TY - JOUR
T1 - Implementation strategy in collaboration with people with lived experience of mental illness to reduce stigma among primary care providers in Nepal (RESHAPE)
T2 - protocol for a type 3 hybrid implementation effectiveness cluster randomized controlled trial
AU - Kohrt, Brandon A.
AU - Turner, Elizabeth L.
AU - Gurung, Dristy
AU - Wang, Xueqi
AU - Neupane, Mani
AU - Luitel, Nagendra P.
AU - Kartha, Muralikrishnan R.
AU - Poudyal, Anubhuti
AU - Singh, Ritika
AU - Rai, Sauharda
AU - Baral, Phanindra Prasad
AU - McCutchan, Sabrina
AU - Gronholm, Petra C.
AU - Hanlon, Charlotte
AU - Lempp, Heidi
AU - Lund, Crick
AU - Thornicroft, Graham
AU - Gautam, Kamal
AU - Jordans, Mark J.D.
N1 - Funding Information:
The authors thank the Nepal Health Research Council, Suraj Koirala (Managing Director, TPO Alliance), the RESHAPE research staff of TPO Nepal, Kedar Maharatta (WHO Nepal mental health focal point), Andrea Horvath Marques (program officer, National Institute of Mental Health), Ramesh Prasad Adhikari (Gandaki Province, National Training Center), Khim Bahadur Khadka (Gandaki Province, Health Office).
Funding Information:
This study is funded by the United States National Institute of Mental Health (R01MH120649, PI: B. Kohrt). The funding body did not participate in the design of the study; collection, analysis, and interpretation of the data; and writing of the manuscript.
Funding Information:
The authors declare that they have no competing interests. KG was supported by Intas Pharmaceuticals Limited to attend the 69th Annual Conference of Indian Psychiatric Society held in Raipur, India between 5-8 January, 2017 and 71st Annual Conference of Indian Psychiatric Society (ANCIPS) held in Lucknow, India between 31st January, 2019 to 3rd February, 2019, and the Asian Pharmaceuticals Private Limited, Nepal sponsored travel, food and accommodation during the 8th National Conference of the Psychiatrists' Association of Nepal held in Biratnagar, Nepal between 28th October to 30th October, 2021. PB was sponsored by the World Health Organization to attend the 8th National Conference of the Psychiatrists' Association of Nepal held in Biratnagar, Nepal organized by the Psychiatrists Association of Nepal between 28th October to 30th October, 2021.
Funding Information:
Regarding the declaration of other funding sources, AP has received support from the NIMH T32 on Social Determinants of HIV (T32MH128395-01). PCG is supported by the UK Medical Research Council (UKRI) in relation to the Indigo Partnership (MR/R023697/1) award. CH is funded through the ASSET research program, supported by the UK’s National Institute of Health Research (NIHR) (NIHR Global Health Research Unit on Health Systems Strengthening in Sub-Saharan Africa at King’s College London (16/136/54)) using UK aid from the UK Government. CH also receives support from NIHR through grant NIHR200842. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research, or the Department of Health and Social Care, England. CH also receives support from the Wellcome Trust (grant 222154_Z20_Z). HL is supported through funding by the National Ankylosing Spondylitis Society, UK; KHP Multiple Long-Term Conditions Challenge Fund; the Guy’s and St Thomas’ Charity for the On Trac project (EFT151101); and the UK Medical Research Council (UKRI) in relation to the Emilia (MR/S001255/1) and Indigo Partnership (MR/R023697/1) and UKRI MRC Project (Artemis) (MR/S023224/1) awards. GT is supported by the National Institute for Health Research (NIHR) Applied Research Collaboration South London at King’s College London NHS Foundation Trust, the NIHR Asset Global Health Unit award, and the NIHR Hope Global Health Group award. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care. GT is also supported by the Guy’s and St Thomas’ Charity for the On Trac Project (EFT151101) and by the UK Medical Research Council (UKRI) in relation to the Emilia (MR/S001255/1) and Indigo Partnership (MR/R023697/1) awards.
Publisher Copyright:
© 2022, The Author(s).
