Integrating screening and management of mental disorders, including substance use disorders into other non-communicable disease care: insights from theory-informed implementation strategies creation for implementation model M0 in Faridabad, India as part of ICMR-MINDS project.
Mental disorders, including substance use disorders (MSUD) frequently co-occur with other Non-Communicable Diseases (NCDs). This leads to increased morbidity, premature mortality, and reduced quality of life. In India, services for MSUD are usually delivered separately from NCD care. This study aimed to develop a theory-informed and context-specific set of implementation strategies as part of Model M0 for integration of screening and management of MSUD into existing NCD care in public health facilities in Faridabad district of Haryana. This work addresses a major service gap in the public health system and provides a structured, practical approach for integration.
Implementation Mapping, updated Consolidated Framework for Implementation Research, Expert Recommendations for Implementing Change (ERIC) taxonomy, Theoretical Domains Framework and Capability, Opportunity, Motivation - Behavior model were used to design and tailor implementation strategies. Mixed-methods formative assessment was carried out. The stakeholders (actors) included the health system leaders (policy makers and state and district health authorities), facility-level healthcare professionals, and patients/service users and caregivers. The barriers, facilitators, and determinants were identified. Co-creation meetings were held with stakeholders. A set of ERIC strategies were operationalized through contextually appropriate actions and materials.
A comprehensive, theory-informed implementation model (Model M0) integrating 51 ERIC strategies across domains such as capacity building, clinical workflow optimization, stakeholder engagement, and data systems strengthening was created. Multiple co-creation meetings conducted with various stakeholders at the level of state, district, and health facility benefited from and incorporated the perspectives and inputs from them. Strategies were mapped to specific change objectives and stakeholders, including patients/service users and caregivers, health care professionals, and health system leaders (policy makers and state and district health authorities). Specific actions and target actors (stakeholders) for each of the strategies were identified. The model M0 included the set of implementation strategies; the interventions (innovations), implementation materials (practical tools and protocols) and indicators to assess process, implementation, patient/clinical, and service outcomes.
This study demonstrates the feasibility of applying a structured implementation science approach to design context-sensitive strategies for integrating services for MSUD into existing NCD care in public health facilities in Faridabad district of Haryana. The implementation Model M0 offers a clear roadmap for how integration can be carried out in routine practice. The recommended way forward is to pilot, review, and refine this model. This will be followed by scale-up within the district and evaluation. The approach may also be useful for other low- and middle-income countries aiming to strengthen integrated care for MSUD within NCD programs.
https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=MTEzMTg4&Enc=&userName=, identifier CTRI/2024/08/072748.
Implementation Mapping, updated Consolidated Framework for Implementation Research, Expert Recommendations for Implementing Change (ERIC) taxonomy, Theoretical Domains Framework and Capability, Opportunity, Motivation - Behavior model were used to design and tailor implementation strategies. Mixed-methods formative assessment was carried out. The stakeholders (actors) included the health system leaders (policy makers and state and district health authorities), facility-level healthcare professionals, and patients/service users and caregivers. The barriers, facilitators, and determinants were identified. Co-creation meetings were held with stakeholders. A set of ERIC strategies were operationalized through contextually appropriate actions and materials.
A comprehensive, theory-informed implementation model (Model M0) integrating 51 ERIC strategies across domains such as capacity building, clinical workflow optimization, stakeholder engagement, and data systems strengthening was created. Multiple co-creation meetings conducted with various stakeholders at the level of state, district, and health facility benefited from and incorporated the perspectives and inputs from them. Strategies were mapped to specific change objectives and stakeholders, including patients/service users and caregivers, health care professionals, and health system leaders (policy makers and state and district health authorities). Specific actions and target actors (stakeholders) for each of the strategies were identified. The model M0 included the set of implementation strategies; the interventions (innovations), implementation materials (practical tools and protocols) and indicators to assess process, implementation, patient/clinical, and service outcomes.
This study demonstrates the feasibility of applying a structured implementation science approach to design context-sensitive strategies for integrating services for MSUD into existing NCD care in public health facilities in Faridabad district of Haryana. The implementation Model M0 offers a clear roadmap for how integration can be carried out in routine practice. The recommended way forward is to pilot, review, and refine this model. This will be followed by scale-up within the district and evaluation. The approach may also be useful for other low- and middle-income countries aiming to strengthen integrated care for MSUD within NCD programs.
https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=MTEzMTg4&Enc=&userName=, identifier CTRI/2024/08/072748.
Authors
Balhara Balhara, Bhardwaj Bhardwaj, Sarkar Sarkar, Verma Verma, Singh Singh, Atri Atri, Saini Saini, Kang Kang, Verma Verma, Grover Grover, Dahiya Dahiya
View on Pubmed