Non-specialist Providers Research Articles

Digital Technology for Building Capacity of Nonspecialist Health Workers for Task Sharing and Scaling Up Mental Health Care Globally.

Workforce shortages pose major obstacles to delivering adequate mental health care and scaling up services to address the global treatment gap. Mounting evidence demonstrates the clinical effectiveness of having nonspecialist health workers, such as community health workers, lay health workers, midwives, or nurses, deliver brief psychosocial treatments for common mental disorders in primary care settings. With rapidly increasing access to, and use of, digital technology worldwide, new opportunities are available to leverage these emerging digital technologies to support nonspecialist health workers and increase mental health workforce capacity. This Perspectives article considers the potential that digital technology holds for supporting nonspecialist health workers in delivering evidence-based mental health care. Specifically, from our search of the academic literature, we identified seven promising examples from primary care settings in different low- and middle-income countries (India, Pakistan, Zimbabwe, Peru, China, and Nigeria) where digital platforms are being used to support delivery of mental health care from a variety of nonspecialist providers by offering training, providing digital tools for diagnosis, guiding treatment, facilitating supervision, and integrating services. We summarize these examples and discuss future opportunities to use digital technology for supporting the development of a trained, effective, and sustainable mental health workforce. We also consider the potential to leverage these technologies for integrating mental health care into existing health systems in low-resource settings.

Innovative Models in Mental Health Delivery Systems: Task Sharing Care with Non-specialist Providers to Close the Mental Health Treatment Gap.

Most people do not have access to adequate mental health care, and lack of skilled human resources is a major factor. We provide a narrative review of approaches to implementing task sharing-engaging non-specialist providers-to deliver mental health care. There is strong evidence both for the effectiveness of task sharing as a means of delivering care for a range of conditions across settings and for the effectiveness of non-specialist providers and health workers in delivering elements of culturally adapted psychosocial and psychological interventions for common and severe mental disorders. Key approaches to facilitate task sharing of care include balanced care, collaborative care, sustained training and supervision, use of trans-diagnostic interventions based on a dimensional approach to wellness and illness, and the use of emerging digital technologies. Non-specialist providers and health workers are well positioned to deliver evidence-based interventions for mental disorders, and a variety of delivery approaches can support, facilitate, and sustain this innovation. These approaches should be used, and evaluated, to increase access to mental health services.

A scoping review of palliative care for persons with severe persistent mental illness.

People with severe persistent mental illness (SPMI) experience a greater burden and severity of chronic disease, late diagnosis, and premature death compared with the general population. Those with SPMI also receive fewer medical treatments, poor quality of care, and are less likely to receive palliative care. A systematic scoping review was undertaken to determine the extent, range, and nature of research activity about people with SPMI requiring palliative care, and to identify gaps and opportunities for future research. A systematic scoping review was undertaken in September 2017 and updated in May 2018 to map literature on this topic, determine the extent and range of what has been published, and report the findings. This five-stage framework was conducted by (1) identifying the research question; (2) identifying relevant studies; (3) determining study selection; (4) charting the data; and 5) collating, summarizing, and reporting the results. A narrative approach to analysis was used to synthesize and interpret findings. A search of multidisciplinary healthcare databases resulted in 46 included articles. Four major themes were identified from the included studies: complexity of care; limited access to care (both through systems and healthcare providers); competence and autonomy; and the potential for relationships between mental health and palliative care. This review reveals a highly vulnerable population with complex needs that are not reliably being met by the healthcare system and providers. Research in this area must continue to develop using rigorous qualitative and quantitative study designs, and interventions should be developed and tested based on existing knowledge to inform care. The voices of people with SPMI in need of palliative care must be represented in future studies to address gaps. To expand a body of literature addressing mainly individuals, system perspectives and sociocultural analysis can bring much to contextualizing the experience of living with SPMI in the palliative phase of care. Adoption of a palliative approach, which promotes the principles of palliative care across nonspecialized care settings provided by nonspecialist palliative providers, has the potential to increase access to high-quality palliative treatment for people with SPMI.