PY - 2022/12
Y1 - 2022/12
N2 - Background: There are increasing efforts for the integration of mental health services into primary care settings in low- and middle-income countries. However, commonly used approaches to train primary care providers (PCPs) may not achieve the expected outcomes for improved service delivery, as evidenced by low detection rates of mental illnesses after training. One contributor to this shortcoming is the stigma among PCPs. Implementation strategies for training PCPs that reduce stigma have the potential to improve the quality of services. Design: In Nepal, a type 3 hybrid implementation-effectiveness cluster randomized controlled trial will evaluate the implementation-as-usual training for PCPs compared to an alternative implementation strategy to train PCPs, entitled Reducing Stigma among Healthcare Providers (RESHAPE). In implementation-as-usual, PCPs are trained on the World Health Organization Mental Health Gap Action Program Intervention Guide (mhGAP-IG) with trainings conducted by mental health specialists. In RESHAPE, mhGAP-IG training includes the added component of facilitation by people with lived experience of mental illness (PWLE) and their caregivers using PhotoVoice, as well as aspirational figures. The duration of PCP training is the same in both arms. Co-primary outcomes of the study are stigma among PCPs, as measured with the Social Distance Scale at 6 months post-training, and reach, a domain from the RE-AIM implementation science framework. Reach is operationalized as the accuracy of detection of mental illness in primary care facilities and will be determined by psychiatrists at 3 months after PCPs diagnose the patients. Stigma will be evaluated as a mediator of reach. Cost-effectiveness and other RE-AIM outcomes will be assessed. Twenty-four municipalities, the unit of clustering, will be randomized to either mhGAP-IG implementation-as-usual or RESHAPE arms, with approximately 76 health facilities and 216 PCPs divided equally between arms. An estimated 1100 patients will be enrolled for the evaluation of accurate diagnosis of depression, generalized anxiety disorder, psychosis, or alcohol use disorder. Masking will include PCPs, patients, and psychiatrists. Discussion: This study will advance the knowledge of stigma reduction for training PCPs in partnership with PWLE. This collaborative approach to training has the potential to improve diagnostic competencies. If successful, this implementation strategy could be scaled up throughout low-resource settings to reduce the global treatment gap for mental illness. Trial registration: ClinicalTrials.gov, NCT04282915. Date of registration: February 25, 2020.
AB - Background: There are increasing efforts for the integration of mental health services into primary care settings in low- and middle-income countries. However, commonly used approaches to train primary care providers (PCPs) may not achieve the expected outcomes for improved service delivery, as evidenced by low detection rates of mental illnesses after training. One contributor to this shortcoming is the stigma among PCPs. Implementation strategies for training PCPs that reduce stigma have the potential to improve the quality of services. Design: In Nepal, a type 3 hybrid implementation-effectiveness cluster randomized controlled trial will evaluate the implementation-as-usual training for PCPs compared to an alternative implementation strategy to train PCPs, entitled Reducing Stigma among Healthcare Providers (RESHAPE). In implementation-as-usual, PCPs are trained on the World Health Organization Mental Health Gap Action Program Intervention Guide (mhGAP-IG) with trainings conducted by mental health specialists. In RESHAPE, mhGAP-IG training includes the added component of facilitation by people with lived experience of mental illness (PWLE) and their caregivers using PhotoVoice, as well as aspirational figures. The duration of PCP training is the same in both arms. Co-primary outcomes of the study are stigma among PCPs, as measured with the Social Distance Scale at 6 months post-training, and reach, a domain from the RE-AIM implementation science framework. Reach is operationalized as the accuracy of detection of mental illness in primary care facilities and will be determined by psychiatrists at 3 months after PCPs diagnose the patients. Stigma will be evaluated as a mediator of reach. Cost-effectiveness and other RE-AIM outcomes will be assessed. Twenty-four municipalities, the unit of clustering, will be randomized to either mhGAP-IG implementation-as-usual or RESHAPE arms, with approximately 76 health facilities and 216 PCPs divided equally between arms. An estimated 1100 patients will be enrolled for the evaluation of accurate diagnosis of depression, generalized anxiety disorder, psychosis, or alcohol use disorder. Masking will include PCPs, patients, and psychiatrists. Discussion: This study will advance the knowledge of stigma reduction for training PCPs in partnership with PWLE. This collaborative approach to training has the potential to improve diagnostic competencies. If successful, this implementation strategy could be scaled up throughout low-resource settings to reduce the global treatment gap for mental illness. Trial registration: ClinicalTrials.gov, NCT04282915. Date of registration: February 25, 2020.
KW - Cost-effectiveness
KW - Depression
KW - Developing countries
KW - Primary care
KW - Randomized controlled trial
KW - Stigma
KW - Training
UR - http://www.scopus.com/inward/record.url?scp=85132078883&partnerID=8YFLogxK
U2 - 10.1186/s13012-022-01202-x
DO - 10.1186/s13012-022-01202-x
M3 - Article
C2 - 35710491
AN - SCOPUS:85132078883
SN - 1748-5908
VL - 17
JO - Implementation Science
JF - Implementation Science
IS - 1
M1 - 39
ER -
