1
|
Do Thi N, Thi GH, Lee Y, Minh KP, Thanh HN, Shin JS, Luong Xuan T. First-aid training for primary Healthcare providers on a remote Island: a mixed-methods study. BMC MEDICAL EDUCATION 2024; 24:790. [PMID: 39044192 PMCID: PMC11267758 DOI: 10.1186/s12909-024-05768-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 07/11/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND Ensuring ongoing first-aid training for primary healthcare providers (PHPs) is one of the critical strategies for providing quality health services and contributing to achieving universal health coverage. However, PHPs have received insufficient attention in terms of training and capacity building, especially in the remote areas of low-to-middle-income countries. This study evaluated the effectiveness of a first-aid training program for PHPs on a Vietnamese island and explored their perspectives and experiences regarding first-aid implementation. METHODS A mixed-methods study was conducted among 39 PHPs working in community healthcare centers. The quantitative method utilized a quasi-experimental design to evaluate participants' first-aid knowledge at three time points: pre-training, immediately post-training, and three months post-training. Sixteen of the PHPs participated in subsequent semi-structured focus group interviews using the qualitative method. Quantitative data were analyzed using repeated measures analysis of variance (ANOVA), while qualitative data were subjected to thematic analysis. RESULTS The quantitative results showed a significant improvement in both the overall mean first-aid knowledge scores and the subdimensions of the first-aid knowledge scores among healthcare providers post-training. There was a statistically significant difference between the baseline and immediate posttest and follow-up knowledge scores (p < 0.001). However, the difference in knowledge scores between the immediate posttest and three-month follow-up was not significant (p > 0.05). Three main themes emerged from the focus group discussions: perception of first-aid in remote areas, facilitators and barriers. Participants identified barriers, including infrastructure limitations, shortage of the primary healthcare workforce, inadequate competencies, and insufficient resources. Conversely, receiving considerable support from colleagues and the benefits of communication technologies in implementing first aid were mentioned as facilitators. The training bolstered the participants' confidence in their first-aid responses, and there was a desire for continued education. CONCLUSIONS Implementing periodic first-aid refresher training for PHPs in a nationwide resource-limited setting can contribute significantly to achieving universal health coverage goals. This approach potentially enhances the preparedness of healthcare providers in these areas to deliver timely and effective first aid during emergencies, which may lead to more consistent primary healthcare services despite various challenges.
Collapse
Affiliation(s)
- Ninh Do Thi
- College of Nursing, Ewha Womans University, Seoul, Korea.
- Hai Phong University of Medicine and Pharmacy, 72 Nguyen Binh Khiem, Hai Phong, Vietnam.
| | - Giang Hoang Thi
- Hai Phong University of Medicine and Pharmacy, 72 Nguyen Binh Khiem, Hai Phong, Vietnam
| | - Yoonjung Lee
- Department of Medical Education, Seoul National University College of Medicine, Seoul, Korea
| | - Khue Pham Minh
- Hai Phong University of Medicine and Pharmacy, 72 Nguyen Binh Khiem, Hai Phong, Vietnam
| | - Hai Nguyen Thanh
- Hai Phong University of Medicine and Pharmacy, 72 Nguyen Binh Khiem, Hai Phong, Vietnam
| | - Jwa-Seop Shin
- Department of Medical Education, Seoul National University College of Medicine, Seoul, Korea
| | - Tuyen Luong Xuan
- Vietnam National Institute of Maritime Medicine, Hai Phong, Vietnam
| |
Collapse
|
2
|
Rimal P, Shrestha S, Khatri R, Sapkota S, Swar SB, Basnet M, Sigdel K, Jirel S, Acharya B. Addressing Challenges for Psychotherapy Supervision in Global Mental Health: Experiential Learnings From Rural Nepal. RESEARCH SQUARE 2024:rs.3.rs-4499074. [PMID: 38978610 PMCID: PMC11230512 DOI: 10.21203/rs.3.rs-4499074/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
Background As the field of global mental health grows, many psychotherapy trainees will work across cultures in low-resource settings in high-income countries or in low- and middle-income countries. Faculty members and mentors may face several challenges in providing supervision for psychologists in low-resource settings. As such, there is a need to develop best practices for psychotherapy supervision in global mental health. Methods We describe the common challenges and potential strategies in psychotherapy supervision based on our research, clinical, and academic partnerships between academic institutions, a nonprofit organization, and the Nepali government. Results The strategies and considerations we have found helpful include focusing on therapies with strong behavioral and interpersonal (rather than emotional or cognitive) components and using locally validated therapies or standard manuals that have been endorsed by the WHO for low-resource settings. Other strategies include providing psychotherapy training for local psychiatrists who may be in supervisory roles and gaining competence in navigating different expectations of social structures and family dynamics. Conclusion Supervisors face many challenges while supporting trainees and early psychologists in global mental health settings. While ensuring local adaptation, key considerations can be developed into best practices to support psychiatrists, supervisors, and trainees based in low- and middle-income countries.