Tier 2: A Warm welcome or a Cold Reality?

Since the introduction of the 2006 NHS dental contract, various waiting list initiatives and the subsequent release of NHS commissioning guidance for dental services, there has been a remarkable and rapid shift towards the provision of intermediate services within the profession. the complexity surrounding those non-specialist providers working within these services has lead to much confusion and the further development of competencies required to work within these settings. this paper focuses on explaining and exploring the topics that arise from an area that has attracted much discussion and debate.

High- versus low-intensity interventions for perinatal depression delivered by non-specialist primary maternal care providers in Nigeria: cluster randomised controlled trial (the EXPONATE trial).

Contextually appropriate interventions delivered by primary maternal care providers (PMCPs) might be effective in reducing the treatment gap for perinatal depression. To compare high-intensity treatment (HIT) with low-intensity treatment (LIT) for perinatal depression. Cluster randomised clinical trial, conducted in Ibadan, Nigeria between 18 June 2013 and 11 December 2015 in 29 maternal care clinics allocated by computed-generated random sequence (15 HIT; 14 LIT). Interventions were delivered individually to antenatal women with DSM-IV (1994) major depression by trained PMCPs. LIT consisted of the basic psychosocial treatment specifications in the World Health Organization Mental Health Gap Action Programme - Intervention Guide. HIT comprised LIT plus eight weekly problem-solving therapy sessions with possible additional sessions determined by scores on the Edinburgh Postnatal Depression Scale (EPDS). The primary outcome was remission of depression at 6 months postpartum (EPDS < 6). There were 686 participants; 452 and 234 in HIT and LIT arms, respectively, with both groups similar at baseline. Follow-up assessments, completed on 85%, showed remission rates of 70% with HIT and 66% with LIT: risk difference 4% (95% CI -4.1%, 12.0%), adjusted odds ratio 1.12 (95% CI 0.73, 1.72). HIT was more effective for severe depression (odds ratio 2.29; 95% CI 1.01, 5.20; P = 0.047) and resulted in a higher rate of exclusive breastfeeding. Infant outcomes, cost-effectiveness and adverse events were similar. Except among severely depressed perinatal women, we found no strong evidence to recommend high-intensity in preference to low-intensity psychological intervention in routine primary maternal care. None.

Recent Developments in the Treatment of Depression

The cognitive and behavioral interventions can be as efficacious as antidepressant medications and more enduring, but some patients will be more likely to respond to one than the other. Recent work has focused on developing sophisticated selection algorithms using machine-learning approaches that answer the question, “What works best for whom?” Moreover, the vast majority of people suffering from depression reside in low- and middle-income countries where access to either psychotherapy or medications is virtually nonexistent. Great strides have been made in training nonspecialist providers (known as task sharing) to overcome this gap. Finally, recent work growing out of evolutionary psychology suggests that antidepressant medications may suppress symptoms at the expense of prolonging the underlying episode so as to increase the risk of relapse whenever someone tries to stop. We address each of these developments and their cumulative implications.

Psychosocial Interventions for Perinatal Depression in China: A Systematic Review and Meta-Analysis

