Scaling Up Science-Based Care for Depression and Unhealthy Alcohol Use in Colombia: An Implementation Science Project

Marsch, Lisa A.; Gómez‐Restrepo, Carlos; Bartels, Sophie M.; Bell, Kathleen R.; Camblor, Pablo Martínez; Castro, Sergio M. Alcocer Martínez De; Charry, María Paula Cárdenas; Cepeda, M. Soledad; Cubillos, Leonardo; John, Deepak; Jassir, Maria Paula; Lemley, Shea M.; Süárez-Obando, Fernando; Torrey, William C.; Uribe, José Miguel; Williams, Makeda

doi:10.1176/appi.ps.202000041

Cited by 5 publications

(6 citation statements)

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“…Marsch et al [ 31 ] conducted a modified stepped wedge implementation study of integrating mental health services into six primary care systems in Colombia. Their integration strategy relied on digital tools to detect, manage, and deliver services for depression and alcohol use disorder within primary care.…”

Section: Methodsmentioning

confidence: 99%

“…Their integration strategy relied on digital tools to detect, manage, and deliver services for depression and alcohol use disorder within primary care. Services provided during the study relied on elements of behavioral activation, problem solving therapy, and cognitive behavioral therapy delivered via digital platform, and included pharmacotherapy when indicated [ 31 ]. At the time of data collection, mhIST had been administered to 117 consumers at six and 12 months after being exposed to the mental health care model.…”

Section: Methodsmentioning

confidence: 99%

“…Researchers from five studies [ 21 , 33 – 35 , 38 ] relied on the Design, Implementation, Monitoring, and Evaluation Model when adapting the mhIST to other contexts, which uses qualitative data to inform item wording as well as translation and back-translation methods [ 43 ]. We reviewed back-translated versions from these five studies, a back-translated version adapted for use in Pakistan by Usman et al [ 32 ], and one Spanish-language translation by Marsch et al [ 31 ]. Consumer data from Lee et al [ 21 ] were excluded at this stage because of substantive changes to the instrument for youth respondents.…”

Section: Methodsmentioning

confidence: 99%

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Psychometric performance of the Mental Health Implementation Science Tools (mhIST) across six low- and middle-income countries

Aldridge

Kemp

Bass

et al. 2022

Implement Sci Commun

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Background Existing implementation measures developed in high-income countries may have limited appropriateness for use within low- and middle-income countries (LMIC). In response, researchers at Johns Hopkins University began developing the Mental Health Implementation Science Tools (mhIST) in 2013 to assess priority implementation determinants and outcomes across four key stakeholder groups—consumers, providers, organization leaders, and policy makers—with dedicated versions of scales for each group. These were field tested and refined in several contexts, and criterion validity was established in Ukraine. The Consumer and Provider mhIST have since grown in popularity in mental health research, outpacing psychometric evaluation. Our objective was to establish the cross-context psychometric properties of these versions and inform future revisions. Methods We compiled secondary data from seven studies across six LMIC—Colombia, Myanmar, Pakistan, Thailand, Ukraine, and Zambia—to evaluate the psychometric performance of the Consumer and Provider mhIST. We used exploratory factor analysis to identify dimensionality, factor structure, and item loadings for each scale within each stakeholder version. We also used alignment analysis (i.e., multi-group confirmatory factor analysis) to estimate measurement invariance and differential item functioning of the Consumer scales across the six countries. Results All but one scale within the Provider and Consumer versions had Cronbach’s alpha greater than 0.8. Exploratory factor analysis indicated most scales were multidimensional, with factors generally aligning with a priori subscales for the Provider version; the Consumer version has no predefined subscales. Alignment analysis of the Consumer mhIST indicated a range of measurement invariance for scales across settings (R2 0.46 to 0.77). Several items were identified for potential revision due to participant nonresponse or low or cross- factor loadings. We found only one item, which asked consumers whether their intervention provider was available when needed, to have differential item functioning in both intercept and loading. Conclusion We provide evidence that the Consumer and Provider versions of the mhIST are internally valid and reliable across diverse contexts and stakeholder groups for mental health research in LMIC. We recommend the instrument be revised based on these analyses and future research examine instrument utility by linking measurement to other outcomes of interest.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Psychometric performance of the Mental Health Implementation Science Tools (mhIST) across six low- and middle-income countries

Aldridge

Kemp

Bass

et al. 2022

Implement Sci Commun

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“…All participants were asked to use the Laddr mobile intervention daily during the 14-day study period. Informed by over 20 years of NIH-funded research and dozens of randomized trials (31)(32)(33)(34)(35), Laddr offers evidence-based health behavior change tools via an integrated platform to target a wide range of behavioral problems, including smoking, binge eating, alcohol use, other substance use, depression, panic, and anxiety. Each section of Laddr provides behavior-specific tools for activating behavior change, solving problems, overcoming obstacles to effective behavior change, and developing skills for maintenance of behavior change.…”

Section: Study Conductmentioning

confidence: 99%

Momentary Influences on Self-Regulation in Two Populations With Health Risk Behaviors: Adults Who Smoke and Adults Who Are Overweight and Have Binge-Eating Disorder

