Dataset Information

Process evaluation of a district mental healthcare plan in Nepal: a mixed-methods case study.

ABSTRACT:

Background

The PRogramme for Improving Mental Health carE (PRIME) evaluated the process and outcomes of the implementation of a mental healthcare plan (MHCP) in Chitwan, Nepal.

Aims

To describe the process of implementation, the barriers and facilitating factors, and to evaluate the process indicators of the MHCP.

Method

A case study design that combined qualitative and quantitative methods based on a programme theory of change (ToC) was used and included: (a) district-, community- and health-facility profiles; (b) monthly implementation logs; (c) pre- and post-training evaluation; (d) out-patient clinical data and (e) qualitative interviews with patients and caregivers.

Results

The MHCP was able to achieve most of the indicators outlined by the ToC. Of the total 32 indicators, 21 (66%) were fully achieved, 10 (31%) partially achieved and 1 (3%) were not achieved at all. The proportion of primary care patients that received mental health services increased by 1200% over the 3-year implementation period. Major barriers included frequent transfer of trained health workers, lack of confidential space for consultation, no mental health supervision in the existing system, and stigma. Involvement of Ministry of Health, procurement of new psychotropic medicines through PRIME, motivation of health workers and the development of a new supervision system were key facilitating factors.

Conclusions

Effective implementation of mental health services in primary care settings require interventions to increase demand for services and to ensure there is clinical supervision for health workers, private rooms for consultations, a separate cadre of psychosocial workers and a regular supply of psychotropic medicines.

SUBMITTER: Luitel NP

PROVIDER: S-EPMC7443901 | biostudies-literature | 2020 Jul

REPOSITORIES: biostudies-literature

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Publications

Process evaluation of a district mental healthcare plan in Nepal: a mixed-methods case study.

Luitel Nagendra P NP Breuer Erica E Adhikari Anup A Kohrt Brandon A BA Lund Crick C Komproe Ivan H IH Jordans Mark J D MJD

BJPsych open 20200728 4

<h4>Background</h4>The PRogramme for Improving Mental Health carE (PRIME) evaluated the process and outcomes of the implementation of a mental healthcare plan (MHCP) in Chitwan, Nepal.<h4>Aims</h4>To describe the process of implementation, the barriers and facilitating factors, and to evaluate the process indicators of the MHCP.<h4>Method</h4>A case study design that combined qualitative and quantitative methods based on a programme theory of change (ToC) was used and included: (a) district-, co ...[more]

PMID: 32718381

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Project description:BackgroundIn low-income countries, care for people with mental, neurological, and substance use (MNS) disorders is largely absent, especially in rural settings. To increase treatment coverage, integration of mental health services into community and primary healthcare settings is recommended. While this strategy is being rolled out globally, rigorous evaluation of outcomes at each stage of the service delivery pathway from detection to treatment initiation to individual outcomes of care has been missing.Methods and findingsA combination of methods were employed to evaluate the impact of a district mental healthcare plan for depression, psychosis, alcohol use disorder (AUD), and epilepsy as part of the Programme for Improving Mental Health Care (PRIME) in Chitwan District, Nepal. We evaluated 4 components of the service delivery pathway: (1) contact coverage of primary care mental health services, evaluated through a community study (N = 3,482 combined for all waves of community surveys) and through service utilisation data (N = 727); (2) detection of mental illness among participants presenting in primary care facilities, evaluated through a facility study (N = 3,627 combined for all waves of facility surveys); (3) initiation of minimally adequate treatment after diagnosis, evaluated through the same facility study; and (4) treatment outcomes of patients receiving primary-care-based mental health services, evaluated through cohort studies (total N = 449 depression, N = 137; AUD, N = 175; psychosis, N = 95; epilepsy, N = 42). The lack of structured diagnostic assessments (instead of screening tools), the relatively small sample size for some study components, and the uncontrolled nature of the study are among the limitations to be noted. All data collection took place between 15 January 2013 and 15 February 2017. Contact coverage increased 7.5% for AUD (from 0% at baseline), 12.2% for depression (from 0%), 11.7% for epilepsy (from 1.3%), and 50.2% for psychosis (from 3.2%) when using service utilisation data over 12 months; community survey results did not reveal significant changes over time. Health worker detection of depression increased by 15.7% (from 8.9% to 24.6%) 6 months after training, and 10.3% (from 8.9% to 19.2%) 24 months after training; for AUD the increase was 58.9% (from 1.1% to 60.0%) and 11.0% (from 1.1% to 12.1%) for 6 months and 24 months, respectively. Provision of minimally adequate treatment subsequent to diagnosis for depression was 93.9% at 6 months and 66.7% at 24 months; for AUD these values were 95.1% and 75.0%, respectively. Changes in treatment outcomes demonstrated small to moderate effect sizes (9.7-point reduction [d = 0.34] in AUD symptoms, 6.4-point reduction [d = 0.43] in psychosis symptoms, 7.2-point reduction [d = 0.58] in depression symptoms) at 12 months post-treatment.ConclusionsThese combined results make a promising case for the feasibility and impact of community- and primary-care-based services delivered through an integrated district mental healthcare plan in reducing the treatment gap and increasing effective coverage for MNS disorders. While the integrated mental healthcare approach does lead to apparent benefits in most of the outcome metrics, there are still significant areas that require further attention (e.g., no change in community-level contact coverage, attrition in AUD detection rates over time, and relatively low detection rates for depression).