Background: The prevalence of perinatal depression is 16.3% in China and has shown a rising trend in the last decade. However, very few studies were found comparing and summarizing psychosocial interventions for perinatal depression. This study aimed at evaluating and characterizing psychosocial interventions for perinatal depression in Mainland China. Methods: In this systematic review and meta-analysis, ten major English and Chinese language electronic bibliographic databases were searched for randomized controlled trials examining the effect of psychosocial interventions for perinatal depressed women in Mainland China. Studies meeting eligibility criteria and published before 25th February 2019 were included, while those focusing on a very specific sub-population or reporting non-psychosocial interventions were excluded. Data was extracted from articles by a standard form. Meta-analysis was conducted to obtain a summary measure of the effectiveness of the interventions in reducing perinatal depressive symptoms. The theoretical underpinnings and implementation processes of the interventions were also characterised. Findings: A total of 6,857 articles were identified in the initial database searching, of which, 26 studies were eligible for data analysis, representing a sample size of 4,673. Meta-analysis indicated that psychosocial interventions in China significantly reduced perinatal depressive symptoms (standard difference in means 0·81, 95% confidence intervals -1·03 to -0·58, P<0·001). However, the overall evidence presented substantial heterogeneity (I 2 =91·12%). Most interventions were implemented in hospitals in urban areas by non-specialist health care providers. Few studies reported details of implementation procedures or scale-up strategies. Interpretation: Current psychosocial interventions in China are somewhat effective in reducing perinatal depressive symptoms. High quality randomized controlled trials on scale-up interventions are required, especially in rural areas. Funding Statement: This study was supported by the Chinese Nursing Association (ZHKY201809). Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: This review was registered with PROSPERO (CRD42018115934).

Integrating mental health into primary health care in Rohingya refugee settings in Bangladesh: experiences of UNHCR

Hundreds of thousands of Rohingya refugees fled from Myanmar to Bangladesh. The greatly increased mental health needs are paired with limited resources for mental health care, particularly human resources. Therefore, UNHCR, the refugee agency of the United Nations, designed a programme to integrate mental health within refugee primary health care, using the Mental Health Gap Action Programme Humanitarian Intervention Guide (mhGAP-HIG) as the central tool. The aim was to scale up mental health services through capacity building of medical staff in refugee health facilities to enable them to identify and manage people with mental, neurological and substance use conditions. This paper is a process description of the programme, using direct experience of the authors, analysis of training evaluations and data from the refugee health information system and clinical supervision reports. Sixty-two primary health care workers were trained. Participants of the mhGAP training showed clear improvements in the post-training knowledge test. These trained staff started providing mental health and psychosocial services after the training in primary health care centres in the refugee camps. Fifteen of them participated in a bi-weekly supervision/on-the-job training visit. Within this period of time, almost 1,200 mental health consultations were realised in the primary health care facilities. Supervision reports of mhGAP-trained participants showed that in order to become effective mental health providers, the participants need to strengthen various skills including performing mental state examinations, providing psychoeducation and using psychosocial support techniques. In conclusion, the integration of mental health within the Rohingya refugee settings faced many challenges but proved to be feasible. Key implications for practice Health system preparation and readiness is an important pre-requirement for integration of mental health into primary health care services. This is particularly significant in humanitarian settings in which the health system is fragile and struggling to keep services at a minimally acceptable level. Capacity-building efforts alone cannot guarantee the success of the integration process, that is, adequate attention should be paid to communication with health policy and decision makers especially on facility and local level to foster the process of integration and support scaling up. On-the-job supervision is a critical factor in mental health capacity building of non-specialist health providers. Without supportive clinical supervision, any plan for integration of mental health into primary care should be considered deficient and ineffective.

Glecaprevir/pibrentasvir for the treatment of chronic hepatitis C virus infection.

In recent years, management of chronic hepatitis C virus (HCV) infection has been revolutionized by the availability of oral direct-acting antivirals (DAAs), which have significantly better efficacy and safety profiles than interferon-containing regimens. Simple, short-duration DAA therapies will facilitate expansion of HCV treatment to nonspecialist providers, which will be vital to achieve the WHO target of eliminating chronic HCV as a major public health threat by 2030. Coformulated glecaprevir/pibrentasvir is the only 8-week, pan-genotypic, 2-DAA regimen recommended by international guidelines as a first-line regimen in treatment-naive, noncirrhotic HCV genotype 1-6 patients. This review provides a comprehensive summary of the pharmacodynamic and pharmacokinetic parameters, efficacy, safety and place in the HCV treatment paradigm for glecaprevir/pibrentasvir.

