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Technology and implementation science to forge the future of evidence-based psychotherapies: the PRIDE scale-up study
  1. Milton L Wainberg1,2,
  2. Maria Lídia Gouveia3,
  3. Melissa Ann Stockton1,
  4. Paulino Feliciano4,
  5. Antonio Suleman4,
  6. Jennifer J. Mootz1,2,
  7. Milena Mello1,2,
  8. Andre Fiks Salem1,2,
  9. M. Claire Greene5,
  10. Charl Bezuidenhout6,
  11. Phuti Ngwepe6,
  12. Kathryn L Lovero1,
  13. Palmira Fortunato dos Santos3,
  14. Simone H. Schriger7,
  15. David S. Mandell8,
  16. Rogerio Mulumba9,
  17. Anibal Neves Anube10,
  18. Dirceu Mabunda11,
  19. Flavio Mandlate3,
  20. Francine Cournos1,5,
  21. Jean-Marie Alves-Bradford1,2,
  22. Terriann Nicholson1,2,
  23. Bianca Kann1,2,
  24. Wilza Fumo3,
  25. Cristiane S Duarte1,2,
  26. Jair de Jesus Mari12,
  27. Marcelo F. Mello13,
  28. Ana O Mocumbi14,15,
  29. Maria A Oquendo16,
  30. Myrna M Weissman1,2
  1. 1Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
  2. 2New York State Psychiatric Institute, New York, New York, USA
  3. 3Mental Health Department, Ministry of Health of Mozambique, Maputo, Mozambique
  4. 4Mental Health Department, Ministry of Health of Mozambique, Nampula, Mozambique
  5. 5Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, USA
  6. 6Research Unit, Foundation for Professional Development, Pretoria, South Africa
  7. 7Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  8. 8University of Pennsylvania, Philadelphia, Pennsylvania, USA
  9. 9Hospital Psiquiátrico de Nampula, Nampula, Mozambique
  10. 10Docente da Faculdade de Ciências de Saúde—UniLúrio, Hospital Psiquiátrico de Nampula, Nampula, Mozambique
  11. 11Mavalane General Hospital, Maputo, Mozambique
  12. 12Department of Psychiatry and Medical Psychology, Escola Paulista de Medicina, Universidade Federal de São Paulo, Sao Paulo, São Paulo, Brazil
  13. 13UNIFESP, Sao Paulo, São Paulo, Brazil
  14. 14Universidade Eduardo Mondlane, Maputo, Mozambique
  15. 15Doenças Não Transmissíveis, Instituto Nacional de Saúde, Maputo, Mozambique
  16. 16Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr Bianca Kann, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY 10032, USA; biancakann1{at}gmail.com

Abstract

Objective To report the interim results from the training of providers inevidence-based psychotherapies (EBPs) and use of mobile applications.

Design and Setting The Partnerships in Research to Implement and Disseminate Sustainable and Scalable Evidence (PRIDE) study is a cluster-randomised hybrid effectiveness-implementation trial comparing three delivery pathways for integrating comprehensive mental healthcare into primary care in Mozambique. Innovations include the use of EBPs and scaling-up of task-shifted mental health services using mobile applications.

Main outcome measures We examined EBP training attendance, certification, knowledge and intentions to deliver each component. We collected qualitative data through rapid ethnography and focus groups. We tracked the use of the mobile applications to investigate early reach of a valid screening tool (Electronic Mental Wellness Tool) and the roll out of the EBPs

Participants Psychiatric technicians and primary care providers trained in the EBPs.

Results PRIDE has trained 110 EBP providers, supervisors and trainers and will train 279 community health workers in upcoming months. The trainings improved knowledge about the EBPs and trainees indicated strong intentions to deliver the EBP core components. Trained providers began using the mobile applications and appear to identify cases and provide appropriate treatment.

Conclusions The future of EBPs requires implementation within existing systems of care with fidelity to their core evidence-based components. To sustainably address the vast mental health treatment gap globally, EBP implementation demands: expanding the mental health workforce by training existing human resources; sequential use of EBPs to comprehensively treat mental disorders and their comorbid presentations and leveraging digital screening and treatment applications.

  • depression & mood disorders
  • schizophrenia & psychotic disorders
  • substance misuse
  • anxiety disorders
  • adult psychiatry
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Footnotes

  • MLW and MLG are joint first authors.

  • MAO and MMW are joint senior authors.

  • Correction notice This article has been corrected since it appeared Online First. Joint 'first' authorship has been replaced with joint 'senior' authorship.

  • Contributors MLW and MW conceptualised the paper, which was then discussed with MLG and MAO for further detail. MLW and MAS completed the initial draft and identified where coauthors could contribute their expertise. AOM, JdeJM, KLL, MM, CD, AFS, MLG, JdJM, JMA, SS, DSM, RM, ANA, DM, FM, FC, J-MA-B, TN, BK, WF contributed to writing the background sections. PF, AS, MM, CB, KLL, PFdS, PN, and MLW contributed to writing the methods and results. MLW, MLG, MAO, and MMW drafted the conclusions. All authors reviewed and contributed to each draft of the paper. MLW and MAS finalised the paper following coauthors’ review.

  • Funding This research was supported by NIMH grants U19 MH113203 and T32 MH096724 and a FIC/NIMH grant D4 3TW009675.

  • Competing interests MAO receives royalties from the Research Foundation for Mental Hygiene for the commercial use of the Columbia Suicide Severity Rating Scale and owns shares in Mantra, Inc. She serves as an advisor to Alkermes and Fundacion Jimenez Diaz (Madrid). Her family owns stock in Bristol Myers Squibb.MMW receives royalties from Multi-Health Systems Inc. for use of the Social Adjustment Scale-Self-Report (SAS-SR) as well as book royalties from Perseus Press, Oxford Press, and APA Publishing. Additionally, MMW has received research funding from the Brain and Behavior Foundation, Templeton Foundation and the Sackler Foundation.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. Data collection is ongoing. Study data will be available once the study is completed upon reasonable request for de-identified data.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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