Abstract
BackgroundThere is mounting evidence supporting the effectiveness of task-shifted mental health interventions in low- and middle-income countries (LMIC). However, there has been limited systematic scale-up or sustainability of these programs, indicating a need to study implementation. One barrier to progress is a lack of locally relevant and valid implementation measures. We adapted an existing brief dissemination and implementation (D&I) measure which includes scales for acceptability, appropriateness, feasibility and accessibility for local use and studied its validity and reliability among a sample of consumers in Ukraine.MethodsLocal qualitative data informed adaptation of the measure and development of vignettes to test the reliability and validity. Participants were veterans and internally displaced persons (IDPs) recruited as part of a separate validity study of adapted mental health instruments. We examined internal consistency reliability, test-retest reliability, and construct and criterion validity for each scale on the measure. We randomly assigned half the participants to respond to a vignette depicting existing local psychiatric services which we knew were not well regarded, while the other half was randomized to a vignette describing a potentially more well-implemented mental health service. Criterion validity was assessed by comparing scores on each scale by vignette and by overall summary ratings of the programs described in the vignettes.ResultsN = 169 participated in the qualitative study and N = 153 participated in the validity study. Qualitative findings suggested the addition of several items to the measure and indicated the importance of addressing professionalism/competency of providers in both the scales and the vignettes. Internal consistency reliabilities ranged from α = 0.85 for feasibility to α = 0.91 for appropriateness. Test-rest reliabilities were acceptable to good for all scales (rho: 0.61–0.79). All scales demonstrated substantial and significant differences in average scores by vignette assignment (ORs: 2.21–5.6) and overall ratings (ORs: 5.1–14.47), supporting criterion validity.ConclusionsThis study represents an innovative mixed-methods approach to testing an implementation science measure in contexts outside the United States. Results support the reliability and validity of most scales for consumers in Ukraine. Challenges included large amounts of missing data due to participants’ difficulties responding to questions about a hypothetical program.
Highlights
There is mounting evidence supporting the effectiveness of task-shifted mental health interventions in low- and middle-income countries (LMIC)
As part of a three-year project sponsored by the United States Agency for International Development Victims of Torture Fund (VOT) JHU has partnered with National University of Kyiv-Mohyla (NaUKMA) to train mental health providers and peer veteran counselors in the Common Elements Treatment Approach (CETA) and test the intervention in a randomized controlled trial
Results of focus group discussions During the Focus Group Discussions (FGD), common themes emerged including: a) the educational/professional background of the clinician must be strong; b) the costs and wait times associated with services are often too high; c) services and providers need to be accessible; d) the location and atmosphere of where services are delivered is important; and e) concerns about confidentiality and stigma associated with receiving mental health treatments
Summary
There is mounting evidence supporting the effectiveness of task-shifted mental health interventions in low- and middle-income countries (LMIC). We adapted an existing brief dissemination and implementation (D&I) measure which includes scales for acceptability, appropriateness, feasibility and accessibility for local use and studied its validity and reliability among a sample of consumers in Ukraine. Creating pragmatic implementation science measures that are both relevant and feasible is a major priority [4]. Adding to these challenges, almost all existing implementation measures were developed for use in HIC, and are based on assumptions that do not hold in many Low and Middle-Income Countries (LMIC). In most LMIC, mental health services are limited and may include diverse “counseling” offered usually through international or local non-governmental organizations (NGOs). With the growing call for implementation research in global mental health [7, 8] it is critical to develop accurate measurement procedures and instruments in order to advance implementation science [3, 9,10,11]
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