冠军和审计和反策略的忠实性及其与抑郁症干预忠实性的关系:混合方法研究
Christopher F Akiba1, Vivian F Go2, Byron J Powell3
1RTI International, 3040 East Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709-2194, USA.
SSM. Mental health
|July 24, 2023
概括
马拉维的实施战略忠实 (ISF) 表明,领导层的参与和积极的实施气候是整合抑郁症护理的关键. 对策略的更高忠诚度与更好的抑郁症干预结果相关.
科学领域:
- 全球健康 全球健康
- 心理健康研究 心理健康研究
- 医疗保健服务研究 医疗服务研究
背景情况:
- 心理健康障碍,特别是抑郁症,是全球严重的残疾负担,不成比例地影响低收入和中等收入国家.
- 抑郁症使非传染性疾病 (NCD) 的管理变得复杂,阻碍了治疗的成功.
- 有效的实施策略对于在LMICs中传播基于证据的抑郁症干预措施至关重要,但其文档和评估仍然具有挑战性.
研究的目的:
- 评估两个实施策略的忠实性:一个基本的冠军战略和一个增强的冠军战略与审计和反.
- 评估马拉维实施战略忠实度 (ISF) 与抑郁症干预措施,基于测量的护理 (MBC) 忠实度之间的关系.
- 探索领导参与和实施气候对战略和干预忠实性的影响.
主要方法:
- 开发了一个基于理论的,混合方法的忠实性评估,结合了战略规范和忠实性框架.
- 收集了临床过程数据,并对6家NCD诊所的员工进行了45次深入采访.
- 使用描述性统计,反射主题分析,数据合并和三角化分析数据,以检查ISF-MBC忠实关系.
主要成果:
- 实施策略的忠实度在冠军策略的61-93%和增强策略的82-91%之间.
- 基于测量的护理忠实度在各诊所中从54%到95%不等.
- 虽然由于样本规模而不是统计显著,但ISF和MBC忠诚度之间的关联在预期的方向上;领导层的参与和实施气候对于保持忠诚度至关重要.
结论:
- 对基本和增强实施策略的忠诚度因地点而异,受领导力和气候的影响.
- 将领导力策略整合到冠军模型中,可以提高它们在解决实施障碍方面的有效性.
- 实施战略的忠实性可能会调节战略与实施结果之间的关系,突出说明上下文的重要性.
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