Leveraging Social Networks to Integrate Depression Treatment into Primary Health and Tuberculosis Care in Brazil.

IF 0.3 Q4 PSYCHIATRY Current Psychiatry Research and Reviews Pub Date : 2024-01-01 Epub Date: 2023-10-17 DOI:10.2174/0126660822243332230921052022
Annika C Sweetland, Claudio Gruber Mann, Maria Jose Fernandes, Camila Matsuzaka, Fatima Virginia de Silva, Jae Lee, Christopher McCarty, Afrânio Kritski, Sandra Fortes, Maria Cavalcanti, Marcelo Feijó Mello, Maria A Oquendo, Thomas Valente, Harold Pincus, Milton L Wainberg
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Abstract

Background: Tuberculosis (TB) and depression are highly comorbid and linked to higher rates of death and disability. Several evidence-based treatments for depression have been successfully implemented in low- and middle-income countries, but more knowledge is needed on how to bring these innovations to scale within complex 'real world' public health systems.

Objective: To explore whether the principles of social network analysis could be used to enhance receptivity to integrating depression treatment into primary care for individuals with and without TB in Brazil.

Methods: We used existing scales to identify settings and providers with high receptivity and connectivity within the primary care network. We trained and supervised existing staff in three primary care sites to deliver a brief evidence-based intervention over one year, coupled with active dissemination activities. Afterwards, we reassessed receptivity among individuals involved, and not involved, in the pilot.

Results: Highly significant changes were observed in mental health literacy, attitudes towards evidence-based practices, work self-efficacy, and implementation leadership supporting our hypothesis. Limited social connections between primary care clinics precluded the examination of the hypothesis that targeting settings with high connectivity could capitalize on the information flow between and transcend the decentralized structure of the network, but leveraging the centralized nature of the TB program to integrate mental health services emerged as a promising alternative.

Conclusions: The findings of this study strongly suggest that social networks may be leveraged to change individual providers' attitudes, thereby contributing to the enhanced dissemination of evidence-based interventions.

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在巴西,利用社交网络将抑郁症治疗纳入初级保健和结核病治疗。
背景:结核病(TB)和抑郁症是高度并发症,与较高的死亡率和残疾率相关。一些基于证据的抑郁症治疗方法已在中低收入国家成功实施,但如何在复杂的 "现实世界 "公共卫生系统中推广这些创新方法还需要更多知识:目的:探讨是否可以利用社会网络分析的原理来提高巴西结核病患者和非结核病患者对将抑郁症治疗纳入初级保健的接受程度:我们使用现有的量表来确定初级医疗网络中接受度高、连接性强的医疗机构和医疗服务提供者。我们对三个基层医疗机构的现有员工进行了为期一年的培训和监督,以提供简短的循证干预,并积极开展传播活动。之后,我们重新评估了参与和未参与试点的个人的接受程度:结果:在心理健康素养、对循证实践的态度、工作自我效能感和实施领导力方面观察到了非常明显的变化,支持了我们的假设。由于初级保健诊所之间的社会联系有限,因此无法对以下假设进行检验,即针对连接性高的环境,可以利用网络分散结构之间的信息流并超越这种分散结构,但利用结核病项目的集中性来整合心理健康服务则是一个很有前景的替代方案:本研究的结果有力地表明,可以利用社会网络来改变个体医疗服务提供者的态度,从而促进循证干预措施的推广。
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来源期刊
Current Psychiatry Research and Reviews
Current Psychiatry Research and Reviews Medicine-Psychiatry and Mental Health
CiteScore
0.60
自引率
0.00%
发文量
51
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