Study protocol for a stepped-wedge implementation study investigating the intersectoral collaboration of implementering the TREAT INTERACT intervention for primary school teachers and the mhGAP for health care workers for child mental health promotion in Uganda.
Humans
Uganda
School Teachers
/ psychology
Child
Mental Health
Intersectoral Collaboration
Pragmatic Clinical Trials as Topic
Health Personnel
/ psychology
Health Literacy
Health Promotion
/ methods
Mental Disorders
/ therapy
School Mental Health Services
School Health Services
Multicenter Studies as Topic
Mental Health Services
/ organization & administration
Adolescents
Children
Global mental health
Implementation
Low- and middle-income countries
Primary schools
Task-sharing
Teachers
Uganda
Journal
Trials
ISSN: 1745-6215
Titre abrégé: Trials
Pays: England
ID NLM: 101263253
Informations de publication
Date de publication:
09 Jul 2024
09 Jul 2024
Historique:
received:
26
03
2024
accepted:
03
07
2024
medline:
10
7
2024
pubmed:
10
7
2024
entrez:
9
7
2024
Statut:
epublish
Résumé
Mental and neuropsychological disorders make up approximately 14% of the total health burden globally, with 80% of the affected living in low- and middle-income countries (LMICs) of whom 90% cannot access mental health services. The main objective of the TREAT INTERACT study is to adapt, implement, and evaluate the impact of a novel, intersectoral approach to prevent, identify, refer, and treat mental health problems in children through a user centred task-sharing implementation of the TREAT INTERACT intervention, inspired by the World Health Organization (WHO) Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) for primary school staff in Mbale, Uganda. Health care personell will be trained in the mhGAP-IG. This is a pragmatic mixed-methods hybrid Type II implementation-effectiveness study utilizing a co-design approach. The main study utilize a stepped-wedged trial design with six starting sequences, randomizing three schools to the intervention at each interval, while the remaining act as "controls". Other designs include a nested prospective cohort study, case control studies, cross-sectional studies, and qualitative research. Main participants' outcomes include teachers' mental health literacy, stigma, and violence towards the school children. Implementation outcomes include detection, reach, sustainability, and service delivery. Child and caregiver outcomes include mental health, mental health literacy, and help-seeking behaviour. Based on the results, we will develop sustainable and scalable implementation advice on mental health promotion and draft implementation guidelines in line with current WHO guidelines. This project will generate new knowledge on the structure, organization, delivery, and costs of mental health services in a LMIC setting, as well as new knowledge on the implementation and delivery of new health services. ClinicalTrials, NCT06275672, 28.12.2023, retrospectively registered.
Sections du résumé
BACKGROUND
BACKGROUND
Mental and neuropsychological disorders make up approximately 14% of the total health burden globally, with 80% of the affected living in low- and middle-income countries (LMICs) of whom 90% cannot access mental health services. The main objective of the TREAT INTERACT study is to adapt, implement, and evaluate the impact of a novel, intersectoral approach to prevent, identify, refer, and treat mental health problems in children through a user centred task-sharing implementation of the TREAT INTERACT intervention, inspired by the World Health Organization (WHO) Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) for primary school staff in Mbale, Uganda. Health care personell will be trained in the mhGAP-IG.
METHODS
METHODS
This is a pragmatic mixed-methods hybrid Type II implementation-effectiveness study utilizing a co-design approach. The main study utilize a stepped-wedged trial design with six starting sequences, randomizing three schools to the intervention at each interval, while the remaining act as "controls". Other designs include a nested prospective cohort study, case control studies, cross-sectional studies, and qualitative research. Main participants' outcomes include teachers' mental health literacy, stigma, and violence towards the school children. Implementation outcomes include detection, reach, sustainability, and service delivery. Child and caregiver outcomes include mental health, mental health literacy, and help-seeking behaviour.
DISCUSSION
CONCLUSIONS
Based on the results, we will develop sustainable and scalable implementation advice on mental health promotion and draft implementation guidelines in line with current WHO guidelines. This project will generate new knowledge on the structure, organization, delivery, and costs of mental health services in a LMIC setting, as well as new knowledge on the implementation and delivery of new health services.
TRIAL REGISTRATION
BACKGROUND
ClinicalTrials, NCT06275672, 28.12.2023, retrospectively registered.
