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Treatment Preferences for Pharmacological versus Psychological Interventions among Primary Care Providers in Nepal: Mixed Methods Analysis of a Pilot Cluster Randomized Controlled Trial

There is increasing evidence supporting the effectiveness of psychological interventions in low- and middle-income countries. However, primary care providers (PCPs) may prefer treating patients with medication. A secondary exploratory analysis of a pilot cluster randomized controlled trial was condu...

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Autores principales: Bhardwaj, Anvita, Gurung, Dristy, Rai, Sauharda, Kaiser, Bonnie N., Cafaro, Cori L., Sikkema, Kathleen J., Lund, Crick, Luitel, Nagendra P., Kohrt, Brandon A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8871897/
https://www.ncbi.nlm.nih.gov/pubmed/35206331
http://dx.doi.org/10.3390/ijerph19042149
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author Bhardwaj, Anvita
Gurung, Dristy
Rai, Sauharda
Kaiser, Bonnie N.
Cafaro, Cori L.
Sikkema, Kathleen J.
Lund, Crick
Luitel, Nagendra P.
Kohrt, Brandon A.
author_facet Bhardwaj, Anvita
Gurung, Dristy
Rai, Sauharda
Kaiser, Bonnie N.
Cafaro, Cori L.
Sikkema, Kathleen J.
Lund, Crick
Luitel, Nagendra P.
Kohrt, Brandon A.
author_sort Bhardwaj, Anvita
collection PubMed
description There is increasing evidence supporting the effectiveness of psychological interventions in low- and middle-income countries. However, primary care providers (PCPs) may prefer treating patients with medication. A secondary exploratory analysis of a pilot cluster randomized controlled trial was conducted to evaluate psychological vs. pharmacological treatment preferences among PCPs. Thirty-four health facilities, including 205 PCPs, participated in the study, with PCPs in 17 facilities assigned to a standard version of the mental health Gap Action Programme (mhGAP) training delivered by mental health specialists. PCPs in the other 17 facilities received mhGAP instruction delivered by specialists and people with lived experience of mental illness (PWLE), using a training strategy entitled Reducing Stigma among HealthcAre ProvidErs (RESHAPE). Pre- and post- intervention attitudes were measured through quantitative and qualitative tools. Qualitative interviews with 49 participants revealed that PCPs in both arms endorsed counseling’s benefits and collaboration within the health system to provide counseling. In the RESHAPE arm, PCPs were more likely to increase endorsement of statements such as “depression improves without medication” (F = 9.83, p < 0.001), “not all people with depression must be treated with antidepressants” (χ(2) = 17.62, p < 0.001), and “providing counseling to people who have alcohol abuse problems is effective” (χ(2) = 26.20, p < 0.001). These mixed-method secondary findings from a pilot trial suggest that in-person participation of PWLE in training PCPs may not only reduce stigma but also increase PCPs’ support of psychological interventions. This requires further investigation in a full-scale trial.
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spelling pubmed-88718972022-02-25 Treatment Preferences for Pharmacological versus Psychological Interventions among Primary Care Providers in Nepal: Mixed Methods Analysis of a Pilot Cluster Randomized Controlled Trial Bhardwaj, Anvita Gurung, Dristy Rai, Sauharda Kaiser, Bonnie N. Cafaro, Cori L. Sikkema, Kathleen J. Lund, Crick Luitel, Nagendra P. Kohrt, Brandon A. Int J Environ Res Public Health Article There is increasing evidence supporting the effectiveness of psychological interventions in low- and middle-income countries. However, primary care providers (PCPs) may prefer treating patients with medication. A secondary exploratory analysis of a pilot cluster randomized controlled trial was conducted to evaluate psychological vs. pharmacological treatment preferences among PCPs. Thirty-four health facilities, including 205 PCPs, participated in the study, with PCPs in 17 facilities assigned to a standard version of the mental health Gap Action Programme (mhGAP) training delivered by mental health specialists. PCPs in the other 17 facilities received mhGAP instruction delivered by specialists and people with lived experience of mental illness (PWLE), using a training strategy entitled Reducing Stigma among HealthcAre ProvidErs (RESHAPE). Pre- and post- intervention attitudes were measured through quantitative and qualitative tools. Qualitative interviews with 49 participants revealed that PCPs in both arms endorsed counseling’s benefits and collaboration within the health system to provide counseling. In the RESHAPE arm, PCPs were more likely to increase endorsement of statements such as “depression improves without medication” (F = 9.83, p < 0.001), “not all people with depression must be treated with antidepressants” (χ(2) = 17.62, p < 0.001), and “providing counseling to people who have alcohol abuse problems is effective” (χ(2) = 26.20, p < 0.001). These mixed-method secondary findings from a pilot trial suggest that in-person participation of PWLE in training PCPs may not only reduce stigma but also increase PCPs’ support of psychological interventions. This requires further investigation in a full-scale trial. MDPI 2022-02-14 /pmc/articles/PMC8871897/ /pubmed/35206331 http://dx.doi.org/10.3390/ijerph19042149 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Bhardwaj, Anvita
Gurung, Dristy
Rai, Sauharda
Kaiser, Bonnie N.
Cafaro, Cori L.
Sikkema, Kathleen J.
Lund, Crick
Luitel, Nagendra P.
Kohrt, Brandon A.
Treatment Preferences for Pharmacological versus Psychological Interventions among Primary Care Providers in Nepal: Mixed Methods Analysis of a Pilot Cluster Randomized Controlled Trial
title Treatment Preferences for Pharmacological versus Psychological Interventions among Primary Care Providers in Nepal: Mixed Methods Analysis of a Pilot Cluster Randomized Controlled Trial
title_full Treatment Preferences for Pharmacological versus Psychological Interventions among Primary Care Providers in Nepal: Mixed Methods Analysis of a Pilot Cluster Randomized Controlled Trial
title_fullStr Treatment Preferences for Pharmacological versus Psychological Interventions among Primary Care Providers in Nepal: Mixed Methods Analysis of a Pilot Cluster Randomized Controlled Trial
title_full_unstemmed Treatment Preferences for Pharmacological versus Psychological Interventions among Primary Care Providers in Nepal: Mixed Methods Analysis of a Pilot Cluster Randomized Controlled Trial
title_short Treatment Preferences for Pharmacological versus Psychological Interventions among Primary Care Providers in Nepal: Mixed Methods Analysis of a Pilot Cluster Randomized Controlled Trial
title_sort treatment preferences for pharmacological versus psychological interventions among primary care providers in nepal: mixed methods analysis of a pilot cluster randomized controlled trial
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8871897/
https://www.ncbi.nlm.nih.gov/pubmed/35206331
http://dx.doi.org/10.3390/ijerph19042149
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