Collapse
|
3
|
Rimal P, Choudhury N, Agrawal P, Basnet M, Bohara B, Citrin D, Dhungana SK, Gauchan B, Gupta P, Gupta TK, Halliday S, Kadayat B, Mahar R, Maru D, Nguyen V, Poudel S, Raut A, Rawal J, Sapkota S, Schwarz D, Schwarz R, Shrestha S, Swar S, Thapa A, Thapa P, White R, Acharya B. Collaborative care model for depression in rural Nepal: a mixed-methods implementation research study. BMJ Open 2021; 11:e048481. [PMID: 34400456 PMCID: PMC8370561 DOI: 10.1136/bmjopen-2020-048481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Despite carrying a disproportionately high burden of depression, patients in low-income countries lack access to effective care. The collaborative care model (CoCM) has robust evidence for clinical effectiveness in improving mental health outcomes. However, evidence from real-world implementation of CoCM is necessary to inform its expansion in low-resource settings. METHODS We conducted a 2-year mixed-methods study to assess the implementation and clinical impact of CoCM using the WHO Mental Health Gap Action Programme protocols in a primary care clinic in rural Nepal. We used the Capability Opportunity Motivation-Behaviour (COM-B) implementation research framework to adapt and study the intervention. To assess implementation factors, we qualitatively studied the impact on providers' behaviour to screen, diagnose and treat mental illness. To assess clinical impact, we followed a cohort of 201 patients with moderate to severe depression and determined the proportion of patients who had a substantial clinical response (defined as ≥50% decrease from baseline scores of Patient Health Questionnaire (PHQ) to measure depression) by the end of the study period. RESULTS Providers experienced improved capability (enhanced self-efficacy and knowledge), greater opportunity (via access to counsellors, psychiatrist, medications and diagnostic tests) and increased motivation (developing positive attitudes towards people with mental illness and seeing patients improve) to provide mental healthcare. We observed substantial clinical response in 99 (49%; 95% CI: 42% to 56%) of the 201 cohort patients, with a median seven point (Q1:-9, Q3:-2) decrease in PHQ-9 scores (p<0.0001). CONCLUSION Using the COM-B framework, we successfully adapted and implemented CoCM in rural Nepal, and found that it enhanced providers' positive perceptions of and engagement in delivering mental healthcare. We observed clinical improvement of depression comparable to controlled trials in high-resource settings. We recommend using implementation research to adapt and evaluate CoCM in other resource-constrained settings to help expand access to high-quality mental healthcare.