Expanding care for patients infected with Hepatitis C through community partnership in Delaware.

BackgroundHepatitis C virus (HCV) is the most common blood-borne pathogen in the U.S., and Delaware has one of the highest sero-prevalence rates in the country. As a cause of significant morbidity and mortality, it is a public health priority to identify and link individuals with HCV to care. The demand of patients with HCV far exceeds the current availability of providers in Delaware that offer HCV management. ObjectiveTo propose a framework for enabling non-specialist providers within Westside Family Healthcare to manage patients with HCV.MethodsAs a recipient of a Harrington Value Institute Community Partnership grant, the HIV Community Program of Christiana Care Health System (CCHS) started working together with the NE Wilmington pilot site of Westside in July 2018 to: 1) provide HCV education to Westside, 2) implement an HCV care model at Westside, and 3) conduct programmatic evaluation of this framework’s effectiveness. Our goal is to improve Westside rates of HCV knowledge amongst patients and staff, as well as to improve the HCV care continuum, starting with universal HCV screening.Results and ConclusionsResults from the first year of collaboration will be available in August 2019. Implementation of this partnership will enable future expansion and continuation of HCV management amongst Westside sites.

A Case Report of the Treatment of Oppositional Defiant Disorder (ODD) in a Non-specialist, Resource-Limited Environment Using the Co-care Approach

As the incidence of Oppositional Defiant Disorder (ODD) continues to grow, non-specialist mental health providers, particularly those in rural and remote areas, were access to mental health services are limited, will be increasingly called upon to treat this disorder. This will be particularly true for general practitioners, family physicians, paediatricians, mid-level providers and others, given the relative scarcity of clinical psychologists, psychiatrists, and mental health providers in such settings. It is important for non-mental health specialists to recognise and have a basic understanding of how ODD can be treated in such settings. As such, this case report presents a typical ODD patient in such a setting, and details the course of the successful treatment of the patient using a variety of approaches, including parent-child interaction training, family therapy, social skills training, problem solving training in a co-care arrangement with a specialist mental health provider.

Successful Implementation of a Shared Medical Appointment Model for Hepatitis C Treatment at a Community Health Center.

Highly efficacious direct acting antiviral (DAA) therapy for treatment of Hepatitis C Virus (HCV) infection is largely inaccessible to communities facing a shortage of available specialist providers. Though less demanding than previous interferon regimens, DAA therapy requires patients to adhere to 8-12weeks of daily treatment, which can be challenging for some patient populations. Duffy Health Center, located on Cape Cod, Massachusetts, provides integrated medical, mental health and case management services to people who are homeless or at risk for homelessness. The goal of this manuscript is to evaluate the outcomes of treatment of HCV infection with a shared medical appointment (SMA) model. The primary outcome was sustained virologic response (SVR-12), or HCV RNA ≤ 15IU/mL at 12weeks post-treatment. There were 102 patients recruited, with a total of 104 treatments administered. Over three-fourths of patients who attended one SMA visit (78 of 102) continued in SMA for the duration of treatment. Of these patients opting for SMA, 99% (77 of 78) completed the full treatment course, and 91% (71 of 78) of SMA patients achieved SVR-12. DAA therapy provided by non-specialist providers using the SMA model yielded comparable response rates to those achieved by specialist providers, and has the potential to substantially increase access to HCV treatment for patient populations within high-risk communities.