Project description:BackgroundMental health issues among Canadian postsecondary students are prevalent. In tandem, an increased acknowledgment of the need for upstream mental health support has been highlighted. While the majority of institutions offer some form of mental health promotion, research suggests students are failing to access support due to barriers including lack of awareness, geographical and financial barriers, and lack of relevance in offerings. Canada's Student Mental Health Network is a web-based knowledge mobilization initiative designed to fill these gaps. With content created and curated "for-students, by-students" and reviewed by subject matter experts, the Network serves as a one-stop shop for evidence-based, mental health support for postsecondary students.ObjectiveThe goal of this research was to conduct the first component of a comprehensive program evaluation of the Network. This paper details a formative, process evaluation after approximately 1 year of operations, with the goal of assessing acceptability and feasibility.MethodsUsing a concurrent mixed methods study design, quantitative and qualitative data were simultaneously collected from students in order to evaluate the acceptability and feasibility of the Network as a mental health promotion resource. Quantitative data were automatically collected through Google Analytics via the website over the course of the first year of operations. Data collected included the number of users accessing the website, user engagement, and user "stickiness." Quantitative data were used to evaluate both accessibility and feasibility. Qualitative data were collected via individual, digital interviews conducted with a modest sample of students (n=8) across areas and levels of study. Qualitative data derived more detailed insights into user experience and website attributes, as well as feedback on content delivery, providing evidence used to evaluate feasibility.ResultsA total of 1200 users globally accessed the Network within the first year of operations, with Canadian users accounting for nearly 90% of total website traffic. An overall 66% engagement rate was observed, with the average user visiting 7 pages per session. Further support for the acceptability of the Network is demonstrated in the Canada-wide reach of the content development and review team. Evidence for the feasibility of the Network was observed through website use statistics indicating the most frequently viewed pages aligned with our goals: providing mental health education and increasing awareness of available resources. Qualitative feedback provided additional context surrounding the feasibility of the space, including positive feedback on the esthetics, relevance, usability, inclusion, and accessibility. Areas for content expansion and improvements to accessibility were also identified.ConclusionsThe results of this study provide evidence in support of the feasibility and acceptability of the Network as a web-based knowledge mobilization initiative in support of postsecondary students' mental health and well-being. Future research will pursue a summative, impact assessment to evaluate utility.

Project description:AimTo explore factors at different socioecological levels that affect mental health service delivery from primary healthcare (PHC) facilities of Arghakhanchi district, a western hilly district of Nepal.BackgroundMental health service delivery has seen four transformational shifts from Alma Ata to Astana Declaration. Mental Health Gap Action Programme has facilitated the delivery of evidence-based interventions on mental, neurological and substance use disorders by non-specialised health workers in PHC settings as well as advocated scaling up of mental healthcare through integration of mental health in PHC.MethodsA cross-sectional qualitative study was conducted in Arghakhanchi district of Nepal from July to August 2019 that collected information through face-to-face key informant interviews of 16 purposively selected participants using validated interview guidelines. Thematic analysis was performed using RQDA package for EZR software. Validation of translated transcripts, member checking and inter-coder percent agreement were performed to maintain rigour in the study.ResultsLack of mental health training and no authority to prescribe psychotropic medications coupled with lack of mental health commodities acted as barriers for mental health service delivery. Awareness regarding mental health and modalities of treatment to the community and provision of training and authority to prescribe psychotropic medicines were recommended by the participants for proper mental health service delivery.ConclusionsAwareness regarding mental illness treatment modalities to the community and mental health training for healthcare service providers would help increase mental health service delivery from PHC facilities. Moreover, strengthened referral system and availability of psychotropic medicines at the PHC level would assist in mental health service delivery from PHC facilities. However, regular monitoring and supervision of the services being delivered is essential.

Project description:IntroductionThe Garage is a multidisciplinary pre-academic arts school for people with artistic abilities who are coping with mental health conditions (MHC). The programme, supported by the National Insurance Institute and the Ministry of Health in Israel, is an innovative rehabilitation service designed to impart and enhance artistic-professional skills and socioemotional abilities to ultimately facilitate participants' integration into higher education and the job market.Methods and analysisThis mixed methods longitudinal study will include an embedded design in which the qualitative data are primary and the quantitative data are secondary, thus providing complementary information. The study will examine the contribution of the Garage to changes in participants' personal recovery, well-being, creative self-concept and community integration as well as possible mechanisms that may account for these changes. Qualitative data will be collected using focus groups with graduates and students (a total of ~60 participants). Quantitative data will be ‎collected by self-report questionnaires only from students attending the programme (before, during and at the end of the academic year). Data on the graduates' integration into higher education and the job market after completing the programme will also be collected from the management team. The qualitative data will be analysed following the grounded theory approach and the quantitative data will be analysed with correlations, paired tests to examine pre-post changes and regression analyses. A merged data analysis will be conducted for data integration.Ethics and disseminationThe University's Human Research Ethics Committee approved the design and procedures of the study (approval #357-16). All participants will sign an informed consent form where it is clarified that participation in the study is on a voluntary basis, and anonymity and confidentiality are guaranteed. The results will be submitted for peer-reviewed journal publications, presented at conferences and disseminated to the funder and the programme's management team.

Dataset Information

Process evaluation of a district mental healthcare plan in Nepal: a mixed-methods case study.

Background

Aims

Method

Results

Conclusions

Publications

Process evaluation of a district mental healthcare plan in Nepal: a mixed-methods case study.

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