Jill K Murphy1, Erin E Michalak2, Jing Liu2, Heather Colquhoun3, Hannah Burton2, Xiaorui Yang4, Tao Yang4, Xing Wang4, Yue Fei5, Yanling He6, Zuowei Wang5, Yifeng Xu4, Ping Zhang7, Yousong Su4, Jia Huang4, Leping Huang5, Lu Yang4, Xiao Lin4, Yiru Fang4, Tianli Liu8, Raymond W Lam2, Jun Chen4. 1. Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada. jill.murphy@ubc.ca. 2. Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada. 3. Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada. 4. Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China. 5. Hongkou District Mental Health Center, Shanghai, China. 6. Shanghai CDC for Mental Health, Division of Training and Health Education, Shanghai, China. 7. Fengxian District Mental Health Center, Shanghai, China. 8. Peking University, Institute of Population Research, Beijing, China.
Abstract
BACKGROUND: Measurement-based care (MBC) is an evidence-based practice for depression, but its use by clinicians remains low. Enhanced MBC (eMBC), which uses digital technologies, can help to facilitate the use of MBC by clinicians and patients. Understanding factors that act as barriers and drivers to the implementation of MBC and eMBC is important to support the design of implementation strategies, promoting uptake by clinicians and patients. OBJECTIVE: This situational analysis identifies barriers and facilitators to the implementation of standard and eMBC at mental health centers in Shanghai, China. METHODS: We used mixed methods to develop a comprehensive understanding of the factors influencing MBC and eMBC implementation in Shanghai. This study took place across three mental health centers in Shanghai. We used situational analysis tools to collect contextual information about the three centers, conducted surveys with n = 116 clinicians and n = 301 patients, conducted semi-structured interviews with n = 30 clinicians and six focus groups with a total of n = 19 patients. Surveys were analysed using descriptive statistics, and semi-structured interviews and focus groups were analysed using framework analysis. RESULTS: Several potential barriers and facilitators to MBC and eMBC implementation were identified. Infrastructure, cost, attitudes and beliefs, and perceptions about feasibility and efficacy emerged as both challenges and drivers to MBC and eMBC implementation in Shanghai. CONCLUSIONS: The results of this study will directly inform the design of an implementation strategy for MBC and eMBC in Shanghai, that will be tested via a randomized controlled trial. This study contributes to the emerging body of literature on MBC implementation and, to the best of our knowledge, is the first such study to take place in Asia. This study identifies several factors that are relevant to the equitable delivery of MBC, recognizing the need to explicitly address equity concerns in global mental health implementation research.
BACKGROUND: Measurement-based care (MBC) is an evidence-based practice for depression, but its use by clinicians remains low. Enhanced MBC (eMBC), which uses digital technologies, can help to facilitate the use of MBC by clinicians and patients. Understanding factors that act as barriers and drivers to the implementation of MBC and eMBC is important to support the design of implementation strategies, promoting uptake by clinicians and patients. OBJECTIVE: This situational analysis identifies barriers and facilitators to the implementation of standard and eMBC at mental health centers in Shanghai, China. METHODS: We used mixed methods to develop a comprehensive understanding of the factors influencing MBC and eMBC implementation in Shanghai. This study took place across three mental health centers in Shanghai. We used situational analysis tools to collect contextual information about the three centers, conducted surveys with n = 116 clinicians and n = 301 patients, conducted semi-structured interviews with n = 30 clinicians and six focus groups with a total of n = 19 patients. Surveys were analysed using descriptive statistics, and semi-structured interviews and focus groups were analysed using framework analysis. RESULTS: Several potential barriers and facilitators to MBC and eMBC implementation were identified. Infrastructure, cost, attitudes and beliefs, and perceptions about feasibility and efficacy emerged as both challenges and drivers to MBC and eMBC implementation in Shanghai. CONCLUSIONS: The results of this study will directly inform the design of an implementation strategy for MBC and eMBC in Shanghai, that will be tested via a randomized controlled trial. This study contributes to the emerging body of literature on MBC implementation and, to the best of our knowledge, is the first such study to take place in Asia. This study identifies several factors that are relevant to the equitable delivery of MBC, recognizing the need to explicitly address equity concerns in global mental health implementation research.
Authors: Tong Guo; Yu-Tao Xiang; Le Xiao; Chang-Qing Hu; Helen F K Chiu; Gabor S Ungvari; Christoph U Correll; Kelly Y C Lai; Lei Feng; Ying Geng; Yuan Feng; Gang Wang Journal: Am J Psychiatry Date: 2015-08-28 Impact factor: 18.112
Authors: John C Fortney; Jürgen Unützer; Glenda Wrenn; Jeffrey M Pyne; G Richard Smith; Michael Schoenbaum; Henry T Harbin Journal: Psychiatr Serv Date: 2016-09-01 Impact factor: 3.084
Authors: J K Murphy; E E Michalak; H Colquhoun; C Woo; C H Ng; S V Parikh; L Culpepper; C S Dewa; A J Greenshaw; Y He; S H Kennedy; X-M Li; T Liu; C N Soares; Z Wang; Y Xu; J Chen; R W Lam Journal: Glob Ment Health (Camb) Date: 2019-06-13