Patterns of concordances in mhGAP-IG screening and DSM-IV/ICD10 diagnoses by trained community service providers in Kenya: a pilot cross-sectional study

The objective of this study was to determine the extent of concordance between positive screens for mental disorders by various trained community-based health workers using the WHO mental health Gap Action Programme Intervention Guide (mhGAP-IG) and independently confirmed DSM-IV/ICD-10 diagnoses. This was a cross-sectional study conducted in Makueni County, Kenya. 40 nurses/clinical officers, 60 Community Health Workers (CHWs), 51 Faith Healers (FHs), and 59 Traditional Healers (THs) from 20 facilities were trained to screen and refer patients with eight priority mental health conditions using the mhGAP-IG. These referrals, as well as referrals from friends or family members, and self-referrals were assessed using the Mini International Neuropsychiatric Instrument (M.I.N.I.) Plus. Concordance between positive screens and M.I.N.I. Plus diagnoses was investigated. 15,078 community members agreed to participate in screening. Of these 12,170 (81%) screened positive for a mental disorder and were referred to their local clinics/hospitals. 8333 (68.5%) of those who were referred went for independent diagnostic assessment at the nearest facility. Positive predictive values varied with different providers and for different conditions. There was over 80% concordance between the initial screen and the M.I.N.I. Plus diagnoses across the different health providers and across all diagnoses. Both formal and informal mental health providers can be trained to successfully and accurately screen for mental health disorders using the mhGAP-IG symptoms. This suggests that community-based non-specialist providers may play a key role in decreasing the mental health treatment gap. Further policy implications are discussed.

Adolescent and nurse perspectives of psychotherapeutic interventions for PTSD delivered through task-shifting in a low resource setting.

BackgroundThis investigation compared the perceived effectiveness of supportive counselling (SC) and prolonged exposure for adolescents (PE-A) by treatment users (adolescents with PTSD) and non-specialist treatment providers (supervised nurses).MethodAdolescent participants and nurse providers were purposively recruited to share their experiences of trial participation through face to face semi-structured in-depth interviews and treatment-specific focus groups (all recorded). Twelve adolescent participant transcripts (ten interviews and two focus groups) and three nurse provider transcripts were doubly transcribed. Thematic content analysis was applied using Atlas.ti software. Two emerging themes are presented in this paper: 1) Perceptions of the intervention and 2) Usefulness of the intervention.ResultsRegardless of treatment arm, adolescents experienced warm counselling relationships and described the process of extending trust to the counselor. Adolescents in the PE-A arm provided clear descriptions of session structure and treatment rationale compared with adolescents receiving SC. The most helpful tools were breathing retraining and imaginal exposure for PE-A and creation of distraction strategies during non-directive SC. Adolescents in both arms continued to use the techniques acquired during treatment and reported symptom improvement. Participants who received SC acknowledged ongoing reexperiencing. Nurses perceived SC to be an immediately transferable skill, but feedback on their preference for one intervention over the other was inconclusive.ConclusionBoth PTSD treatment strategies, implemented by non-specialists, were perceived as helpful. Overall, adolescents reported warm therapeutic relationships and a reduction in PTSD symptoms. Nurses stated that they would require institutional support to ensure delivery of these interventions in a scalable and sustainable manner.

Knowledge and attitudes towards epilepsy among nonmedical health workers in rural Bolivia: Results after a long-term activity in the Chaco region

IntroductionEpilepsy represents a major global healthcare issue, particularly in low- and middle-income countries (LMIC), where nonmedical health workers play a key role in providing care to people with epilepsy (PWE). Over the last 20 years, many projects have been carried out by our group in the Chaco region, Plurinational State of Bolivia, with the aim of enhancing knowledge about epilepsy. However, the level of knowledge of epilepsy that nonmedical health workers have reached has never been assessed until now.The main objective of our study was to assess the level of knowledge, attitudes, and practices (KAP) towards epilepsy among nonmedical health staff of the rural communities of the Chaco region in Bolivia. MethodsThe study was conducted in three departments of Bolivia. The nonmedical health personnel were invited to participate in a training program. They answered a validated questionnaire to evaluate their knowledge and attitudes towards epilepsy before and after the courses. ResultsOne hundred nineteen subjects [42 men (36.2%); mean age 29.3 ± 1.1 years] were interviewed among community health workers and nurses before the courses, demonstrating a very good level of knowledge regarding epilepsy and its causes. Only 55 health workers participated in the second training module, and their answer did not significantly differ from the baseline. ConclusionOur study confirms the usefulness of continuous educational campaigns, especially directed to nonspecialist healthcare providers of rural communities of LMIC, as they may be the only persons responsible for providing healthcare to PWE in that setting. Moreover, the importance of the baseline assessment of KAP was highlighted in order to adapt the educational campaigns to the baseline level of knowledge found.

