Implementation strategy in collaboration with people with lived experience of mental illness to reduce stigma among primary care providers in Nepal (RESHAPE): protocol for a type 3 hybrid implementation effectiveness cluster randomized controlled trial

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dc.contributor.authorKohrt, Brandon A
dc.contributor.authorTurner, Elizabeth L
dc.contributor.authorGurung, Dristy
dc.contributor.authorWang, Xueqi
dc.contributor.authorNeupane, Mani
dc.contributor.authorLuitel, Nagendra P
dc.contributor.authorKartha, Muralikrishnan R
dc.contributor.authorPoudyal, Anubhuti
dc.contributor.authorSingh, Ritika
dc.contributor.authorRai, Sauharda
dc.contributor.authorBaral, Phanindra P
dc.contributor.authorMcCutchan, Sabrina
dc.contributor.authorGronholm, Petra C
dc.contributor.authorHanlon, Charlotte
dc.contributor.authorLempp, Heidi
dc.contributor.authorLund, Crick
dc.contributor.authorThornicroft, Graham
dc.contributor.authorGautam, Kamal
dc.contributor.authorJordans, Mark J D
dc.date.accessioned2022-10-18T14:53:19Z
dc.date.available2022-10-18T14:53:19Z
dc.date.issued2022-06-16
dc.date.updated2022-06-19T03:11:46Z
dc.description.abstractBackground There are increasing efforts for the integration of mental health services into primary care settings in low- and middle-income countries. However, commonly used approaches to train primary care providers (PCPs) may not achieve the expected outcomes for improved service delivery, as evidenced by low detection rates of mental illnesses after training. One contributor to this shortcoming is the stigma among PCPs. Implementation strategies for training PCPs that reduce stigma have the potential to improve the quality of services. Design In Nepal, a type 3 hybrid implementation-effectiveness cluster randomized controlled trial will evaluate the implementation-as-usual training for PCPs compared to an alternative implementation strategy to train PCPs, entitled Reducing Stigma among Healthcare Providers (RESHAPE). In implementation-as-usual, PCPs are trained on the World Health Organization Mental Health Gap Action Program Intervention Guide (mhGAP-IG) with trainings conducted by mental health specialists. In RESHAPE, mhGAP-IG training includes the added component of facilitation by people with lived experience of mental illness (PWLE) and their caregivers using PhotoVoice, as well as aspirational figures. The duration of PCP training is the same in both arms. Co-primary outcomes of the study are stigma among PCPs, as measured with the Social Distance Scale at 6 months post-training, and reach, a domain from the RE-AIM implementation science framework. Reach is operationalized as the accuracy of detection of mental illness in primary care facilities and will be determined by psychiatrists at 3 months after PCPs diagnose the patients. Stigma will be evaluated as a mediator of reach. Cost-effectiveness and other RE-AIM outcomes will be assessed. Twenty-four municipalities, the unit of clustering, will be randomized to either mhGAP-IG implementation-as-usual or RESHAPE arms, with approximately 76 health facilities and 216 PCPs divided equally between arms. An estimated 1100 patients will be enrolled for the evaluation of accurate diagnosis of depression, generalized anxiety disorder, psychosis, or alcohol use disorder. Masking will include PCPs, patients, and psychiatrists. Discussion This study will advance the knowledge of stigma reduction for training PCPs in partnership with PWLE. This collaborative approach to training has the potential to improve diagnostic competencies. If successful, this implementation strategy could be scaled up throughout low-resource settings to reduce the global treatment gap for mental illness. Trial registration ClinicalTrials.gov, NCT04282915 . Date of registration: February 25, 2020.en_US
dc.identifier.apacitationKohrt, B. A., Turner, E. L., Gurung, D., Wang, X., Neupane, M., Luitel, N. P., ... Jordans, M. J. D. (2022). Implementation strategy in collaboration with people with lived experience of mental illness to reduce stigma among primary care providers in Nepal (RESHAPE): protocol for a type 3 hybrid implementation effectiveness cluster randomized controlled trial. <i>Implementation Science</i>, 17(1), 39. http://hdl.handle.net/11427/36842en_ZA
dc.identifier.chicagocitationKohrt, Brandon A, Elizabeth L Turner, Dristy Gurung, Xueqi Wang, Mani Neupane, Nagendra P Luitel, Muralikrishnan R Kartha, et al "Implementation strategy in collaboration with people with lived experience of mental illness to reduce stigma among primary care providers in Nepal (RESHAPE): protocol for a type 3 hybrid implementation effectiveness cluster randomized controlled trial." <i>Implementation Science</i> 17, 1. (2022): 39. http://hdl.handle.net/11427/36842en_ZA
dc.identifier.citationKohrt, B.A., Turner, E.L., Gurung, D., Wang, X., Neupane, M., Luitel, N.P., Kartha, M.R. & Poudyal, A. et al. 2022. Implementation strategy in collaboration with people with lived experience of mental illness to reduce stigma among primary care providers in Nepal (RESHAPE): protocol for a type 3 hybrid implementation effectiveness cluster randomized controlled trial. <i>Implementation Science.</i> 17(1):39. http://hdl.handle.net/11427/36842en_ZA