Collapse
Affiliation(s)
- Pragya Rimal
- Nyaya Health Nepal, Kathmandu, Nepal
- Possible, Kathmandu, Nepal
| | - Nandini Choudhury
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Possible, New York, New York, USA
| | | | - Madhur Basnet
- Nyaya Health Nepal, Kathmandu, Nepal
- Department of Psychiatry, BP Koirala Institute of Health Sciences, Dharan, Kathmandu, Nepal
| | | | - David Citrin
- Possible, New York, New York, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | | | | | | | | | - Scott Halliday
- Possible, New York, New York, USA
- Global Health, University of Washington, Seattle, Washington, USA
| | | | | | - Duncan Maru
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Possible, New York, New York, USA
| | - Viet Nguyen
- Health Services, Los Angeles County Department of Health Services, Los Angeles, California, USA
- University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | | | - Anant Raut
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Possible, New York, New York, USA
| | | | - Sabitri Sapkota
- Possible, Kathmandu, Nepal
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Dan Schwarz
- Possible, New York, New York, USA
- Division of Global Health Equity, Brigham and Women's Hospital Department of Medicine, Boston, Massachusetts, USA
| | - Ryan Schwarz
- Possible, New York, New York, USA
- Division of Global Health Equity, Brigham and Women's Hospital Department of Medicine, Boston, Massachusetts, USA
| | - Srijana Shrestha
- Possible, New York, New York, USA
- Department of Psychology, Wheaton College, Wheaton, Illinois, USA
| | | | | | - Poshan Thapa
- University of New South Wales School of Public Health and Community Medicine, Sydney, New South Wales, Australia
| | | | - Bibhav Acharya
- Possible, New York, New York, USA
- Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, California, USA
| |
Collapse
|
4
|
Rimal P, Maru D, Chwastiak L, Agrawal P, Rao D, Swar S, Citrin D, Acharya B. Treatment recommendations made by a consultant psychiatrist to improve the quality of care in a collaborative mental health intervention in rural Nepal. BMC Psychiatry 2020; 20:46. [PMID: 32024490 PMCID: PMC7003398 DOI: 10.1186/s12888-020-2464-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 01/24/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The Collaborative Care Model (CoCM) for mental healthcare, where a consulting psychiatrist supports primary care and behavioral health workers, has the potential to address the large unmet burden of mental illness worldwide. A core component of this model is that the psychiatrist reviews treatment plans for a panel of patients and provides specific clinical recommendations to improve the quality of care. Very few studies have reported data on such recommendations. This study reviews and classifies the recommendations made by consulting psychiatrists in a rural primary care clinic in Nepal. METHODS A chart review was conducted for all patients whose cases were reviewed by the treatment team from January to June 2017, after CoCM had been operational for 6 months. Free text of the recommendations were extracted and two coders analyzed the data using an inductive approach to group and categorize recommendations until the coders achieved consensus. Cumulative frequency of the recommendations are tabulated and discussed in the context of an adapted CoCM in rural Nepal. RESULTS The clinical team discussed 1174 patient encounters (1162 unique patients) during panel reviews throughout the study period. The consultant psychiatrist made 214 recommendations for 192 (16%) patients. The most common recommendations were to revisit the primary mental health diagnosis (16%, n = 34), add or increase focus on counselling and psychosocial support (9%, n = 20), increase the antidepressant dose (9%, n = 20), and discontinue inappropriate medications (6%, n = 12). CONCLUSIONS In this CoCM study, the majority of treatment plans did not require significant change. The recommendations highlight the challenge that non-specialists face in making an accurate mental health diagnosis, the relative neglect of non-pharmacological interventions, and the risk of inappropriate medications. These results can inform interventions to better support non-specialists in rural areas.
