Global health reciprocal innovation to address mental health and well-being: strategies used and lessons learnt

Abstract

Over the past two decades there have been major advances in the development of interventions promoting mental health and well-being in low- and middle-income countries (LMIC), including delivery of care by non-specialist providers, incorporation of mobile technologies and development of multilevel community-based interventions. Growing inequities in mental health have led to calls to adopt similar strategies in high-income countries (HIC), learning from LMIC. To overcome shared challenges, it is crucial for projects implementing these strategies in different global settings to learn from one another. Our objective was to examine cases in which mental health and well-being interventions originating in or conceived for LMIC were implemented in the USA. The cases included delivery of psychological interventions by non-specialists, HIV-related stigma reduction programmes, substance use mitigation strategies and interventions to promote parenting skills and family functioning. We summarise commonly used strategies, barriers, benefits and lessons learnt for the transfer of these innovative practices among LMIC and HIC. Common strategies included intervention delivery by non-specialists and use of digital modalities to facilitate training and increase reach. Common barriers included lack of reimbursement mechanisms for care delivered by non-specialists and resistance from professional societies. Despite US investigators’ involvement in most of the original research in LMIC, only a few cases directly involved LMIC researchers in US implementation. In order to achieve greater equity in global mental health and well-being, more efforts and targeted funding are needed to develop best practices for global health reciprocal innovation and iterative learning in HIC and LMIC.

The case for global health reciprocal innovation

“…The Supplement papers describe examples of LMIC innovations for adaptation to HICs such as an HIV-related stigma reduction in-person workshop that was originally developed and tested in five countries in Africa, adapted and tested in Alabama, and then adapted and implemented in the Dominican Republic (DR), with ongoing efforts to incorporate lessons from the DR into future implementation in the southern USA. 7 Dearing et al provide the example of WelTel, a bidirectional texting platform between patients and providers that was demonstrated to improve medication adherence and viral suppression in people living with HIV in Kenya and that has since been redesigned and adapted to support adherence to oral pre-exposure prophylaxis in the USA. 4 A Colombian innovation, Ciclovia, periodically closes streets to automobiles, so that pedestrians can more freely walk, run, skate and pedal and has been adapted by municipalities in many countries over the past 50 years.…”

“…6 Another Supplement paper by Turan et al documents cases in which mental health and well-being interventions originating in or conceived for LMICs were implemented in the USA, including delivery of psychological interventions by non-specialists, HIV-related stigma reduction programmes, substance BMJ Global Health use mitigation strategies and interventions to promote parenting skills and family functioning. 7 Notably, the field of mental health has been proactive and innovative by encouraging reciprocal learning through some of its research programmes, including, for example NIH RFA-MH22-130 and NIH RFA-MH-22-100. Patel-Larson et al describe in the Supplement a platform for innovation exchange between domestic and global health US HIV/ AIDS programmes.…”

“…8 Other Supplement papers describe barriers and facilitators for implementing a GHRI approach, which highlight the complexities inherent in exchanging health innovations between different sociocultural and structural contexts. [4][5][6][7] Some papers include lessons learnt to guide the future use of a GHRI approach. 4 6 7 Rid et al explore ethical, legal and regulatory considerations involved in implementing GHRI, including GHRI's ethical commitment to equitable research partnerships as well as a concern that GHRI studies could displace funding for studies whose results have more immediate or significant benefits for populations in LMICs.…”

Mutual capacity building model for adaptation (MCB-MA): a seven-step procedure for bidirectional learning and support during intervention adaptation

“…Adaptation facilitates scale-up of an evidence-based practice, while being responsive to the needs and cultural practice of new communities or populations [ 15 , 20 ]. In many cases, interventions initially developed in HICs are adapted for LMICs and for delivery by non-specialist or lay providers [ 5 , 16 , 21 ]. For instance, Life-Steps, a brief problem-solving and motivational interviewing based approach to improve adherence to antiretroviral therapy for people living with HIV, was initially developed in the United States [ 22 ], but has now been adapted for use in Zimbabwe [ 23 ] and South Africa [ 24 ].…”

“…“Development aid” is similarly unidirectional, with knowledge and resources flowing from HICs to LMICs, often without respect for the strengths of LMIC communities [ 3 ]. In contrast, “reciprocal innovation” [ 4 , 5 ] is the idea that people from different settings have similar challenges and can share ideas and resources across settings [ 6 ]. While there is a growing literature on the theoretical importance of reciprocal innovation [ 2 ], there have been few examples of its operationalization [ 5 , 7 – 10 ] or structured procedures to guide practice.…”