Identifiants
pubmed: 38982328
doi: 10.1186/s13063-024-08312-5
pii: 10.1186/s13063-024-08312-5
doi:
Banques de données
ClinicalTrials.gov
['NCT06275672']
Types de publication
Clinical Trial Protocol
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
465Subventions
Organisme : Norges Forskningsråd
ID : 316317/H30
Informations de copyright
© 2024. The Author(s).
Références
Arias D, Saxena S, Verguet S. Quantifying the global burden of mental disorders and their economic value. eClinicalMedicine. 2022;54:101675.
pubmed: 36193171
pmcid: 9526145
doi: 10.1016/j.eclinm.2022.101675
Molodynski A, Cusack C, Nixon J. Mental healthcare in Uganda: desperate challenges but real opportunities. BJPsych Int. 2017;14(4):98–100.
pubmed: 29093962
pmcid: 5663025
doi: 10.1192/S2056474000002129
Patel V, Chisholm D, Parikh R, Charlson FJ, Degenhardt L, Dua T, et al. Addressing the burden of mental, neurological, and substance use disorders: key messages from Disease Control Priorities, 3rd edition. Lancet. 2016;387(10028):1672–85.
pubmed: 26454360
doi: 10.1016/S0140-6736(15)00390-6
Eccles MP, Mittman BS. Welcome to implementation science. Implement Sci. 2006;1(1):1.
pmcid: 1436009
doi: 10.1186/1748-5908-1-1
Wainberg ML, Scorza P, Shultz JM, Helpman L, Mootz JJ, Johnson KA, et al. Challenges and opportunities in global mental health: a research-to-practice perspective. Curr Psychiatry Rep. 2017;19(5):28.
pubmed: 28425023
pmcid: 5553319
doi: 10.1007/s11920-017-0780-z
Glasgow RE, Lichtenstein E, Marcus AC. Why don’t we see more translation of health promotion research to practice? Rethinking the efficacy-to-effectiveness transition. Am J Public Health. 2003;93(8):1261–7.
pubmed: 12893608
pmcid: 1447950
doi: 10.2105/AJPH.93.8.1261
Arias D, Saxena S, Verguet S. Quantifying the global burden of mental disorders and their economic value. eClinicalMedicine. 2022;54. Available from: https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(22)00405-9/fulltext . Cited 2023 Jul 31.
Semrau M, Lempp H, Keynejad R, Evans-Lacko S, Mugisha J, Raja S, et al. Service user and caregiver involvement in mental health system strengthening in low- and middle-income countries: systematic review. BMC Health Serv Res. 2016;16(1):79.
pubmed: 26931580
pmcid: 4774091
doi: 10.1186/s12913-016-1323-8
World Health Assembly 69. Framework on integrated, people-centred health services: report by the Secretariat. World Health Organization; 2016. Report No.: A69/39. Available from: https://apps.who.int/iris/handle/10665/252698 . Cited 2023 Jul 25.
Putman S. Mental illness: diagnostic title or derogatory term? (Attitudes towards mental illness) Developing a learning resource for use within a clinical call centre. A systematic literature review on attitudes towards mental illness. J Psychiatr Ment Health Nurs. 2008;15(8):684–93.
pubmed: 18803744
doi: 10.1111/j.1365-2850.2008.01288.x
Thornicroft G, Brohan E, Rose D, Sartorius N, Leese M, INDIGO Study Group. Global pattern of experienced and anticipated discrimination against people with schizophrenia: a cross-sectional survey. Lancet Lond Engl. 2009;373(9661):408–15.
doi: 10.1016/S0140-6736(08)61817-6
Huang KY, Cheng S, Theise R. School contexts as social determinants of child health: current practices and implications for future public health practice. Public Health Rep. 2013;128(63):21–8.
pubmed: 24179275
pmcid: 3945445
doi: 10.1177/00333549131286S304
Bundy DAP, Silva N de, Horton S, Patton GC, Schultz L, Jamison DT. Child and adolescent health and development: realizing neglected potential. In: Bundy DAP, Silva N de, Horton S, Jamison DT, Patton GC, editors. Child and adolescent health and development. 3rd ed. Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2017. Available from: http://www.ncbi.nlm.nih.gov/books/NBK525272/ . Cited 2023 Jul 25.