Family-based youth mental health interventions delivered by nonspecialist providers in low- and middle-income countries: A systematic review.

Youth in low- and middle-income countries (LMICs) are at increased risk for poor mental health due to economic and social disadvantage. Interventions that strengthen families may equip children and adolescents with the supports and resources to fulfill their potential and buffer them from future stressors and adversity. Due to human resource constraints, task-sharing-delivery of interventions by nonspecialists-may be an effective strategy to facilitate the dissemination of mental health interventions in low resource contexts. To this end, we conducted a systematic review of the literature on family-based interventions delivered in LMICs by nonspecialist providers (NSPs) targeting youth mental health and family related outcomes. Cochrane and PRISMA procedures guided this review. Searches were conducted in PsychInfo, PubMed, and Web of Science, with additional articles pulled from reference lists. This search yielded 10 studies. Four studies were developed specifically for the delivery context using formative qualitative research; the remaining interventions underwent adaptation for use in the context. All interventions employed a period of structured training; nine studies additionally provided ongoing supervision to counselors. Interventions noted widespread acceptance of program material and delivery by NSPs. They also noted the need for ongoing supervision of NSPs to increase treatment fidelity. Usage of NSPs is quite consistently proving feasible, acceptable, and efficacious and is almost certainly a valuable component within approaches to scaling up mental health programs. A clear next step is to establish and evaluate sustainable models of training and supervision to further inform scalability. (PsycINFO Database Record

Psychosocial interventions for disruptive behaviour problems in children in low- and middle-income countries: a systematic review and meta-analysis.

Most of the evidence for psychosocial interventions for disruptive behaviour problems comes from Western, high-income countries. The transferability of this evidence to culturally diverse, low-resource settings with few mental health specialists is unknown. We conducted a systematic review with random-effects meta-analysis of randomized controlled trials examining the effects of psychosocial interventions on reducing behaviour problems among children (under 18) living in low- and middle-income countries (LMIC). Twenty-six randomized controlled trials (representing 28 psychosocial interventions), evaluating 4,441 subjects, met selection criteria. Fifteen (54%) prevention interventions targeted general or at-risk populations, whereas 13 (46%) treatment interventions targeted children selected for elevated behaviour problems. Most interventions were delivered in group settings (96%) and half (50%) were administered by non-specialist providers. The overall effect (standardized mean difference, SMD) of prevention studies was -0.25 (95% confidence interval (CI): -0.41 to -0.09; I2 : 78%) and of treatment studies was -0.56 (95% CI: -0.51 to -0.24; I2 : 74%). Subgroup analyses demonstrated effectiveness for child-focused (SMD: -0.35; 95% CI: -0.57 to -0.14) and behavioural parenting interventions (SMD: -0.43; 95% CI: -0.66 to -0.20), and that interventions were effective across age ranges. Our meta-analysis supports the use of psychosocial interventions as a feasible and effective way to reduce disruptive behaviour problems among children in LMIC. Our study provides strong evidence for child-focused and behavioural parenting interventions, interventions across age ranges and interventions delivered in groups. Additional research is needed on training and supervision of non-specialists and on implementation of effective interventions in LMIC settings.