Collapse
Affiliation(s)
| | - Duncan Maru
- Nyaya Health Nepal, Kathmandu, Nepal ,0000 0001 0670 2351grid.59734.3cDepartments of Global Health System Design and Global Health, Internal Medicine, and Pediatrics, Mount Sinai School of Medicine, New York, NY USA ,0000 0001 0670 2351grid.59734.3cArnhold Institute for Global Health, Mount Sinai School of Medicine, New York, NY USA
| | - Lydia Chwastiak
- 0000000122986657grid.34477.33Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA USA ,0000000122986657grid.34477.33Department of Global Health, University of Washington, Seattle, WA USA ,0000000122986657grid.34477.33Northwest Mental Health Technology Transfer Center, University of Washington, Seattle, WA USA
| | | | - Deepa Rao
- 0000000122986657grid.34477.33Department of Global Health, University of Washington, Seattle, WA USA ,0000000122986657grid.34477.33Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA USA
| | - Sikhar Swar
- Nyaya Health Nepal, Kathmandu, Nepal ,0000 0004 0442 6252grid.415089.1Department of Psychiatry, Kathmandu Medical College, Duwakot, Nepal
| | - David Citrin
- Nyaya Health Nepal, Kathmandu, Nepal ,0000000122986657grid.34477.33Department of Anthropology, University of Washington, Seattle, WA USA ,0000000122986657grid.34477.33Department of Global Health, University of Washington, Seattle, WA USA ,0000000122986657grid.34477.33Henry M. Jackson School of International Studies, University of Washington, Seattle, WA USA
| | - Bibhav Acharya
- Nyaya Health Nepal, Kathmandu, Nepal ,0000 0001 2297 6811grid.266102.1Department of Psychiatry, University of California, San Francisco, CA USA
| |
Collapse
|
5
|
Miles LW, Williams N, Luthy KE, Eden L. Adult Vaccination Rates in the Mentally Ill Population: An Outpatient Improvement Project. J Am Psychiatr Nurses Assoc 2020; 26:172-180. [PMID: 30866701 DOI: 10.1177/1078390319831763] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Adults who suffer with severe and persistent mental illness (SPMI) rarely access medical care to receive preventive vaccines. Aims: To increase the rate of vaccines among the SPMI population in an outpatient community mental health center (CMHC). Methods: A review of the literature identified a gap between the general population and SPMI clients in receiving preventive vaccinations. An initial mixed-method convenience survey of SPMI clients (n = 392) provided information on current vaccination status, demographics, beliefs, and interest in receiving vaccines. A vaccination program was developed to address identified barriers and increase vaccination rates. Postintervention data were collected through a mixed-method convenience survey of SPMI clients (n = 60) who participated in immunizations clinics to evaluate client satisfaction. A partnership between the health department and CMHC was developed to deliver vaccines in a nontraditional site. Vaccines administered included annual influenza; hepatitis A; hepatitis B; herpes zoster; measles, mumps, and rubella; pneumococcal; and tetanus, diphtheria, and pertussis (Tdap). Results: More than 1,000 vaccines were administered in the first 8 months, with a significant increase in vaccination rates over baseline for individual vaccines ranging from 18.75% to 83%. Postintervention survey results found a 95% satisfaction rate. Conclusions: Implementation of a vaccination program in a nontraditional site that facilitates access for SPMI clients can promote an overwhelming increase in the vaccination rates for this underserved population. Results suggest that the integration of mental health and CMHC services can have a profound positive effect on SPMI population health.
Collapse
Affiliation(s)
- Leslie W Miles
- Leslie W. Miles, DNP, APRN, PMHNP-BC, Brigham Young University, Provo, UT, USA
| | - Nathalia Williams
- Nathalia Williams, MS, FNP, Brigham Young University, Provo, UT, USA
| | - Karlen E Luthy
- Karlen E. Luthy, DNP, FNP, Brigham Young University, Provo, UT, USA
| | - Lacey Eden
- Lacey Eden, MS, FNP, Brigham Young University, Provo, UT, USA
| |
Collapse
|
6
|
Mehanni S, Wong L, Acharya B, Agrawal P, Aryal A, Basnet M, Citrin D, Dangal B, Deukmedjian G, Dhungana SK, Gauchan B, Gupta TK, Halliday S, Kalaunee SP, Kshatriya U, Kumar A, Maru D, Maru S, Nguyen V, Paudel JS, Rimal P, Saleh M, Schwarz R, Swar SB, Thapa A, Tiwari A, White R, Wu WJ, Schwarz D. Transition to active learning in rural Nepal: an adaptable and scalable curriculum development model. BMC MEDICAL EDUCATION 2019; 19:61. [PMID: 30786884 PMCID: PMC6383231 DOI: 10.1186/s12909-019-1492-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 02/12/2019] [Indexed: 05/24/2023]
