TY - JOUR
KW - Chronic Disease
KW - Depression/epidemiology/therapy
KW - Humans
KW - Mental Health
KW - Observational Studies as Topic
KW - Primary Health Care
KW - South Africa
KW - collaborative care
KW - Depression
KW - implementation science
KW - Multi-morbidity
AU - I. Petersen
AU - C. G. Kemp
AU - D. Rao
AU - B. H. Wagenaar
AU - K. Sherr
AU - M. Grant
AU - M. Bachmann
AU - R. V. Barnabas
AU - N. Mntambo
AU - S. Gigaba
AU - A. van Rensburg
AU - Z. Luvuno
AU - I. Amarreh
AU - L. Fairall
AU - N. N. Hongo
AU - A. Bhana
A1 - 
AB - BACKGROUND: People with chronic general medical conditions who have comorbid depression experience poorer health outcomes. This problem has received scant attention in low- and middle-income countries. The aim of the ongoing study reported here is to refine and promote the scale-up of an evidence-based task-sharing collaborative care model, the Mental Health Integration (MhINT) program, to treat patients with comorbid depression and chronic disease in primary health care settings in South Africa. METHODS: Adopting a learning-health-systems approach, this study uses an onsite, iterative observational implementation science design. Stage 1 comprises assessment of the original MhINT model under real-world conditions in an urban subdistrict in KwaZulu-Natal, South Africa, to inform refinement of the model and its implementation strategies. Stage 2 comprises assessment of the refined model across urban, semiurban, and rural contexts. In both stages, population-level effects are assessed by using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) evaluation framework with various sources of data, including secondary data collection and a patient cohort study (N=550). The Consolidated Framework for Implementation Research is used to understand contextual determinants of implementation success involving quantitative and qualitative interviews (stage 1, N=78; stage 2, N=282). RESULTS: The study results will help refine intervention components and implementation strategies to enable scale-up of the MhINT model for depression in South Africa. NEXT STEPS: Next steps include strengthening ongoing engagements with policy makers and managers, providing technical support for implementation, and building the capacity of policy makers and managers in implementation science to promote wider dissemination and sustainment of the intervention.
AD - Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa (Petersen, Grant, Gigaba, Van Rensburg, Luvuno, Bhana); Department of Global Health (Kemp, Rao, Wagenaar, Sherr, Barnabas), Department of Psychiatry and Behavioral Sciences (Rao), Department of Epidemiology (Wagenaar), University of Washington, Seattle; Norwich Medical School, University of East Anglia, Norwich, Norfolk, United Kingdom (Bachmann); School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa (Mntambo, Gigaba); Center for Global Mental Health Research, National Institute of Mental Health, Bethesda, Maryland (Amarreh); Knowledge Translation Unit, University of Cape Town, Cape Town, South Africa, and King's Global Health Institute, King's College London, London (Fairall); Mental Health and Substance Abuse Directorate, KwaZulu-Natal Department of Health, Natalia, Pietermaritzburg, South Africa (Hongo); Health Systems Research Unit, South African Medical Research Council, Durban, South Africa (Bhana).; Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa (Petersen, Grant, Gigaba, Van Rensburg, Luvuno, Bhana); Department of Global Health (Kemp, Rao, Wagenaar, Sherr, Barnabas), Department of Psychiatry and Behavioral Sciences (Rao), Department of Epidemiology (Wagenaar), University of Washington, Seattle; Norwich Medical School, University of East Anglia, Norwich, Norfolk, United Kingdom (Bachmann); School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa (Mntambo, Gigaba); Center for Global Mental Health Research, National Institute of Mental Health, Bethesda, Maryland (Amarreh); Knowledge Translation Unit, University of Cape Town, Cape Town, South Africa, and King's Global Health Institute, King's College London, London (Fairall); Mental Health and Substance Abuse Directorate, KwaZulu-Natal Department of Health, Natalia, Pieter(TRUNCATED)
BT - Psychiatric services (Washington, D.C.)
C5 - Education & Workforce; Healthcare Disparities
CP - 9
DO - 10.1176/appi.ps.202000014
IS - 9
JF - Psychiatric services (Washington, D.C.)
LA - eng
M1 - Journal Article
N2 - BACKGROUND: People with chronic general medical conditions who have comorbid depression experience poorer health outcomes. This problem has received scant attention in low- and middle-income countries. The aim of the ongoing study reported here is to refine and promote the scale-up of an evidence-based task-sharing collaborative care model, the Mental Health Integration (MhINT) program, to treat patients with comorbid depression and chronic disease in primary health care settings in South Africa. METHODS: Adopting a learning-health-systems approach, this study uses an onsite, iterative observational implementation science design. Stage 1 comprises assessment of the original MhINT model under real-world conditions in an urban subdistrict in KwaZulu-Natal, South Africa, to inform refinement of the model and its implementation strategies. Stage 2 comprises assessment of the refined model across urban, semiurban, and rural contexts. In both stages, population-level effects are assessed by using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) evaluation framework with various sources of data, including secondary data collection and a patient cohort study (N=550). The Consolidated Framework for Implementation Research is used to understand contextual determinants of implementation success involving quantitative and qualitative interviews (stage 1, N=78; stage 2, N=282). RESULTS: The study results will help refine intervention components and implementation strategies to enable scale-up of the MhINT model for depression in South Africa. NEXT STEPS: Next steps include strengthening ongoing engagements with policy makers and managers, providing technical support for implementation, and building the capacity of policy makers and managers in implementation science to promote wider dissemination and sustainment of the intervention.
PY - 2021
SN - 1557-9700; 1075-2730; 1075-2730
SP - 1065
EP - 1075
EP - 
T1 - Implementation and Scale-Up of Integrated Depression Care in South Africa: An Observational Implementation Research Protocol
T2 - Psychiatric services (Washington, D.C.)
TI - Implementation and Scale-Up of Integrated Depression Care in South Africa: An Observational Implementation Research Protocol
U1 - Education & Workforce; Healthcare Disparities
U2 - 33691487
U3 - 10.1176/appi.ps.202000014
VL - 72
VO - 1557-9700; 1075-2730; 1075-2730
Y1 - 2021
Y2 - Sep 1
ER -