Is supported self-management for depression effective for adults in community-based settings in Vietnam?: a modified stepped-wedge cluster randomized controlled trial

Murphy, Jill; Xie, Hui; Nguyen, Vu Cong; Chau, Leena W.; Oanh, Pham Thi Kieu; Tran, Nhu Kieu; O’Neil, John; Goldsmith, Charles H.; Hoi, Nguyen Van; Ma, Yue; Lou, Hayami; Jones, Wayne; Minas, Harry

doi:10.1186/s13033-020-00342-1

Cited by 20 publications

(33 citation statements)

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“…Engagement of social collaborators (lay social workers) to deliver the SSM intervention has important implications for improving availability of, and access to, depression care in Vietnam. Despite the challenges identi ed here, the SSM intervention demonstrated signi cant improvement for patients (27). This model, involving social collaborators, can help ll a critical gap in care for mild to moderate depression in Vietnam and other low-resource contexts.…”

Section: Discussionmentioning

confidence: 84%

“…Studies have reported that trained non-specialist providers in primary care clinics helped to reduce depressive symptoms in adults (36) and improve outcomes for depression, post-traumatic stress disorder, and alcohol use disorder (37) in LMICs. The MAC-FI study demonstrated that, despite the challenges identi ed, lay social workers (social collaborators) can provide effective social support to improve mental health care via SSM to those with mild to moderate depression, with training and supervision from a social worker (27).…”

Section: Discussion and Recommendationsmentioning

confidence: 99%

“…The Mental Health in Adults and Children -Frugal Innovations (MAC-FI) study, funded jointly by Grand Challenges Canada and MOLISA, implemented a community-based mental health intervention as a randomized controlled trial (RCT) that demonstrated improved depression care in Vietnam using tasksharing approaches (27). MAC-FI included an examination of the contextual factors affecting the integration and sustainability of service delivery by social collaborators in Vietnam's mental health system.…”

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confidence: 99%

“…A provincial-level social worker provided supervision and support to evaluate delity. Full details of the SSM intervention are described elsewhere (27). Results showed that SSM was successful at reducing symptoms of depression when compared with the control group, who received care as usual (27).…”

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confidence: 99%

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Lay Social Workers implementing a task-sharing approach to managing depression in Vietnam

Chau

Murphy

Cong

et al. 2020

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Background While depression is a leading contributor to burden of disease in Vietnam, there is a critical gap in depression care due to the shortage of mental health specialists and extremely limited mental health services in general health care settings. We have previously reported the effectiveness of a supported self-management (SSM) task-sharing intervention for depression, delivered by social collaborators (lay social workers). The purpose of this study was to identify factors influencing the effectiveness of delivery of SSM by social collaborators and delineate areas for further attention that are relevant for scale-up. Methods A hundred and ten (110) key informant interviews were conducted with three stakeholder groups (patients, social collaborators, experts) from eight provinces in Vietnam. Participants were identified through records from a recently completed randomized trial that showed the effectiveness of SSM in community-based settings in Vietnam. Qualitative descriptive methods and thematic analysis were used to examine the interviews. A coding framework and corresponding themes were developed deductively, based on the findings from the randomized trial and the literature, and through inductive analysis, to describe the contextual factors that impacted the social collaborators’ role in successfully implementing the SSM intervention. Results Our analysis identified the following benefits of working with social collaborators: 1) increased awareness of mental health in the family and community; 2) reduced stigma; 3) a better understanding that depression is treatable; 4) increased help-seeking; and 5) improved access to care. There were also significant challenges, including social collaborator characteristics (age, education, pre-existing training and skills) and contextual factors influencing their work (roles and responsibilities, training, compensation, support from government). Conclusions Engaging social collaborators in the delivery of SSM in the community can help fill a critical gap in depression care in Vietnam. However, several contextual challenges that are an impediment to increased engagement and sustainable integration into health and social systems need to be resolved through policy change to regulate their practice, define their scope of work, and provide adequate remuneration.

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Section: Discussionmentioning

confidence: 84%

Section: Discussion and Recommendationsmentioning

confidence: 99%

mentioning

confidence: 99%

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confidence: 99%

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Lay Social Workers implementing a task-sharing approach to managing depression in Vietnam

Chau

Murphy

Cong

et al. 2020

Preprint

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“…Yet there is substantial variation in their training and experience, scope of work, and remuneration resulting from a lack of regulation and accreditation. For the most part they are unsalaried, although some may receive stipends for carrying out certain tasks [ 27 ].…”

Section: Introductionmentioning

confidence: 99%

Lay social workers implementing a task-sharing approach to managing depression in Vietnam