PD13-07 THE MAJORITY OF OVERACTIVE BLADDER PATIENTS DO NOT REQUIRE SPECIALIST CARE

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Advanced Practice Providers1 Apr 2018PD13-07 THE MAJORITY OF OVERACTIVE BLADDER PATIENTS DO NOT REQUIRE SPECIALIST CARE Stephen Strahan, Camille Charbonneau, Richard Baverstock, Trafford Crump, and Kevin Carlson Stephen StrahanStephen Strahan More articles by this author , Camille CharbonneauCamille Charbonneau More articles by this author , Richard BaverstockRichard Baverstock More articles by this author , Trafford CrumpTrafford Crump More articles by this author , and Kevin CarlsonKevin Carlson More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.781AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Overactive bladder (OAB) is a common condition resulting in a significant number of referrals to specialists. Guidelines recommend patient education and conservative measures prior to medication or invasive techniques to manage OAB. We have established a multidisciplinary model of care employing non-specialist providers in the initial management of these patients. We set out to assess patient reported outcomes (PROs) and satisfaction associated with this model. METHODS From December 2014 to October 2016 patients referred to our clinic with OAB symptoms were prospectively enrolled. PROs (OAB v8, IPSS) were collected at initial consultation. PROs and patient satisfaction based on the Consumer Assessment of Health Care Providers and Systems (CAHPS) were assessed at subsequent follow-up visits for 12 months. Those who did not return for a follow-up visit were mailed a survey package at 12 months. Change in PROs were assessed using paired t-test. Conservative therapies and medications used were assessed for change in PROs using ordinary least squares. RESULTS Of the 301 patients enrolled, 201 (66%) were managed by non-specialist providers without the need to see a urologist. Baseline and end of study PRO and CAHPS data were available for 135 (67%) of these patients. Change in PROs showed statistically significant improvement over the 12-month period. The mean OAB V8 and IPSS scores improved by 5.4 and 4.3 respectively (p<0.001 for each). No single conservative therapy or medication made a statistically significant improvement in PROs on univariate analysis. Patient satisfaction based on CAHPS overall rating was high (8.9/10). CONCLUSIONS The majority of OAB patients do not require management by a specialist to achieve a satisfactory outcome. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e301-e302 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Stephen Strahan More articles by this author Camille Charbonneau More articles by this author Richard Baverstock More articles by this author Trafford Crump More articles by this author Kevin Carlson More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Conceptualizing depression in Vietnam: Primary health care providers' explanatory models of depression.

The purpose of this qualitative study was to elicit the explanatory models (EMs) of primary healthcare providers (PHPs) in Vietnam in order to (a) understand if and how the concept of depression is understood in Vietnam from the perspective of nonspecialist providers and community members, and (b) to inform the process of introducing services for depression in primary care in Vietnam. We conducted semistructured interviews with 30 PHPs in one rural and one urban district of Hanoi, Vietnam in 2014. We found that although PHPs possess low levels of formal knowledge about depression, they provide consistent accounts of its symptoms and aetiology among their patient population, suggesting that depression is a relevant concept in Vietnam. PHPs describe a predominantly psychosocial understanding of depression, with little mention of either affective symptoms or neurological aetiology. This implies that, with enhanced training, psychosocial approaches to depression care would be appropriate and acceptable in this context. Distinctions were identified between rural and urban populations in both understandings of depression and help-seeking, suggesting that enhanced services should account for the diversity of the Vietnamese context. Alcohol misuse among men emerged as a considerable concern, both in relation to depression and as stand-alone issue facing Vietnamese communities, indicating the need for further research in this area. Low help-seeking for depression in primary care implies the need for enhanced community outreach. The results of this study demonstrate the value of eliciting EMs to inform planning for enhanced mental health service delivery in a global context.

Supplemental Material for Family-Based Youth Mental Health Interventions Delivered by Nonspecialist Providers in Low- and Middle-Income Countries: A Systematic Review

Supplemental Material for Family-Based Youth Mental Health Interventions Delivered by Nonspecialist Providers in Low- and Middle-Income Countries: A Systematic Review