Bundy DAP, Schultz L, Sarr B, Banham L, Colenso P, Drake L. The school as a platform for addressing health in middle childhood and adolescence. In: Bundy DAP, Silva N de, Horton S, Jamison DT, Patton GC, editors. Child and adolescent health and development. 3rd ed. Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2017. Available from: http://www.ncbi.nlm.nih.gov/books/NBK525255/ . Cited 2023 Jul 25.
Barry MM, Clarke AM, Jenkins R, Patel V. A systematic review of the effectiveness of mental health promotion interventions for young people in low and middle income countries. BMC Public Health. 2013;13(1):835.
pubmed: 24025155
pmcid: 3848687
doi: 10.1186/1471-2458-13-835
Bradshaw M, Gericke H, Coetzee BJ, Stallard P, Human S, Loades M. Universal school-based mental health programmes in low- and middle-income countries: a systematic review and narrative synthesis. Prev Med. 2021;1(143):106317.
doi: 10.1016/j.ypmed.2020.106317
Pedersen GA, Smallegange E, Coetzee A, Hartog K, Turner J, Jordans MJD, et al. A systematic review of the evidence for family and parenting interventions in low- and middle-income countries: child and youth mental health outcomes. J Child Fam Stud. 2019;28(8):2036–55.
doi: 10.1007/s10826-019-01399-4
UNESCO. UNESCO Institute for Statistics. 2020. Uganda. Available from: https://uis.unesco.org/en/country/ug . Cited 2023 Jul 25.
Opio JN, Munn Z, Aromataris E. Prevalence of mental disorders in Uganda: a systematic review and meta-analysis. Psychiatr Q. 2022;93(1):199–226.
pubmed: 34427855
doi: 10.1007/s11126-021-09941-8
Magruder KM, McLaughlin KA, Elmore Borbon DL. Trauma is a public health issue. Eur J Psychotraumatology. 2017;8(1):1375338.
doi: 10.1080/20008198.2017.1375338
The Republic of Uganda. Uganda Violence against children survey | UNICEF Uganda. 2018. Available from: https://www.unicef.org/uganda/reports/uganda-violence-against-children-survey . Cited 2022 Oct 26.
Clarke K, Patalay P, Allen E, Knight L, Naker D, Devries K. Patterns and predictors of violence against children in Uganda: a latent class analysis. BMJ Open. 2016;6(5):e010443.
pubmed: 27221125
pmcid: 4885281
doi: 10.1136/bmjopen-2015-010443
Ministry of Health, Uganda. Child and adolescent mental health policy guidelines 2017 | MOH Knowledge Management Portal. 2017. Available from: http://library.health.go.ug/community-health/child-health-school-health/child-and-adolescent-mental-health-policy-guidelines . Cited 2023 Jul 25.
Iversen SA, Nalugya J, Babirye JN, Engebretsen IMS, Skokauskas N. Child and adolescent mental health services in Uganda. Int J Ment Health Syst. 2021;3(15):66.
doi: 10.1186/s13033-021-00491-x
Skylstad V, Akol A, Ndeezi G, Nalugya J, Moland KM, Tumwine JK, et al. Child mental illness and the help-seeking process: a qualitative study among parents in a Ugandan community. Child Adolesc Psychiatry Ment Health. 2019;13(1):3.
pubmed: 30651751
pmcid: 6329129
doi: 10.1186/s13034-019-0262-7
Kaggwa MM, Harms S, Mamun MA. Mental health care in Uganda. Lancet Psychiatry. 2022;9(10):766–7.
pubmed: 36116446
doi: 10.1016/S2215-0366(22)00305-4
Padmanathan P, De Silva MJ. The acceptability and feasibility of task-sharing for mental healthcare in low and middle income countries: a systematic review. Soc Sci Med. 2013;1982(97):82–6.
doi: 10.1016/j.socscimed.2013.08.004
United Nations. Transforming our world: the 2030 Agenda for Sustainable Development | Department of Economic and Social Affairs. 2015. Available from: https://sdgs.un.org/2030agenda . Cited 2023 Jul 25.