dc.identifier.ris TY - Journal Article AU - Kohrt, Brandon A AU - Turner, Elizabeth L AU - Gurung, Dristy AU - Wang, Xueqi AU - Neupane, Mani AU - Luitel, Nagendra P AU - Kartha, Muralikrishnan R AU - Poudyal, Anubhuti AU - Singh, Ritika AU - Rai, Sauharda AU - Baral, Phanindra P AU - McCutchan, Sabrina AU - Gronholm, Petra C AU - Hanlon, Charlotte AU - Lempp, Heidi AU - Lund, Crick AU - Thornicroft, Graham AU - Gautam, Kamal AU - Jordans, Mark J D AB - Background There are increasing efforts for the integration of mental health services into primary care settings in low- and middle-income countries. However, commonly used approaches to train primary care providers (PCPs) may not achieve the expected outcomes for improved service delivery, as evidenced by low detection rates of mental illnesses after training. One contributor to this shortcoming is the stigma among PCPs. Implementation strategies for training PCPs that reduce stigma have the potential to improve the quality of services. Design In Nepal, a type 3 hybrid implementation-effectiveness cluster randomized controlled trial will evaluate the implementation-as-usual training for PCPs compared to an alternative implementation strategy to train PCPs, entitled Reducing Stigma among Healthcare Providers (RESHAPE). In implementation-as-usual, PCPs are trained on the World Health Organization Mental Health Gap Action Program Intervention Guide (mhGAP-IG) with trainings conducted by mental health specialists. In RESHAPE, mhGAP-IG training includes the added component of facilitation by people with lived experience of mental illness (PWLE) and their caregivers using PhotoVoice, as well as aspirational figures. The duration of PCP training is the same in both arms. Co-primary outcomes of the study are stigma among PCPs, as measured with the Social Distance Scale at 6 months post-training, and reach, a domain from the RE-AIM implementation science framework. Reach is operationalized as the accuracy of detection of mental illness in primary care facilities and will be determined by psychiatrists at 3 months after PCPs diagnose the patients. Stigma will be evaluated as a mediator of reach. Cost-effectiveness and other RE-AIM outcomes will be assessed. Twenty-four municipalities, the unit of clustering, will be randomized to either mhGAP-IG implementation-as-usual or RESHAPE arms, with approximately 76 health facilities and 216 PCPs divided equally between arms. An estimated 1100 patients will be enrolled for the evaluation of accurate diagnosis of depression, generalized anxiety disorder, psychosis, or alcohol use disorder. Masking will include PCPs, patients, and psychiatrists. Discussion This study will advance the knowledge of stigma reduction for training PCPs in partnership with PWLE. This collaborative approach to training has the potential to improve diagnostic competencies. If successful, this implementation strategy could be scaled up throughout low-resource settings to reduce the global treatment gap for mental illness. Trial registration ClinicalTrials.gov, NCT04282915 . Date of registration: February 25, 2020. DA - 2022-06-16 DB - OpenUCT DP - University of Cape Town IS - 1 J1 - Implementation Science KW - Cost-effectiveness KW - Developing countries KW - Depression KW - Primary care KW - Randomized controlled trial KW - Stigma KW - Training LK - https://open.uct.ac.za PY - 2022 T1 - Implementation strategy in collaboration with people with lived experience of mental illness to reduce stigma among primary care providers in Nepal (RESHAPE): protocol for a type 3 hybrid implementation effectiveness cluster randomized controlled trial TI - Implementation strategy in collaboration with people with lived experience of mental illness to reduce stigma among primary care providers in Nepal (RESHAPE): protocol for a type 3 hybrid implementation effectiveness cluster randomized controlled trial UR - http://hdl.handle.net/11427/36842 ER - en_ZA
dc.identifier.urihttps://doi.org/10.1186/s13012-022-01202-x
dc.identifier.urihttp://hdl.handle.net/11427/36842
dc.identifier.vancouvercitationKohrt BA, Turner EL, Gurung D, Wang X, Neupane M, Luitel NP, et al. Implementation strategy in collaboration with people with lived experience of mental illness to reduce stigma among primary care providers in Nepal (RESHAPE): protocol for a type 3 hybrid implementation effectiveness cluster randomized controlled trial. Implementation Science. 2022;17(1):39. http://hdl.handle.net/11427/36842.en_ZA
dc.language.isoenen_US
dc.language.rfc3066en
dc.publisher.departmentDepartment of Psychiatry and Mental Healthen_US
dc.publisher.facultyFaculty of Health Sciencesen_US
dc.rights.holderThe Author(s)
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en_US
dc.sourceImplementation Scienceen_US
dc.source.journalissue1en_US
dc.source.journalvolume17en_US
dc.source.pagination39en_US
dc.source.urihttps://implementationscience.biomedcentral.com/
dc.subjectCost-effectivenessen_US
dc.subjectDeveloping countriesen_US
dc.subjectDepressionen_US
dc.subjectPrimary careen_US
dc.subjectRandomized controlled trialen_US
dc.subjectStigmaen_US
dc.subjectTrainingen_US
dc.titleImplementation strategy in collaboration with people with lived experience of mental illness to reduce stigma among primary care providers in Nepal (RESHAPE): protocol for a type 3 hybrid implementation effectiveness cluster randomized controlled trialen_US
dc.typeJournal Articleen_US
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