No abstract

BackgroundGender-based violence (GBV) represents a major cause of psychological morbidity worldwide, and particularly in low- and middle-income countries (LMICs). Although there are effective treatments for common mental disorders associated with GBV, they typically require lengthy treatment programs that may limit scaling up in LMICs. The aim of this study was to test the effectiveness of a new 5-session behavioural treatment called Problem Management Plus (PM+) that lay community workers can be taught to deliver.Methods and findingsIn this single-blind, parallel, randomised controlled trial, adult women who had experienced GBV were identified through community screening for psychological distress and impaired functioning in Nairobi, Kenya. Participants were randomly allocated in a 1:1 ratio either to PM+ delivered in the community by lay community health workers provided with 8 days of training or to facility-based enhanced usual care (EUC) provided by community nurses. Participants were aware of treatment allocation, but research assessors were blinded. The primary outcome was psychological distress as measured by the total score on the 12-item General Health Questionnaire (GHQ-12) assessed at 3 months after treatment. Secondary outcomes were impaired functioning (measured by the WHO Disability Adjustment Schedule [WHODAS]), symptoms of posttraumatic stress (measured by the Posttraumatic Stress Disorder Checklist [PCL]), personally identified problems (measured by Psychological Outcome Profiles [PSYCHLOPS]), stressful life events (measured by the Life Events Checklist [LEC]), and health service utilisation. Between 15 April 2015 and 20 August 2015, 1,393 women were screened for eligibility on the basis of psychological distress and impaired functioning. Of these, 518 women (37%) screened positive, of whom 421 (81%) were women who had experienced GBV. Of these 421 women, 209 were assigned to PM+ and 212 to EUC. Follow-up assessments were completed on 16 January 2016. The primary analysis was intention to treat and included 53 women in PM+ (25%) and 49 women in EUC (23%) lost to follow-up. The difference between PM+ and EUC in the change from baseline to 3 months on the GHQ-12 was 3.33 (95% CI 1.86–4.79, P = 0.001) in favour of PM+. In terms of secondary outcomes, for WHODAS the difference between PM+ and EUC in the change from baseline to 3-month follow-up was 1.96 (95% CI 0.21–3.71, P = 0.03), for PCL it was 3.95 (95% CI 0.06–7.83, P = 0.05), and for PSYCHLOPS it was 2.15 (95% CI 0.98–3.32, P = 0.001), all in favour of PM+. These estimated differences correspond to moderate effect sizes in favour of PM+ for GHQ-12 score (0.57, 95% CI 0.32–0.83) and PSYCHLOPS (0.67, 95% CI 0.31–1.03), and small effect sizes for WHODAS (0.26, 95% CI 0.02–0.50) and PCL (0.21, 95% CI 0.00–0.41). Twelve adverse events were reported, all of which were suicidal risks detected during screening. No adverse events were attributable to the interventions or the trial. Limitations of the study include no long-term follow-up, reliance on se...

No abstract

Background: Competency frameworks are being taken up by a growing number of sectors and for a broad range of applications. However, the topic of competency frameworks is characterised by conceptual ambiguity, misunderstanding and debate. Lack of consistency in the conceptualisation and use of key terminology creates a barrier to research and development, consensus, communication and collaboration, limiting the potential that competency frameworks have to deal with real workforce challenges. This paper aims to advance the field by conducting a detailed review of the literature to understand the underlying causes of conceptual differences and divergent views and proposing a re-conceptualisation of competency framework terminology for use by the health sector. Methods: A broad scoping review of literature was conducted to identify publications relating to the conceptualisation of competency frameworks and key terms, examine how they are conceptualised and determine how this evolved. In addition, a purposive sample of health-related competency frameworks was chosen to illustrate how the terms and concepts are currently being applied in the health context. Results:Of the 4 155 records identified, 623 underwent text searches and broad quantitative analysis, and 70 were included for qualitative analysis. Quantitative analysis identified 26 key terms, which were coded under six thematic headings. Qualitative analysis using the thematic areas revealed two distinct conceptualisations of competency frameworks and their terminology emerging concurrently in the education and employment sectors, with different underpinnings and purposes. As competency frameworks have developed, these two conceptualisations intertwined, resulting in the same terms being used to convey different concepts. Examination of health-related frameworks showed that this merging of concepts is prominent, with lack of consistency in definitions and use of key terms even within a single organisation. Discussion and conclusions: Building on previous efforts to address the lack of conceptual clarity surrounding competency frameworks, this paper proposes a re-conceptualisation of the terminology that encompasses two distinct competency framework interpretations, using a glossary of mutually exclusive terms to differentiate concepts. The re-conceptualisation holds relevance for multiple competency framework applications within health, enabling harmonisation, clear communication, consensus-building and effective implementation of competency frameworks.

Psychological First Aid (PFA) is the recommended immediate psychosocial response during crises. As PFA is now widely implemented in crises worldwide, there are increasing calls to evaluate its effectiveness. World Vision used PFA as a fundamental component of their emergency response following the 2014 conflict in Gaza. Anecdotal reports from Gaza suggest a range of benefits for those who received PFA. Though not intending to undertake rigorous research, World Vision explored learnings about PFA in Gaza through Focus Group Discussions with PFA providers, Gazan women, men and children and a Key Informant Interview with a PFA trainer. The qualitative analyses aimed to determine if PFA helped individuals to feel safe, calm, connected to social supports, hopeful and efficacious – factors suggested by the disaster literature to promote coping and recovery (Hobfoll et al., 2007). Results show positive psychosocial benefits for children, women and men receiving PFA, confirming that PFA contributed to: safety, reduced distress, ability to engage in calming practices and to support each other, and a greater sense of control and hopefulness irrespective of their adverse circumstances. The data shows that PFA formed an important part of a continuum of care to meet psychosocial needs in Gaza and served as a gateway for addressing additional psychosocial support needs. A “whole-of-family” approach to PFA showed particularly strong impacts and strengthened relationships. Of note, the findings from World Vision's implementation of PFA in Gaza suggests that future PFA research go beyond a narrow focus on clinical outcomes, to a wider examination of psychosocial, familial and community-based outcomes.