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Implementation outcomes and strategies for depression interventions in low- and middle-income countries: a systematic review
BACKGROUND: We systematically reviewed implementation research targeting depression interventions in low- and middle-income countries (LMICs) to assess gaps in methodological coverage. METHODS: PubMed, CINAHL, PsycINFO, and EMBASE were searched for evaluations of depression interventions in LMICs re...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Cambridge University Press
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7176918/ https://www.ncbi.nlm.nih.gov/pubmed/32346482 http://dx.doi.org/10.1017/gmh.2020.1 |
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author | Wagenaar, Bradley H. Hammett, Wilson H. Jackson, Courtney Atkins, Dana L. Belus, Jennifer M. Kemp, Christopher G. |
author_facet | Wagenaar, Bradley H. Hammett, Wilson H. Jackson, Courtney Atkins, Dana L. Belus, Jennifer M. Kemp, Christopher G. |
author_sort | Wagenaar, Bradley H. |
collection | PubMed |
description | BACKGROUND: We systematically reviewed implementation research targeting depression interventions in low- and middle-income countries (LMICs) to assess gaps in methodological coverage. METHODS: PubMed, CINAHL, PsycINFO, and EMBASE were searched for evaluations of depression interventions in LMICs reporting at least one implementation outcome published through March 2019. RESULTS: A total of 8714 studies were screened, 759 were assessed for eligibility, and 79 studies met inclusion criteria. Common implementation outcomes reported were acceptability (n = 50; 63.3%), feasibility (n = 28; 35.4%), and fidelity (n = 18; 22.8%). Only four studies (5.1%) reported adoption or penetration, and three (3.8%) reported sustainability. The Sub-Saharan Africa region (n = 29; 36.7%) had the most studies. The majority of studies (n = 59; 74.7%) reported outcomes for a depression intervention implemented in pilot researcher-controlled settings. Studies commonly focused on Hybrid Type-1 effectiveness-implementation designs (n = 53; 67.1), followed by Hybrid Type-3 (n = 16; 20.3%). Only 21 studies (26.6%) tested an implementation strategy, with the most common being revising professional roles (n = 10; 47.6%). The most common intervention modality was individual psychotherapy (n = 30; 38.0%). Common study designs were mixed methods (n = 27; 34.2%), quasi-experimental uncontrolled pre-post (n = 17; 21.5%), and individual randomized trials (n = 16; 20.3). CONCLUSIONS: Existing research has focused on early-stage implementation outcomes. Most studies have utilized Hybrid Type-1 designs, with the primary aim to test intervention effectiveness delivered in researcher-controlled settings. Future research should focus on testing and optimizing implementation strategies to promote scale-up of evidence-based depression interventions in routine care. These studies should use high-quality pragmatic designs and focus on later-stage implementation outcomes such as cost, penetration, and sustainability. |
format | Online Article Text |
id | pubmed-7176918 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Cambridge University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-71769182020-04-28 Implementation outcomes and strategies for depression interventions in low- and middle-income countries: a systematic review Wagenaar, Bradley H. Hammett, Wilson H. Jackson, Courtney Atkins, Dana L. Belus, Jennifer M. Kemp, Christopher G. Glob Ment Health (Camb) Review BACKGROUND: We systematically reviewed implementation research targeting depression interventions in low- and middle-income countries (LMICs) to assess gaps in methodological coverage. METHODS: PubMed, CINAHL, PsycINFO, and EMBASE were searched for evaluations of depression interventions in LMICs reporting at least one implementation outcome published through March 2019. RESULTS: A total of 8714 studies were screened, 759 were assessed for eligibility, and 79 studies met inclusion criteria. Common implementation outcomes reported were acceptability (n = 50; 63.3%), feasibility (n = 28; 35.4%), and fidelity (n = 18; 22.8%). Only four studies (5.1%) reported adoption or penetration, and three (3.8%) reported sustainability. The Sub-Saharan Africa region (n = 29; 36.7%) had the most studies. The majority of studies (n = 59; 74.7%) reported outcomes for a depression intervention implemented in pilot researcher-controlled settings. Studies commonly focused on Hybrid Type-1 effectiveness-implementation designs (n = 53; 67.1), followed by Hybrid Type-3 (n = 16; 20.3%). Only 21 studies (26.6%) tested an implementation strategy, with the most common being revising professional roles (n = 10; 47.6%). The most common intervention modality was individual psychotherapy (n = 30; 38.0%). Common study designs were mixed methods (n = 27; 34.2%), quasi-experimental uncontrolled pre-post (n = 17; 21.5%), and individual randomized trials (n = 16; 20.3). CONCLUSIONS: Existing research has focused on early-stage implementation outcomes. Most studies have utilized Hybrid Type-1 designs, with the primary aim to test intervention effectiveness delivered in researcher-controlled settings. Future research should focus on testing and optimizing implementation strategies to promote scale-up of evidence-based depression interventions in routine care. These studies should use high-quality pragmatic designs and focus on later-stage implementation outcomes such as cost, penetration, and sustainability. Cambridge University Press 2020-03-02 /pmc/articles/PMC7176918/ /pubmed/32346482 http://dx.doi.org/10.1017/gmh.2020.1 Text en © The Author(s) 2020 http://creativecommons.org/licenses/by/4.0/ http://creativecommons.org/licenses/by/4.0/This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Review Wagenaar, Bradley H. Hammett, Wilson H. Jackson, Courtney Atkins, Dana L. Belus, Jennifer M. Kemp, Christopher G. Implementation outcomes and strategies for depression interventions in low- and middle-income countries: a systematic review |
title | Implementation outcomes and strategies for depression interventions in low- and middle-income countries: a systematic review |
title_full | Implementation outcomes and strategies for depression interventions in low- and middle-income countries: a systematic review |
title_fullStr | Implementation outcomes and strategies for depression interventions in low- and middle-income countries: a systematic review |
title_full_unstemmed | Implementation outcomes and strategies for depression interventions in low- and middle-income countries: a systematic review |
title_short | Implementation outcomes and strategies for depression interventions in low- and middle-income countries: a systematic review |
title_sort | implementation outcomes and strategies for depression interventions in low- and middle-income countries: a systematic review |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7176918/ https://www.ncbi.nlm.nih.gov/pubmed/32346482 http://dx.doi.org/10.1017/gmh.2020.1 |
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