increasing provider responsibility.
CONCLUSIONS: Training that prioritizes leadership visibility and open communication will facilitate ongoing Malawi Ministry of Health efforts to scale up evidence-based depression treatment within NCD clinics. This proves useful where extensive and external monitoring may be limited. Ultimately, these results can inform successful strategies to close implementation gaps to achieve integration of mental health services in low-resource settings through improved leadership and implementation climate.
BACKGROUND: These findings are reported from ClinicalTrials.gov, NCT03711786. Registered on 18/10/2018. https://clinicaltrials.gov/ct2/show/NCT03711786 .
摘要：
背景：低收入和中等收入国家往往无法获得精神卫生服务，导致呼吁整合到其他初级保健系统中。在撒哈拉以南非洲，在非传染性疾病（NCD）环境中整合抑郁症治疗是可行的，可接受,而且有效。然而,领导力和实施气候挑战往往阻碍有效的整合和服务质量。这项研究的目的是确定离散的领导策略，以帮助克服马拉维NCD诊所整合抑郁症护理的障碍，并了解诊所领导如何塑造实施氛围。
方法：我们对地区医疗官员进行了39次深入访谈，NCD协调员，一个NCD提供者，以及来自10个马拉维NCD诊所的研究助理（注意，一名地区医疗官员为两个诊所提供服务）。根据半结构化面试指南，参与者被问及领导力和实施环境对克服将抑郁症护理纳入现有非传染性疾病服务的障碍的影响的观点.主题分析使用归纳和演绎方法来识别新兴主题并在参与者类型之间进行比较。
结果：结果显示，参与式领导可以促进积极的实施氛围，诊所可以提高克服实施障碍的能力。有效的领导者平易近人，从事诊所的日常运作和解决问题。他们在干预期间直接参与和指导，为患者筛查和治疗计划咨询提供帮助。不同级别的领导层利用各自的地位和权力动态来影响提供者对干预的态度和看法。领导者通过向提供者告知干预来源并教育他们精神保健的重要性来采取行动，因为它经常被低估。最后,他们优先考虑团队合作和集体所有进行干预，增加供应商的责任。
结论：优先考虑领导知名度和开放沟通的培训将促进马拉维卫生部正在进行的努力，以扩大NCD诊所内基于证据的抑郁症治疗。这证明在广泛和外部监测可能受到限制的情况下是有用的。最终,这些结果可以提供成功的战略,以缩小实施差距,从而通过改善领导能力和实施氛围,在低资源环境中实现精神卫生服务的整合.
背景：这些发现来自ClinicalTrials.gov，NCT03711786。于2018年10月18日注册。https://clinicaltrials.gov/ct2/show/NCT03711786.
方法：我们对地区医疗官员进行了39次深入访谈，NCD协调员，一个NCD提供者，以及来自10个马拉维NCD诊所的研究助理（注意，一名地区医疗官员为两个诊所提供服务）。根据半结构化面试指南，参与者被问及领导力和实施环境对克服将抑郁症护理纳入现有非传染性疾病服务的障碍的影响的观点.主题分析使用归纳和演绎方法来识别新兴主题并在参与者类型之间进行比较。
结果：结果显示，参与式领导可以促进积极的实施氛围，诊所可以提高克服实施障碍的能力。有效的领导者平易近人，从事诊所的日常运作和解决问题。他们在干预期间直接参与和指导，为患者筛查和治疗计划咨询提供帮助。不同级别的领导层利用各自的地位和权力动态来影响提供者对干预的态度和看法。领导者通过向提供者告知干预来源并教育他们精神保健的重要性来采取行动，因为它经常被低估。最后,他们优先考虑团队合作和集体所有进行干预，增加供应商的责任。
结论：优先考虑领导知名度和开放沟通的培训将促进马拉维卫生部正在进行的努力，以扩大NCD诊所内基于证据的抑郁症治疗。这证明在广泛和外部监测可能受到限制的情况下是有用的。最终,这些结果可以提供成功的战略,以缩小实施差距,从而通过改善领导能力和实施氛围,在低资源环境中实现精神卫生服务的整合.
背景：这些发现来自ClinicalTrials.gov，NCT03711786。于2018年10月18日注册。https://clinicaltrials.gov/ct2/show/NCT03711786.