Abstract
BACKGROUND Traditional medical education in much of the world has historically relied on passive learning. Although active learning has been in the medical education literature for decades, its incorporation into practice has been inconsistent. We describe and analyze the implementation of a multidisciplinary continuing medical education curriculum in a rural Nepali district hospital, for which a core objective was an organizational shift towards active learning. METHODS The intervention occurred in a district hospital in remote Nepal, staffed primarily by mid-level providers. Before the intervention, education sessions included traditional didactics. We conducted a mixed-methods needs assessment to determine the content and educational strategies for a revised curriculum. Our goal was to develop an effective, relevant, and acceptable curriculum, which could facilitate active learning. As part of the intervention, physicians acted as both learners and teachers by creating and delivering lectures. Presenters used lecture templates to prioritize clarity, relevance, and audience engagement, including discussion questions and clinical cases. Two 6-month curricular cycles were completed during the study period. Daily lecture evaluations assessed ease of understanding, relevance, clinical practice change, and participation. Periodic lecture audits recorded learner talk-time, the proportion of lecture time during which learners were talking, as a surrogate for active learning. Feedback from evaluation and audit results was provided to presenters, and pre- and post-curriculum knowledge assessment exams were conducted. RESULTS Lecture audits showed a significant increase in learner talk-time, from 14% at baseline to 30% between months 3-6, maintained at 31% through months 6-12. Lecture evaluations demonstrated satisfaction with the curriculum. Pre- and post-curriculum knowledge assessment scores improved from 50 to 64% (difference 13.3% ± 4.5%, p = 0.006). As an outcome for the measure of organizational change, the curriculum was replicated at an additional clinical site. CONCLUSION We demonstrate that active learning can be facilitated by implementing a new educational strategy. Lecture audits proved useful for internal program improvement. The components of the intervention which are transferable to other rural settings include the use of learners as teachers, lecture templates, and provision of immediate feedback. This curricular model could be adapted to similar settings in Nepal, and globally.
Collapse
Affiliation(s)
- Stephen Mehanni
- Possible, Kathmandu, Nepal
- Health Equity Action Leadership Initiative, University of California, San Francisco, San Francisco, CA USA
- Gallup Indian Medical Center, Gallup, NM USA
| | - Lena Wong
- Possible, Kathmandu, Nepal
- Health Equity Action Leadership Initiative, University of California, San Francisco, San Francisco, CA USA
- Tuba City Regional Health Care, Tuba City, AZ USA
| | - Bibhav Acharya
- Possible, Kathmandu, Nepal
- Department of Psychiatry, University of California San Francisco, San Francisco, CA USA
| | | | | | - Madhur Basnet
- Possible, Kathmandu, Nepal
- Department of Psychiatry, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - David Citrin
- Possible, Kathmandu, Nepal
- Henry M. Jackson School of International Studies, University of Washington, Seattle, WA USA
- Department of Global Health, University of Washington, Seattle, WA USA
- Department of Anthropology, University of Washington, Seattle, WA USA
| | | | - Grace Deukmedjian
- Possible, Kathmandu, Nepal
- Health Equity Action Leadership Initiative, University of California, San Francisco, San Francisco, CA USA
- Department of Pediatrics, Natividad Medical Center, Salinas, CA USA
| | | | - Bikash Gauchan
- Possible, Kathmandu, Nepal
- Health Equity Action Leadership Initiative, University of California, San Francisco, San Francisco, CA USA
| | | | - Scott Halliday
- Possible, Kathmandu, Nepal
- Henry M. Jackson School of International Studies, University of Washington, Seattle, WA USA
| | - S. P. Kalaunee
- Possible, Kathmandu, Nepal
- College of Business and Leadership, Eastern University, St. Davids, PA USA
| | | | - Anirudh Kumar
- Possible, Kathmandu, Nepal
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Duncan Maru
- Possible, Kathmandu, Nepal
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY USA
- Department of Health Systems Design and Global Health, Icahn School of Medicine at Mount Sinai, New York, NY USA