Callaghan M, Ford N, Schneider H. A systematic review of task- shifting for HIV treatment and care in Africa. Hum Resour Health. 2010;31(8):8.
doi: 10.1186/1478-4491-8-8
Tooher R, Collins J, Braunack-Mayer A, Burgess T, Skinner SR, O’Keefe M, et al. Intersectoral collaboration to implement school-based health programmes: Australian perspectives. Health Promot Int. 2017;32(2):312–21.
pubmed: 26822033
Herlitz L, MacIntyre H, Osborn T, Bonell C. The sustainability of public health interventions in schools: a systematic review. Implement Sci. 2020;15(1):4.
pubmed: 31906983
pmcid: 6945701
doi: 10.1186/s13012-019-0961-8
World Health Organization. mhGAP intervention guide for mental, neurological and substance use disorders in non-specialized health settings: Mental Health Gap Action Programme (mhGAP). Geneva: World Health Organization; 2010. (WHO Guidelines Approved by the Guidelines Review Committee). Available from: http://www.ncbi.nlm.nih.gov/books/NBK138690/ . Cited 2023 Aug 1.
World Health Organization. mhGAP intervention guide for mental, neurological and substance use disorders in non-specialized health settings: Mental Health Gap Action Programme (mhGAP): Version 2.0. World Health Organization; 2016. Available from: https://www.ncbi.nlm.nih.gov/books/NBK390815/ . Cited 2023 Aug 1.
World Health Organization. mhGAP in Uganda - bringing treatment, dignity and real change. 2020. Available from: https://www.who.int/news-room/feature-stories/detail/mhgap-in-uganda-bringing-treatment-dignity-and-real-change . Cited 2023 Aug 1.
Kigozi FN, Kizza D, Nakku J, Ssebunnya J, Ndyanabangi S, Nakiganda B, et al. Development of a district mental healthcare plan in Uganda. Br J Psychiatry. 2016;208(Suppl 56):s40–6.
pubmed: 26447171
pmcid: 4698555
doi: 10.1192/bjp.bp.114.153742
Akol A, Nalugya J, Nshemereirwe S, Babirye JN, Engebretsen IMS. Does child and adolescent mental health in-service training result in equivalent knowledge gain among cadres of non-specialist health workers in Uganda? A pre-test post-test study. Int J Ment Health Syst. 2017;11(1):50.
pubmed: 28855962
pmcid: 5571627
doi: 10.1186/s13033-017-0158-y
Mugisha J, Hanlon C, Knizek BL, Ssebunnya J, Vancampfort D, Kinyanda E, et al. The experience of mental health service users in health system strengthening: lessons from Uganda. Int J Ment Health Syst. 2019;13:60.
pubmed: 31516548
pmcid: 6728966
doi: 10.1186/s13033-019-0316-5
Ssebunnya J, Kigozi F, Lund C, Kizza D, Okello E. Stakeholder perceptions of mental health stigma and poverty in Uganda. BMC Int Health Hum Rights. 2009;9(1):5.
pubmed: 19335889
pmcid: 2670268
doi: 10.1186/1472-698X-9-5
Curran GM, Bauer M, Mittman B, Pyne JM, Stetler C. Effectiveness-implementation hybrid designs: combining elements of clinical effectiveness and implementation research to enhance public health impact. Med Care. 2012;50(3):217–26.
pubmed: 22310560
pmcid: 3731143
doi: 10.1097/MLR.0b013e3182408812
Chan AW, Tetzlaff JM, Gøtzsche PC, Altman DG, Mann H, Berlin JA, et al. SPIRIT 2013 explanation and elaboration: guidance for protocols of clinical trials. BMJ. 2013;8(346):e7586.
doi: 10.1136/bmj.e7586
Damschroder LJ. Clarity out of chaos: use of theory in implementation research. Psychiatry Res. 2020;1(283):112461.
doi: 10.1016/j.psychres.2019.06.036
Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4(1):50.
pubmed: 19664226
pmcid: 2736161
doi: 10.1186/1748-5908-4-50
Aarons GA, Hurlburt M, Horwitz SM. Advancing a conceptual model of evidence-based practice implementation in public service sectors. Adm Policy Ment Health. 2011;38(1):4–23.
pubmed: 21197565
doi: 10.1007/s10488-010-0327-7
Proctor E, Silmere H, Raghavan R, Hovmand P, Aarons G, Bunger A, et al. Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Adm Policy Ment Health. 2011;38(2):65–76.
pubmed: 20957426
doi: 10.1007/s10488-010-0319-7
Barker G, Ricardo C, Nascimento M, World Health Organization, Instituto Promundo. Engaging men and boys in changing gender-based inequity in health : evidence from programme interventions / Gary Barker, Christine Ricardo and Marcos Nascimento. Engag Hommes Garçons Dans Lutte Contre Inégalités Sexospécifiques En Matière Santé Enseign Tirés Programme Interv Gary Bark Christine Ricardo Marcos Nascimento. 2007;69.
