International adaptation of Meaning-Centered Psychotherapy for Latinos: Providers' views on pre-implementation.

Rosario Costas-Muñiz, Normarie Torres-Blasco, Eida M Castro-Figueroa, Maria Claros, Bharat Narang, Oscar Galindo Vazquez, Fernanda Montaña, Jose C Sanchez, Francesca Gany
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引用次数: 1

Abstract

Background: This qualitative study aims to identify facilitators of and barriers to the implementation of Meaning-Centered Psychotherapy (MCP) by providers of mental health services to Latinos in the US and Latin America using the practical, robust implementation and sustainability model (PRISM). This information will be used to increase usability and acceptability of MCP for Latino patients with cancer and their providers in Latin America and the US.

Methods: A total of 14 Latino cancer patient mental health providers completed in-depth semi-structured interviews. Participants were recruited from 9 countries and 12 different sites. They provided feedback about barriers to and facilitators of implementation of MCP at the patient, provider, and clinic levels in their clinical setting. The qualitative data from the interviews was coded according to PRISM domains. Three analysts independently coded the transcripts; discrepancies between analysts were resolved through discussion and consensus.

Results: Based on PRISM, themes were: clinic environment (protected time for training and supervision), intervention characteristics (adapt the intervention using more simple language, include more visual aids, include more family-oriented content), patient (develop materials for the identification and screening of patients, provide educational materials, increase motivation and knowledge about psychotherapy, assess commitment to psychotherapy, adapt for the inpatient vs. outpatient setting), provider (receive interactive/participatory training, educational materials, ongoing supervision, have flexibility of delivering the intervention in a less structured manner, theoretical framework of the provider) and external environment (work at policy level to integrate services for oncology patients).

Conclusion: These qualitative data revealed potential facilitators and barriers of this intervention (MCP) on an international scale. Identified cultural, contextual, and healthcare systems factors illustrated the importance of examining pre-implementation needs prior to implementing a trial. We will design and plan a future RCT using the PRISM framework and these pre-implementation data.

Plain language summary: This study integrates frameworks of implementation science and cultural adaptation through the examination of pre-implementation contextual issues at the preparation phase of a cultural adaptation of a psychotherapeutic intervention, Meaning-Centered Psychotherapy (MCP), for Latinos with advanced cancer. By examining implementation needs early in the implementation process, during preparation, the intervention can be adapted in a way that attends to and addresses the providers' most cited challenges in implementation: having a rigid protocol/structure, complexity of the intervention, disease burden preventing adherence to the intervention, transportation, and competing demands, and limited clinic space to offer the intervention.

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拉丁美洲人意义中心心理治疗的国际适应:提供者对实施前的看法。
背景:本定性研究旨在利用实用、稳健的实施和可持续性模型(PRISM),确定美国和拉丁美洲拉丁裔心理健康服务提供者实施意义中心心理治疗(MCP)的促进因素和障碍。这些信息将用于提高拉丁美洲和美国拉丁裔癌症患者及其提供者MCP的可用性和可接受性。方法:对14名拉丁裔癌症患者心理健康提供者进行深度半结构化访谈。参与者来自9个国家和12个不同的地点。他们提供了关于在他们的临床环境中在患者、提供者和诊所层面实施MCP的障碍和促进因素的反馈。访谈的定性数据根据PRISM域进行编码。三名分析师分别对这些记录进行了编码;分析人员之间的差异通过讨论和共识得到解决。结果:基于PRISM,主题为:临床环境(有时间进行培训和监督),干预特征(使用更简单的语言调整干预,包括更多的视觉辅助,包括更多面向家庭的内容),患者(开发用于识别和筛选患者的材料,提供教育材料,增加对心理治疗的动机和知识,评估对心理治疗的承诺,适应住院患者与门诊患者的环境),提供者(接受互动式/参与式培训,教材,持续监督,以较不结构化的方式灵活地提供干预,提供者的理论框架)和外部环境(在政策层面上为肿瘤患者整合服务)。结论:这些定性数据揭示了这种干预(MCP)在国际范围内的潜在促进因素和障碍。已确定的文化、环境和卫生保健系统因素说明了在实施试验之前检查实施前需求的重要性。我们将使用PRISM框架和这些实施前数据设计和规划未来的RCT。简单的语言总结:本研究整合了实施科学和文化适应的框架,通过在心理治疗干预,以意义为中心的心理治疗(MCP)的文化适应准备阶段的实施前情境问题的检查。通过在实施过程的早期检查实施需求,在准备过程中,干预措施可以以一种方式进行调整,以解决提供者在实施中最常提到的挑战:严格的协议/结构、干预措施的复杂性、阻碍坚持干预措施的疾病负担、运输和竞争需求,以及提供干预措施的诊所空间有限。
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