Strengthening integrated depression services within routine primary health care using the RE-AIM framework in South Africa

Bibliographic Data

ID19594897
AuthorsInge Petersen (0000-0001-8057-8336, University College London, corresponding author), Christopher G Kemp (0000-0003-1231-1546, Johns Hopkins University), Deepa Rao (0000-0003-4076-0170, University of Washington), Bradley H Wagenaar (0000-0002-3351-7175, University of Washington), M Bachmann (0000-0003-1770-3506, University of East Anglia), Kenneth Sherr (0000-0002-2963-0829, University of Washington), Tasneem Kathree (0000-0002-8451-9197, University of KwaZulu-Natal), Zamasomi Luvuno (0000-0002-1188-6949, University of KwaZulu-Natal), André Janse Van Rensburg (0000-0001-8880-2232, University of KwaZulu-Natal), Andre van Rensburg, Sithabisile Gugulethu Gigaba (0000-0003-1919-1241, University of KwaZulu-Natal), Londiwe Mthethwa (University of KwaZulu-Natal), Merridy Grant (0000-0002-7790-5102, Curtin University), Oné Selohilwe (0000-0002-2692-5605, University of KwaZulu-Natal), Nikiwe Hongo, Gillian Faris (University of KwaZulu-Natal), Christy-Joy Ras (0000-0003-2001-172X, University of Cape Town), L Fairall (0000-0002-7460-4670, University of Cape Town), Sanah Bucibo (University of KwaZulu-Natal), Arvin Bhana (0000-0003-4235-0108, South African Medical Research Council)
EditorsAhmed Waqas (0000-0002-3772-194X)
Year2023
Volume3
Issue11
Pagese0002604
Publication date2023-11-13
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenuePLOS Global Public Health (JOURNAL)
Journal identifiersISSN: 2767-3375 • E-ISSN: 2767-3375
PublisherPublic Library of Science (PLoS) (PUBLISHER)
DOI10.1371/journal.pgph.0002604
PMID37956110
OpenAlexW4388627446
LanguageEN
Citations received2
References cited41

Integration of mental health into routine primary health care (PHC) services in low-and middle-income countries is globally accepted to improve health outcomes of other conditions and narrow the mental health treatment gap. Yet implementation remains a challenge. The aim of this study was to identify implementation strategies that improve implementation outcomes of an evidence-based depression care collaborative implementation model integrated with routine PHC clinic services in South Africa. An iterative, quasi-experimental, observational implementation research design, incorporating the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework, was applied to evaluate implementation outcomes of a strengthened package of implementation strategies (stage two) compared with an initial evaluation of the model (stage one). The first stage package was implemented and evaluated in 10 PHC clinics and the second stage strengthened package in 19 PHC clinics (inclusive of the initial 10 clinics) in one resource-scarce district in the province of KwaZulu-Natal, South Africa. Diagnosed service users were more likely to be referred for counselling treatment in the second stage compared with stage one (OR 23.15, SE = 18.03, z = 4.04, 95%CI [5.03–106.49], p p = 0.02). Nurses who perceived the integrated care model as acceptable were also more likely to successfully diagnose patients (OR 2.57, 95% CI [1.03–6.40], p = 0.043). Consistent availability of a clinic counsellor was associated with a greater probability of referral (OR 5.9, 95%CI [1.29–27.75], p = 0.022). Treatment uptake among referred service users remained a concern across both stages, with inconsistent co-located counselling services associated with poor uptake. The importance of implementation research for strengthening implementation strategies along the cascade of care for integrating depression care within routine PHC services is highlighted

Business · Family medicine · Health care · Implementation research · Integrated care · Mental health · Observational study · Outreach · Psychiatry · Psychological intervention · Health Policy Implementation Science · Medicine · Mental Health Treatment and Access · Nursing · Primary Care and Health Outcomes

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