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY USA
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Sheela Maru
- Possible, Kathmandu, Nepal
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY USA
- Department of Health Systems Design and Global Health, Icahn School of Medicine at Mount Sinai, New York, NY USA
- Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Viet Nguyen
- Possible, Kathmandu, Nepal
- Health Equity Action Leadership Initiative, University of California, San Francisco, San Francisco, CA USA
| | - Jhalak Sharma Paudel
- National Health Training Center, Department of Health Services, Ministry of Health and Population, Kathmandu, Nepal
| | - Pragya Rimal
- Possible, Kathmandu, Nepal
- Health Equity Action Leadership Initiative, University of California, San Francisco, San Francisco, CA USA
| | - Marwa Saleh
- Possible, Kathmandu, Nepal
- Health Equity Action Leadership Initiative, University of California, San Francisco, San Francisco, CA USA
| | - Ryan Schwarz
- Possible, Kathmandu, Nepal
- Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Boston, MA USA
- Department of Medicine, Harvard Medical School, Boston, MA USA
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA USA
| | - Sikhar Bahadur Swar
- Possible, Kathmandu, Nepal
- Department of Psychiatry, Kathmandu Medical College, Kathmandu, Nepal
| | | | | | - Rebecca White
- Possible, Kathmandu, Nepal
- Health Equity Action Leadership Initiative, University of California, San Francisco, San Francisco, CA USA
| | - Wan-Ju Wu
- Possible, Kathmandu, Nepal
- Department of Obstetrics and Gynecology, Boston Medical Center, Boston, MA USA
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, MA USA
| | - Dan Schwarz
- Possible, Kathmandu, Nepal
- Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Boston, MA USA
- Department of Medicine, Harvard Medical School, Boston, MA USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA USA
- Ariadne Labs, Brigham and Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston, MA USA
| |
Collapse
|
7
|
Buzza C, Fiskin A, Campbell J, Guo J, Izenberg J, Kamholz B, Hung E, Acharya B. Competencies for Global Mental Health: Developing Training Objectives for a Post-Graduate Fellowship for Psychiatrists. Ann Glob Health 2018; 84:717-726. [PMID: 30779522 DOI: 10.9204/aogh.2382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Despite an increase in psychiatry trainees' interest in global mental health (GMH), there is a lack of relevant training competencies developed using educational frameworks that incorporate viewpoints from high- and low-income countries. Objective: The aim of this study was to determine competencies for a two-year post-graduate GMH fellowship for psychiatrists utilizing Kern's six-step process as a theoretical framework for curriculum development. Methods: We conducted a targeted needs assessment via key informant interviews with a purposive sample of stakeholders (n = 19), including psychiatry trainees, generalist clinicians, medical directors, psychiatrists, researchers, and GMH educators from high- and low-resource settings in the United States and abroad. We analyzed data using a template method of thematic analysis. Findings: We tabulated learning objectives across 20 domains. Broadly, clinical objectives focused on providing supervision for short-term, evidence-based psychotherapies and on identifying red flags and avoiding harmful medication use among vulnerable populations such as children and the elderly. Non-clinical objectives focused on social determinants of health, education, and clinical supervision as part of capacity-building for non-specialists, engagement in a systems-wide project to improve care, and ethical and equitable partnerships that involve reciprocal and bidirectional education. Several competencies were also relevant for global health work in general. Conclusions: A theory-informed framework for curriculum development and a diverse set of key informants can provide educational objectives that meet the priorities of the trainees and the clinical sites in both low- and high-income settings. Limitations of this study include a small sample size and a focus on clinical needs of specific sites, both of which may affect generalizability. Given the focus on training specialists (psychiatrists), the low-resource sites highlighted the importance of educating and supervising their permanent, generalist clinicians, rather than providing direct, independent patient care.
