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Mixed-methods evaluation of mental healthcare integration into tuberculosis and maternal-child healthcare services of four South African districts

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dc.contributor.authorLovero, Kathryn L.
dc.contributor.authorLammie, Samantha L.
dc.contributor.authorvan Zyl, Andre
dc.contributor.authorPaul, Sharon N.
dc.contributor.authorNgwepe, Phuti
dc.contributor.authorMootz, Jennifer J.
dc.contributor.authorCarlson, Catherine
dc.contributor.authorSweetland, Annika C.
dc.contributor.authorShelton, Rachel C.
dc.contributor.authorWainberg, Milton L.
dc.contributor.authorMedina-Marino, Andrew
dc.contributor.otherColumbia University
dc.contributor.otherEmory University
dc.contributor.otherUniversity of Alabama Tuscaloosa
dc.date.accessioned2023-09-28T19:09:49Z
dc.date.available2023-09-28T19:09:49Z
dc.date.issued2019
dc.description.abstractBackgroundThe South African National Mental Health Policy Framework and Strategic Plan 2013-2020 was adopted to address the country's substantial burden and inadequate treatment of mental illness. It outlines measures toward the goal of full integration of mental health services into primary care by 2020. To evaluate progress and challenges in implementation, we conducted a mixed-methods assessment of mental health service provision in tuberculosis and maternal-child healthcare services of four districts in South Africa.MethodsForty clinics (ten per district) were purposively selected to represent both urban and rural locations. District-level program managers (DPMs) for mental health, tuberculosis, and maternal-child healthcare were qualitatively interviewed about district policy and procedures for management of mental illness and challenges in integrating mental health services into primary care. Clinic nurses and mental health practitioners (MHPs) completed a quantitative questionnaire to assess their engagement with stepped care for patients with mental illness. Qualitative and quantitative data were collected concurrently and compared to triangulate progress in implementation of integrated services.ResultsA total of 59 nurses and 17 MHPs completed questionnaires, and nine DPMs were interviewed (total n=85). DPMs indicated that nurses should screen for mental illness at every patient visit, although only 43 (73%) nurses reported conducting universal screening and 26 (44%) reported using a specific screening tool. For patients who screen positive for mental illness, DPMs described a stepped-care approach in which MHPs diagnose patients and then treat or refer them to specialized care. However, only 7 (41%) MHPs indicated that they diagnose mental illness and 14 (82%) offer any treatment for mental illness. Addressing challenges to current integration efforts, DPMs highlighted 1) insufficient funding and material resources, 2) poor coordination at the district administrative level, and 3) low mental health awareness in district administration and the general population.ConclusionsThough some progress has been made toward integration of mental health services into primary care settings, there is a substantial lack of training and clarity of roles for nurses and MHPs. To enhance implementation, increased efforts must be directed toward improving district-level administrative coordination, mental health awareness, and financial and material resources.en_US
dc.format.mediumelectronic
dc.format.mimetypeapplication/pdf
dc.identifier.citationLovero, K. L., Lammie, S. L., van Zyl, A., Paul, S. N., Ngwepe, P., Mootz, J. J., Carlson, C., Sweetland, A. C., Shelton, R. C., Wainberg, M. L., & Medina-Marino, A. (2019). Mixed-methods evaluation of mental healthcare integration into tuberculosis and maternal-child healthcare services of four South African districts. In BMC Health Services Research (Vol. 19, Issue 1). Springer Science and Business Media LLC. https://doi.org/10.1186/s12913-019-3912-9
dc.identifier.doi10.1186/s12913-019-3912-9
dc.identifier.orcidhttps://orcid.org/0000-0001-6496-6339
dc.identifier.orcidhttps://orcid.org/0000-0002-1727-6316
dc.identifier.orcidhttps://orcid.org/0000-0002-9390-4652
dc.identifier.urihttps://ir.ua.edu/handle/123456789/10958
dc.languageEnglish
dc.language.isoen_US
dc.publisherBMC
dc.rights.licenseAttribution 4.0 International (CC BY 4.0)
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/
dc.subjectMental health
dc.subjectMental disorders
dc.subjectPrimary care
dc.subjectHealthcare integration
dc.subjectHealth systems
dc.subjectSouth Africa
dc.subjectSub-Saharan Africa
dc.subjectMixed-methods
dc.subjectImplementation
dc.subjectMIDDLE-INCOME COUNTRIES
dc.subjectANTENATAL DEPRESSION
dc.subjectSYSTEM GOVERNANCE
dc.subjectRURAL DISTRICT
dc.subjectGLOBAL BURDEN
dc.subjectRISK-FACTORS
dc.subjectDISORDERS
dc.subjectPREVALENCE
dc.subjectCHALLENGES
dc.subject12-MONTH
dc.subjectHealth Care Sciences & Services
dc.titleMixed-methods evaluation of mental healthcare integration into tuberculosis and maternal-child healthcare services of four South African districtsen_US
dc.typeArticle
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