Chau

Murphy

Nguyen

et al. 2021

Int J Ment Health Syst

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Background While depression is a leading contributor to burden of disease in Vietnam, there is a critical gap in depression care due to the shortage of mental health specialists and extremely limited mental health services in general health care settings. We have previously reported the effectiveness of a supported self-management (SSM) task-sharing intervention for depression, delivered by social collaborators (lay social workers). The purpose of this study was to identify factors influencing the effectiveness of delivery of SSM by social collaborators and delineate areas for further attention that are relevant for scale-up. Methods A hundred and ten (110) key informant interviews were conducted with three stakeholder groups (patients, social collaborators, experts) from eight provinces in Vietnam. Participants were identified through records from a recently completed randomized trial that showed the effectiveness of SSM in community-based settings in Vietnam. Qualitative descriptive methods and thematic analysis were used to examine the interviews. A coding framework and corresponding themes were developed deductively, based on the findings from the randomized trial and the literature, and through inductive analysis, to describe the contextual factors that impacted the social collaborators’ role in successfully implementing the SSM intervention. Results Our analysis identified the following benefits of working with social collaborators: (1) increased awareness of mental health in the family and community; (2) reduced stigma; (3) a better understanding that depression is treatable; (4) increased help-seeking; and (5) improved access to care. There were also significant challenges, including social collaborator characteristics (age, education, pre-existing training and skills) and contextual factors influencing their work (roles and responsibilities, training, compensation, support from government). Conclusions Engaging social collaborators in the delivery of SSM in the community can help fill a critical gap in depression care in Vietnam. However, several contextual challenges that are an impediment to increased engagement and sustainable integration into health and social systems need to be resolved through policy change to regulate their practice, define their scope of work, and provide adequate remuneration.

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Primary-level worker interventions for the care of people living with mental disorders and distress in low- and middle-income countries

Ginneken

Chin

Lim

et al. 2021

Cochrane Database of Systematic Reviews

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Background Community‐based primary‐level workers (PWs) are an important strategy for addressing gaps in mental health service delivery in low‐ and middle‐income countries. Objectives To evaluate the effectiveness of PW‐led treatments for persons with mental health symptoms in LMICs, compared to usual care. Search methods MEDLINE, Embase, CENTRAL, ClinicalTrials.gov, ICTRP, reference lists (to 20 June 2019). Selection criteria Randomised trials of PW‐led or collaborative‐care interventions treating people with mental health symptoms or their carers in LMICs. PWs included: primary health professionals (PHPs), lay health workers (LHWs), community non‐health professionals (CPs). Data collection and analysis Seven conditions were identified apriori and analysed by disorder and PW examining recovery, prevalence, symptom change, quality‐of‐life (QOL), functioning, service use (SU), and adverse events (AEs). Risk ratios (RRs) were used for dichotomous outcomes; mean difference (MDs), standardised mean differences (SMDs), or mean change differences (MCDs) for continuous outcomes. For SMDs, 0.20 to 0.49 represented small, 0.50 to 0.79 moderate, and ≥0.80 large clinical effects. Analysis timepoints: T1 (<1 month), T2 (1‐6 months), T3 ( >6 months) post‐intervention. Main results Description of studies 95 trials (72 new since 2013) from 30 LMICs (25 trials from 13 LICs). Risk of bias Most common: detection bias, attrition bias (efficacy), insufficient protection against contamination. Intervention effects *Unless indicated, comparisons were usual care at T2. “Probably”, “may”, or “uncertain” indicates "moderate", "low," or "very low" certainty evidence. Adults with common mental disorders (CMDs) LHW‐led interventions a. may increase recovery (2 trials, 308 participants; RR 1.29, 95%CI 1.06 to 1.56); b. may reduce prevalence (2 trials, 479 participants; RR 0.42, 95%CI 0.18 to 0.96); c. may reduce symptoms (4 trials, 798 participants; SMD ‐0.59, 95%CI ‐1.01 to ‐0.16); d. may improve QOL (1 trial, 521 participants; SMD 0.51, 95%CI 0.34 to 0.69); e. may slightly reduce functional impairment (3 trials, 1399 participants; SMD ‐0.47, 95%CI ‐0.8 to ‐0.15); f. may reduce AEs (risk of suicide ideation/attempts); g. may have uncertain effects on SU. Collaborative‐care a. may increase recovery (5 trials, 804 participants; RR 2.26, 95%CI 1.50 to 3.43); b. may reduce prevalence although the actual effect range indicates it may have little‐or‐no effect (2 trials, 2820 participants; RR 0.57, 95%CI 0.32 to 1.01); c. may slightly red...

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Is supported self-management for depression effective for adults in community-based settings in Vietnam?: a modified stepped-wedge cluster randomized controlled trial

Cited by 20 publications

References 31 publications

Lay Social Workers implementing a task-sharing approach to managing depression in Vietnam

Lay Social Workers implementing a task-sharing approach to managing depression in Vietnam

Lay social workers implementing a task-sharing approach to managing depression in Vietnam

Primary-level worker interventions for the care of people living with mental disorders and distress in low- and middle-income countries

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