Collapse
Affiliation(s)
- Colin Buzza
- Department of Psychiatry, University of California, San Francisco, CA, US
| | - Anna Fiskin
- Department of Psychiatry, University of California, San Francisco, CA, US
| | - Jorien Campbell
- Department of Psychiatry, University of California, San Francisco, CA, US
| | - Jennifer Guo
- Department of Psychiatry, University of California, San Francisco, CA, US
| | - Jacob Izenberg
- Department of Psychiatry, University of California, San Francisco, CA, US
| | - Barbara Kamholz
- Department of Psychiatry, University of California, San Francisco, CA, US.,San Francisco Veterans Affairs Medical Center, San Francisco, CA, US
| | - Erick Hung
- Department of Psychiatry, University of California, San Francisco, CA, US
| | - Bibhav Acharya
- Department of Psychiatry, University of California, San Francisco, CA, US.,Possible, a non-profit organization, Achham, NP
| |
Collapse
|
8
|
Buzza C, Fiskin A, Campbell J, Guo J, Izenberg J, Kamholz B, Hung E, Acharya B. Competencies for Global Mental Health: Developing Training Objectives for a Post-Graduate Fellowship for Psychiatrists. Ann Glob Health 2018. [PMID: 30779522 PMCID: PMC6748267 DOI: 10.29024/aogh.2382] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background: Despite an increase in psychiatry trainees’ interest in global mental health (GMH), there is a lack of relevant training competencies developed using educational frameworks that incorporate viewpoints from high- and low-income countries. Objective: The aim of this study was to determine competencies for a two-year post-graduate GMH fellowship for psychiatrists utilizing Kern’s six-step process as a theoretical framework for curriculum development. Methods: We conducted a targeted needs assessment via key informant interviews with a purposive sample of stakeholders (n = 19), including psychiatry trainees, generalist clinicians, medical directors, psychiatrists, researchers, and GMH educators from high- and low-resource settings in the United States and abroad. We analyzed data using a template method of thematic analysis. Findings: We tabulated learning objectives across 20 domains. Broadly, clinical objectives focused on providing supervision for short-term, evidence-based psychotherapies and on identifying red flags and avoiding harmful medication use among vulnerable populations such as children and the elderly. Non-clinical objectives focused on social determinants of health, education, and clinical supervision as part of capacity-building for non-specialists, engagement in a systems-wide project to improve care, and ethical and equitable partnerships that involve reciprocal and bidirectional education. Several competencies were also relevant for global health work in general. Conclusions: A theory-informed framework for curriculum development and a diverse set of key informants can provide educational objectives that meet the priorities of the trainees and the clinical sites in both low- and high-income settings. Limitations of this study include a small sample size and a focus on clinical needs of specific sites, both of which may affect generalizability. Given the focus on training specialists (psychiatrists), the low-resource sites highlighted the importance of educating and supervising their permanent, generalist clinicians, rather than providing direct, independent patient care.
Collapse
Affiliation(s)
- Colin Buzza
- Department of Psychiatry, University of California, San Francisco, CA, US
| | - Anna Fiskin
- Department of Psychiatry, University of California, San Francisco, CA, US
| | - Jorien Campbell
- Department of Psychiatry, University of California, San Francisco, CA, US
| | - Jennifer Guo
- Department of Psychiatry, University of California, San Francisco, CA, US
| | - Jacob Izenberg
- Department of Psychiatry, University of California, San Francisco, CA, US
| | - Barbara Kamholz
- Department of Psychiatry, University of California, San Francisco, CA, US.,San Francisco Veterans Affairs Medical Center, San Francisco, CA, US
| | - Erick Hung
- Department of Psychiatry, University of California, San Francisco, CA, US
| | - Bibhav Acharya
- Department of Psychiatry, University of California, San Francisco, CA, US.,Possible, a non-profit organization, Achham, NP
| |
Collapse
|
9
|
