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Impacts of Community Resilience on the Implementation of a Mental Health Promotion Program in Rural Australia.

ABSTRACT: Mental health promotion programs are important in rural communities but the factors which influence program effectiveness remain unclear. The aim of this mixed-methods study was to assess how community resilience affected the implementation of a mental health promotion program in rural Tasmania, Australia. Four study communities were selected based on population size, rurality, access to local support services, history of suicide within the community, and maturity of the mental health promotion program. Data from self-report questionnaires (n = 245), including items of Communities Advancing Resilience Toolkit (CART) assessment, and qualitative (focus group and interview) data from key local stakeholders (n = 24), were pooled to explore the factors perceived to be influencing program implementation. Survey results indicate the primary community resilience strengths across the four sites were related to the 'Connection and Caring' domain. The primary community resilience challenges related to resources. Qualitative findings suggested lack of communication and leadership are key barriers to effective program delivery and identified a need to provide ongoing support for program staff. Assessment of perceived community resilience may be helpful in informing the implementation of mental health promotion programs in rural areas and, in turn, improve the likelihood of their success and sustainability.

SUBMITTER: de Deuge J

PROVIDER: S-EPMC7142994 | biostudies-literature | 2020 Mar

REPOSITORIES: biostudies-literature

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Impacts of Community Resilience on the Implementation of a Mental Health Promotion Program in Rural Australia.

de Deuge Josephine J Hoang Ha H Kent Katherine K Mond Jonathon J Bridgman Heather H Skromanis Sarah S Smith Laura L Auckland Stuart S

International journal of environmental research and public health 20200319 6

Mental health promotion programs are important in rural communities but the factors which influence program effectiveness remain unclear. The aim of this mixed-methods study was to assess how community resilience affected the implementation of a mental health promotion program in rural Tasmania, Australia. Four study communities were selected based on population size, rurality, access to local support services, history of suicide within the community, and maturity of the mental health promotion ...[more]

PMID: 32204412

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Project description:IntroductionTo address the know-do gap in the integration of mental health care into primary care in resource-limited settings, a multi-faceted implementation program initially designed to integrate HIV/AIDS care into primary care was adapted for severe mental disorders and epilepsy in Burera District, Rwanda. The Mentoring and Enhanced Supervision at Health Centers (MESH MH) program supported primary care-delivered mental health service delivery scale-up from 6 to 19 government-run health centers over two years. This quasi-experimental study assessed implementation reach, fidelity, and clinical outcomes at health centers supported by MESH MH during the scale up period.MethodsMESH MH consisted of four strategies to ensure the delivery of the priority care packages at health centers: training; supervision and mentorship; audit and feedback; and systems-based quality improvement (QI). Implementation reach (service use) across the 19 health centers supported by MESH MH during the two year scale-up period was described using routine service data. Implementation fidelity was measured at four select health centers by comparing total clinical supervisory visits and checklists to target goals, and by tracking clinical observation checklist item completion rates over a nine month period. A prospective before and after evaluation measured clinical outcomes in consecutive adults presenting to four select health centers over a nine month period. Primary outcome assessments at baseline, 2 and 6 months included symptoms and functioning, measured by the General Health Questionnaire (GHQ-12) and the World Health Organization Disability Assessment Scale (WHO-DAS Brief), respectively. Secondary outcome assessments included engagement in income generating work and caregiver burden using a quantitative scale adapted to context.ResultsA total of 2239 mental health service users completed 15,744 visits during the scale up period. MESH MH facilitated 70% and 76% of supervisory visit and clinical checklist utilization target goals, respectively. Checklist item completion rates significantly improved overall, and for three of five checklist item subgroups examined. 121 of 146 consecutive service users completed outcome measurements six months after entry into care. Scores improved significantly over six months on both the GHQ-12, with median score improving from 26 to 10 (mean within-person change 12.5 [95% CI: 10.9-14.0] p< 0.0001), and the WHO-DAS Brief, with median score improving from 26.5 to 7 (mean within-person change 16.9 [95% CI: 14.9-18.8] p< 0.0001). Over the same period, the percentage of surveyed service users reporting an inability to work decreased significantly (51% to 6% (p < 0.001)), and the proportion of households reporting that a caregiver had left income-generating work decreased significantly (41% to 4% (p < 0.001)).ConclusionMESH MH was associated with high service use, improvements in mental health care delivery by primary care nurses, and significant improvements in clinical symptoms and functional disability of service users receiving care at health centers supported by the program. Multifaceted implementation programs such as MESH MH can reduce the evidence to practice gap for mental health care delivery by nonspecialists in resource-limited settings. The primary limitation of this study is the lack of a control condition, consistent with the implementation science approach of the study.Study registrationISRCTN #37231.