Scherer

Metcalf

Whicker

et al. 2022

Front. Digit. Health

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IntroductionSelf-regulation has been implicated in health risk behaviors and is a target of many health behavior interventions. Despite most prior research focusing on self-regulation as an individual-level trait, we hypothesize that self-regulation is a time-varying mechanism of health and risk behavior that may be influenced by momentary contexts to a substantial degree. Because most health behaviors (e.g., eating, drinking, smoking) occur in the context of everyday activities, digital technologies may help us better understand and influence these behaviors in real time. Using a momentary self-regulation measure, the current study (which was part of a larger multi-year research project on the science of behavior change) used ecological momentary assessment (EMA) to assess if self-regulation can be engaged and manipulated on a momentary basis in naturalistic, non-laboratory settings.MethodsThis one-arm, open-label exploratory study prospectively collected momentary data for 14 days from 104 participants who smoked regularly and 81 participants who were overweight and had binge-eating disorder. Four times per day, participants were queried about momentary self-regulation, emotional state, and social and environmental context; recent smoking and exposure to smoking cues (smoking sample only); and recent eating, binge eating, and exposure to binge-eating cues (binge-eating sample only). This study used a novel, momentary self-regulation measure comprised of four subscales: momentary perseverance, momentary sensation seeking, momentary self-judgment, and momentary mindfulness. Participants were also instructed to engage with Laddr, a mobile application that provides evidence-based health behavior change tools via an integrated platform. The association between momentary context and momentary self-regulation was explored via mixed-effects models. Exploratory assessments of whether recent Laddr use (defined as use within 12 h of momentary responses) modified the association between momentary context and momentary self-regulation were performed via mixed-effects models.ResultsParticipants (mean age 35.2; 78% female) in the smoking and binge-eating samples contributed a total of 3,233 and 3,481 momentary questionnaires, respectively. Momentary self-regulation subscales were associated with several momentary contexts, in the combined as well as smoking and binge-eating samples. For example, in the combined sample momentary perseverance was associated with location, positively associated with positive affect, and negatively associated with negative affect, stress, and tiredness. In the smoking sample, momentary perseverance was positively associated with momentary difficulty in accessing cigarettes, caffeine intake, and momentary restraint in smoking, and negatively associated with temptation and urge to smoke. In the binge-eating sample, momentary perseverance was positively associated with difficulty in accessing food and restraint in eating, and negatively associated with urge to binge eat. While recent Laddr use was not associated directly with momentary self-regulation subscales, it did modify several of the contextual associations, including challenging contexts.ConclusionsOverall, this study provides preliminary evidence that momentary self-regulation may vary in response to differing momentary contexts in samples from two exemplar populations with risk behaviors. In addition, the Laddr application may modify some of these relationships. These findings demonstrate the possibility of measuring momentary self-regulation in a trans-diagnostic way and assessing the effects of momentary, mobile interventions in context. Health behavior change interventions may consider measuring and targeting momentary self-regulation in addition to trait-level self-regulation to better understand and improve health risk behaviors. This work will be used to inform a later stage of research focused on assessing the transdiagnostic mediating effect of momentary self-regulation on medical regimen adherence and health outcomes.Clinical Trial RegistrationClinicalTrials.gov, Identifier: NCT03352713.

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“…The DIADA project is a multicenter implementation research project aimed at assessing the integration of a technology-based mental healthcare in six primary care sites in Colombia ( 12 , 13 ). The model leverages technology and collaborative learning to improve detection, diagnosis and treatment of depression and unhealthy alcohol use.…”

Section: Introductionmentioning

confidence: 99%

Perceived access to general and mental healthcare in primary care in Colombia during COVID-19: A cross-sectional study

Gómez‐Restrepo

Cepeda

Torrey

et al. 2022

Front. Public Health

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IntroductionThe COVID-19 pandemic has had an impact both in general and mental healthcare, challenged the health systems worldwide, and affected their capacity to deliver essential health services. We aimed to describe perceived changes in ease of access to general and mental healthcare among patients with a diagnosis of depression and/or unhealthy alcohol use in Colombia.MethodsThis study is embedded in the DIADA project, a multicenter implementation research study aimed at evaluating the integration of mental healthcare in primary care in Colombia. Between November 2020 and August 2021, we conducted a COVID-19 pandemic impact assessment in a cohort of participants with newly diagnosed depression and/or unhealthy alcohol use part of DIADA project. We assessed the ease of access and factors related to perceived ease of access to general or mental healthcare, during the COVID-19 pandemic.Results836 participants completed the COVID-19 pandemic impact assessment. About 30% of participants considered their mental health to be worse during the pandemic and 84.3% perceived access to general healthcare to be worse during the pandemic. Most of participants (85.8%) were unable to assess access to mental health services, but a significant proportion considered it to be worse. Experiencing worse ease of access to general healthcare was more frequent among women, patients with diagnosis of depression, and patients with comorbidities. Experiencing worse ease of access to mental healthcare was more frequent among patients aged between 30 and 49.9 years, from socioeconomic status between 4 and 6, affiliated to the contributive social security regime, attending urban study sites, and those who perceived their mental health was worse during the pandemic.DiscussionDespite the overall perception of worse mental health during the pandemic, the use of mental healthcare was low compared to general healthcare. Ease of access was perceived to be worse compared to pre-pandemic. Ease of access and access were affected by geographical study site, socioeconomic status, age and gender. Our findings highlight the need for improved communication between patients and institutions, tailored strategies to adapt the healthcare provision to patients' characteristics, and continued efforts to strengthen the role of mental healthcare provision in primary care.

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Scaling Up Science-Based Care for Depression and Unhealthy Alcohol Use in Colombia: An Implementation Science Project

Cited by 5 publications

References 55 publications

Psychometric performance of the Mental Health Implementation Science Tools (mhIST) across six low- and middle-income countries

Psychometric performance of the Mental Health Implementation Science Tools (mhIST) across six low- and middle-income countries

Momentary Influences on Self-Regulation in Two Populations With Health Risk Behaviors: Adults Who Smoke and Adults Who Are Overweight and Have Binge-Eating Disorder

Perceived access to general and mental healthcare in primary care in Colombia during COVID-19: A cross-sectional study

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