Murphy J, Corbett KK, Linh DT, Oanh PT, Nguyen VC. Barriers and facilitators to the integration of depression services in primary care in Vietnam: a mixed methods study. BMC Health Serv Res 2018; 18:641. [PMID: 30115050 PMCID: PMC6097413 DOI: 10.1186/s12913-018-3416-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 07/24/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although the prevalence of depression in Vietnam is on par with global rates, services for depression are limited. The government of Vietnam has prioritized enhancing depression care through primary healthcare (PHC) and efforts are currently underway to test and scale-up psychosocial interventions throughout the country. With these initiatives in progress, it is important to understand implementation factors that might influence the successful integration of depression services into PHC. As the implementers of these new interventions, primary care providers (PHPs) are well placed to provide important insight into implementation factors affecting the integration of depression services into PHC. This mixed-methods study examines factors at the individual, organizational and structural levels that may act as barriers and facilitators to the integration of depression services into PHC in Vietnam from the perspective of PHPs. METHODS Data collection took place in Hanoi, Vietnam in 2014. We conducted semi-structured interviews with PHPs (n = 30) at commune health centres and outpatient clinics in one rural and one urban district of Hanoi. Theoretical thematic analysis was used to analyse interview data. We administered an online survey to PHPs at n = 150 randomly selected communes across Hanoi. N = 226 PHPs responded to the survey. We used descriptive statistics to describe the study variables acting as barriers and facilitators and used a chi-square test of independence to indicate statistically significant (p < .05) associations between study variables and the profession, location and gender of PHPs. RESULTS Individual-level barriers include low level of knowledge and familiarity with depression among PHPs. Organizational barriers include low resource availability in PHC and low managerial discretion. Barriers at the structural level include limited mental health training among all PHPs and the existing programmatic structure of PHC in Vietnam, which sets mental health apart from general services. Facilitators at the individual level include positive attitudes among PHPs towards people with depression and interest in undergoing enhanced training in depression service delivery. CONCLUSIONS While facilitating factors at the individual level are encouraging, considerable barriers at the structural level must be addressed to ensure the successful integration of depression services into PHC in Vietnam.
Collapse
Affiliation(s)
- Jill Murphy
- Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, Suite 2400, 515 W. Hastings Street, Vancouver, BC, V6B 5K3, Canada.
| | - Kitty K Corbett
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave. West, Waterloo, ON, N2L3G1, Canada
| | - Dang Thuy Linh
- Institute of Population, Health and Development, 18 Lane 132, Hoa Bang, Yen Hoa, Hanoi, 122667, Vietnam
| | - Pham Thi Oanh
- Institute of Population, Health and Development, 18 Lane 132, Hoa Bang, Yen Hoa, Hanoi, 122667, Vietnam
| | - Vu Cong Nguyen
- Institute of Population, Health and Development, 18 Lane 132, Hoa Bang, Yen Hoa, Hanoi, 122667, Vietnam
| |
Collapse
|
10
|
Developing a scalable training model in global mental health: pilot study of a video-assisted training Program for Generalist Clinicians in Rural Nepal. Glob Ment Health (Camb) 2017; 4:e8. [PMID: 28596909 PMCID: PMC5454786 DOI: 10.1017/gmh.2017.4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 12/28/2016] [Accepted: 02/16/2017] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND In low- and middle-income countries, mental health training often includes sending few generalist clinicians to specialist-led programs for several weeks. Our objective is to develop and test a video-assisted training model addressing the shortcomings of traditional programs that affect scalability: failing to train all clinicians, disrupting clinical services, and depending on specialists. METHODS We implemented the program -video lectures and on-site skills training- for all clinicians at a rural Nepali hospital. We used Wilcoxon signed-rank tests to evaluate pre- and post-test change in knowledge (diagnostic criteria, differential diagnosis, and appropriate treatment). We used a series of 'Yes' or 'No' questions to assess attitudes about mental illness, and utilized exact McNemar's test to analyze the proportions of participants who held a specific belief before and after the training. We assessed acceptability and feasibility through key informant interviews and structured feedback. RESULTS For each topic except depression, there was a statistically significant increase (Δ) in median scores on knowledge questionnaires: Acute Stress Reaction (Δ = 20, p = 0.03), Depression (Δ = 11, p = 0.12), Grief (Δ = 40, p < 0.01), Psychosis (Δ = 22, p = 0.01), and post-traumatic stress disorder (Δ = 20, p = 0.01). The training received high ratings; key informants shared examples and views about the training's positive impact and complementary nature of the program's components. CONCLUSION Video lectures and on-site skills training can address the limitations of a conventional training model while being acceptable, feasible, and impactful toward improving knowledge and attitudes of the participants.
Collapse
|