Project description:Background and Aims:Despite the many known health benefits of physical activity (PA), older adults are the least active citizens in many countries. Regular PA significantly decreases the odds of functional limitation and social disengagement. However, there is a dearth of publicly funded support services for older adults. The primary objective of this study is to conduct a formative evaluation to examine the implementation of community-driven health promotion programs for older adults in British Columbia, Canada. Methods:The Active Aging Grant (AAG) initiative funded 30 community-based organizations in British Columbia to design and deliver community-driven health promotion programs for older adults, with an explicit focus on PA and social connectedness. Guided by the Framework for Successful Implementation, we recruited program coordinators and participants and used semistructured interview guides to focus on design, delivery, and experience within the program. Framework analysis was used with NVivo 11. Results:Thirty-six in-depth, semistructured interviews were conducted in 2017, after program completion. Data saturation was achieved after interviewing 10 coordinators and 26 program participants from seven of the organizations. Eighteen were female; nine were male; 68% fell in the age range of 65-84. We detail the innovation characteristics, provider characteristics, and contextual factors that facilitate and impede program implementation. Aspects that facilitate implementation include that they promote PA, foster social connectedness, and address isolation and loneliness; personal accountability; affordability; program design; providers' appropriate skills; community collaborations; and transportation support. Aspects that hinder implementation include lack of resources for marketing and communications, lack of volunteers and dedicated staff, and access to transportation. We also highlight two themes that emerged outside the theoretical framework, the roles of gender and funding in program implementation. Conclusions:As part of a formative evaluation, the information will help adapt and enhance implementation of a larger scale-out intervention aimed to increase PA and social connectedness amongst older adults in British Columbia, Canada.

Project description:BackgroundWorkplace health programs (WHPs) may improve adult health but very little evidence exists on multi-level WHPs implemented at-scale and so the relationship between program implementation factors and outcomes of WHPs are poorly understood. This study evaluated Get Healthy at Work (GHaW), a state-wide government-funded WHP in Australia.MethodsA mixed-method design included a longitudinal quasi-experimental survey of businesses registered with GHaW and a comparison group of businesses surveyed over a 12-month period. Semi-structured interviews and focus groups with key contacts and employees of selected intervention group businesses and the service providers of the program were conducted to assess program adoption and adaptation.ResultsPositive business-level changes in workplace culture were observed over time among GHaW businesses compared with the control group. Multilevel regression modelling revealed perceptions that employees were generally healthy (p = 0.045 timeXgroup effect) and that the workplace promoted healthy behaviours (p = 0.004 timeXgroup effect) improved significantly while the control group reported no change in work culture perceptions. Changes in perceptions about work productivity were not observed; however only one third of businesses registered for the program had adopted GHaW during the evaluation period. Qualitative results revealed a number of factors contributing to program adoption: which depended on program delivery (e.g., logistics, technology and communication channels), design features of the program, and organisational factors (primarily business size and previous experience of WHPs).ConclusionsEvaluation of program factors is important to improve program delivery and uptake and to ensure greater scalability. GHaW has the potential to improve workplace health culture, which may lead to better health promoting work environments. These results imply that government can play a central role in enabling prioritisation and incentivising health promotion in the workplace.

Dataset Information

Impacts of Community Resilience on the Implementation of a Mental Health Promotion Program in Rural Australia.

Publications

Impacts of Community Resilience on the Implementation of a Mental Health Promotion Program in Rural Australia.

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