Pushing the bench: A mixed methods study of barriers to and facilitators of identification and referral into depression care by professional nurses in KwaZulu-Natal, South Africa.

Autor:	Kemp CG; Department of International Health, Johns Hopkins University, Baltimore, MD, USA., Mntambo N; Centre for Rural Health, School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa., Weiner BJ; Department of Global Health, University of Washington, Seattle, WA, USA., Grant M; Centre for Rural Health, School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa., Rao D; Department of Global Health, University of Washington, Seattle, WA, USA.; Department of Psychiatry and Behavioral Medicine, University of Washington, Seattle, WA, USA., Bhana A; Centre for Rural Health, School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa.; SA Medical Research Council, Health Systems Research Unit, Durban, South Africa., Gigaba SG; Centre for Rural Health, School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa., Luvuno ZPB; Centre for Rural Health, School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa., Simoni JM; Department of Global Health, University of Washington, Seattle, WA, USA.; Department of Psychology, University of Washington, Seattle, WA, USA., Hughes JP; Department of Biostatistics, University of Washington, Seattle, WA, USA., Petersen I; Centre for Rural Health, School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa.
Jazyk:	angličtina
Zdroj:	SSM. Mental health [SSM Ment Health] 2021 Dec; Vol. 1. Date of Electronic Publication: 2021 Jul 22.
DOI:	10.1016/j.ssmmh.2021.100009
Abstrakt:	Objective: Integration of mental health and chronic disease services in primary care could reduce the mental health treatment gap and improve associated health outcomes in low-resource settings. Low rates of nurse identification and referral of patients with depression limit the effectiveness of integrated mental health care; the barriers to and facilitators of identification and referral in South Africa and comparable settings remain undefined. This study explored barriers to and facilitators of nurse identification and referral of patients with depressive symptoms as part of integrated mental health service delivery in KwaZulu-Natal, South Africa. Design: Triangulation mixed methods study incorporating qualitative and quantitative data. Methods: Data collection, analysis, and interpretation were guided by the Consolidated Framework for Implementation Research (CFIR). Participants were professional nurses at ten primary health care facilities in Amajuba, KwaZulu-Natal, South Africa. Qualitative data collection involved semi-structured interviews targeting specific CFIR constructs with high- and low-referring nurses. Deductive and inductive coding were used to derive primary themes related to barriers and facilitators. Quantitative data collection involved a structured questionnaire assessing determinants explored in the interviews. Qualitative comparative analysis was used to identify the necessary or sufficient conditions for high and low nurse referral. Results: Twenty-two nurses were interviewed. Primary themes related to insufficient training, supervision, and competency; emotional burden; limited human and physical resources; perceived patient need for integrated services; and intervention acceptability. Sixty-eight nurses completed questionnaires. Quantitative results confirmed and expanded upon the qualitative findings. Low self-assessed competency was a consistent barrier to appropriate service delivery. Conclusions: To promote the success of integrated care in a context of severe staff shortages and over-burdened providers, implementation strategies including direct training, structured supervision, and routine behavioral health screening tools are warranted. Interventions to improve mental health literacy of patients as well as emotional support for nurses are also needed.
Databáze:	MEDLINE
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