Artículos de revistas
Implementation of a pilot community-based psychosocial intervention for patients with psychoses in Chile and Brazil: a comparative analysis of users’ perspectives
Fecha
2021Registro en:
Global Mental Health 8, e15, 1–9 (2021)
10.1017/ gmh.2021.10
Autor
Dev, Saloni
Kankan, Tanvi
Blasco, Drew
Le, PhuongThao D.
Agrest, Martin
Dishy, Gabriella
Mascayano Tapia, Franco Sebastían Armando
Schilling, Sara
Jorquera González, María José
Dahl, Catarina
Tavares Cavalcanti, María
Price, LeShawndra
Conover, Sarah
Yang, Lawrence H.
Alvarado Muñoz, Rubén
Susser, Ezra S.
Institución
Resumen
Background. Few studies provide clear rationale for and the reception of adaptations of
evidence-based interventions. To address this gap, we describe the context-dependent adaptations
in critical time intervention-task shifting (CTI-TS), a manualized recovery program
for individuals with psychosis in Rio de Janeiro, Brazil and Santiago, Chile. Implications
of the adaptations – incorporating a task-shifting approach and modifying the mode of
community-based service delivery – are examined from users’ perspectives.
Methods. A secondary analysis of in-depth interviews with CTI-TS users (n = 9 in Brazil; n = 15
in Chile) was conducted. Using the framework method, we thematically compared how
participants from each site perceived the main adapted components of CTI-TS.
Results. Users of both sites appreciated the task-shifting worker pair to provide personalized,
flexible, and relatable support. They wanted CTI-TS to be longer and experienced difficulty
maintaining intervention benefits in the long-term. In Chile, stigma and a perceived professional
hierarchy toward the task-shifting providers were more profound than in Brazil.
Engagement with community-based services delivery in homes and neighborhoods (Chile),
and at community mental health centers (Brazil) were influenced by various personal, familial,
financial, and social factors. Uniquely, community violence was a significant barrier to
engagement in Brazil.
Conclusion. CTI-TS’ major adaptations were informed by the distinct mental health systems
and social context of Santiago and Rio. Evaluation of user experiences with these adaptations
provides insights into implementing and scaling-up task-shifting and community-oriented
interventions in the region through the creation of specialized roles for the worker pair,
targeting sustained intervention effects, and addressing socio-cultural barriers.