Accepted for/Published in: JMIR Mental Health
Date Submitted: Apr 10, 2020
Date Accepted: Jul 26, 2020
Implementing psychological interventions through non-specialist providers and telemedicine in high-income countries: A multi-stakeholder perspective
ABSTRACT
Background:
Task-sharing has been used worldwide to improve access to health care, where non (mental health) specialist providers—individuals with no formal training in mental health—have been educated to effectively treat perinatal depressive and anxiety symptoms. Little formative research has been conducted to examine relevant barriers and facilitators of non-specialist providers and the use of telemedicine in treatment service delivery in high-income countries.
Objective:
The primary objective of this study was to examine the main barriers and facilitators of non-specialist provider-delivered psychological treatments for perinatal populations with common mental health disorders such as depression and anxiety from a multi-stakeholder perspective.
Methods:
The study took place in Toronto, Canada. N=33 in-depth interviews were conducted with multiple stakeholder groups (women with lived experience, their significant others, as well as health and mental health clinicians). Qualitative data was quantified to estimate commonly endorsed themes within and across stakeholder groups.
Results:
Psychological treatments delivered by non-specialist providers was considered acceptable by the vast majority of participants (n=30 of 33; 90%). Across all stakeholder groups, nurses (61%) and midwives (42%) were the most commonly endorsed cadre of non-specialist providers. The wide majority of stakeholders (96%) were amenable to non-specialist providers delivering psychological treatment, who were empathic (60%) and via telemedicine (82%) although concerns were raised about the ability to establish a therapeutic alliance via telemedicine (16 of 33 or 48%). Patient and patient advocate stakeholders were more likely to emphasize stigma as an important barrier to accessing psychological treatments (7 of 12 or 58%) compared to clinicians (2 of 9 or 22%) and spouses (1 of 5 or 20%). Clinician stakeholders were more likely to emphasized the importance of ensuring non-specialist providers were well-trained to deliver psychological treatments (33% or 3 of 9), compared to other stakeholder groups.
Conclusions:
Our findings suggest that despite challenges in accessing psychological treatments, training non-specialist providers and the use of telemedicine are would be largely acceptable and integrated into existing health systems. These results can inform the design, implementation, and integration of non-specialist delivered interventions via telemedicine for women with perinatal depressive and anxiety symptoms in high-income country contexts. Clinical Trial: Not applicable
Citation
Request queued. Please wait while the file is being generated. It may take some time.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.