Levac L, Ronis S, Cowper-Smith Y, Vaccarino O. A scoping review: the utility of participatory research approaches in psychology. J Community Psychol. 2019;47(8):1865–92.
pubmed: 31441516
pmcid: 6852237
doi: 10.1002/jcop.22231
RStudio Team. RStudio: Integrated Development Environment for R. Boston, MA: RStudio, PBC.; 2020. Available from: http://www.rstudio.com/
Devries K, Child J, Allen E, Walakira E, Parkes J, Naker D. School violence, mental health, and educational performance in Uganda. Pediatrics. 2013;2:133.
World Health Organization. mhGAP Intervention Guide - Version 2.0. 2019. Available from: https://www.who.int/publications-detail-redirect/9789241549790 . Cited 2023 Jul 25.
Akol A, Makumbi F, Babirye JN, Nalugya JS, Nshemereirwe S, Engebretsen IMS. Does mhGAP training of primary health care providers improve the identification of child- and adolescent mental, neurological or substance use disorders? Results from a randomized controlled trial in Uganda. Glob Ment Health Camb Engl. 2018;5:e29.
doi: 10.1017/gmh.2018.18
The World Bank. World Bank. 2020. World Bank Group Strategy for Fragility, Conflict, and Violence 2020–2025. Available from: https://documents.worldbank.org/en/publication/documents-reports/documentdetail/844591582815510521/World-Bank-Group-Strategy-for-Fragility-Conflict-and-Violence-2020-2025 . Cited 2024 Feb 5.
Pope C, Ziebland S, Mays N. Analysing qualitative data. BMJ. 2000;320(7227):114–6.
pubmed: 10625273
pmcid: 1117368
doi: 10.1136/bmj.320.7227.114
Gale NK, Heath G, Cameron E, Rashid S, Redwood S. Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Med Res Methodol. 2013;13(1):117.
pubmed: 24047204
pmcid: 3848812
doi: 10.1186/1471-2288-13-117
Mehrizi MHR, Ghasemzadeh F, Molas-Gallart J. Stakeholder mapping as an assessment framework for policy implementation. Evaluation. 2009;15(4):427–44.
doi: 10.1177/1356389009341731
Bitton A, Fifield J, Ratcliffe H, Karlage A, Wang H, Veillard JH, et al. Primary healthcare system performance in low-income and middle-income countries: a scoping review of the evidence from 2010 to 2017. BMJ Glob Health. 2019;4(Suppl 8):e001551.
pubmed: 31478028
pmcid: 6703296
doi: 10.1136/bmjgh-2019-001551
Means AR, Kemp CG, Gwayi-Chore MC, Gimbel S, Soi C, Sherr K, et al. Evaluating and optimizing the consolidated framework for implementation research (CFIR) for use in low- and middle-income countries: a systematic review. Implement Sci. 2020;15(1):17.
pubmed: 32164692
pmcid: 7069199
doi: 10.1186/s13012-020-0977-0
McBain RK, Kofner A, Stein BD, Cantor JH, Vogt WB, Yu H. Growth and distribution of child psychiatrists in the United States: 2007–2016. Pediatrics. 2019;144(6):e20191576.
pubmed: 31685696
doi: 10.1542/peds.2019-1576
Lempp H, Abayneh S, Gurung D, Kola L, Abdulmalik J, Evans-Lacko S, et al. Service user and caregiver involvement in mental health system strengthening in low- and middle-income countries: a cross-country qualitative study. Epidemiol Psychiatr Sci. 2018;27(1):29–39.
pubmed: 29113598
doi: 10.1017/S2045796017000634
Yapa HM, Bärnighausen T. Implementation science in resource-poor countries and communities. Implement Sci. 2018;13(1):154.
pubmed: 30587195
pmcid: 6307212
doi: 10.1186/s13012-018-0847-1
Katsonga-Phiri T, Grant KE, Brown M. Trauma intervention in sub-Saharan African children: a systematic literature review. Trauma Violence Abuse. 2019;20(4):453–69.
pubmed: 29333952
doi: 10.1177/1524838017717747
United Nations. The Sustainable Development Agenda. United Nations Sustainable Development. 2022. Available from: https://www.un.org/sustainabledevelopment/development-agenda/ . Cited 2023 Jan 23.