Barriers and facilitators to the integration of mental health services into primary health care: a systematic review

Systematic Reviews

Dickens Akena¹  Zohray M. Talib²  Celestino Obua³  Alison Kinengyere⁴  Elialilia S. Okello⁴  Edith K. Wakida⁵  Arnold Mindra⁶ 

[1] Africa Center for Systematic Reviews and Knowledge Translation, College of Health Sciences Makerere University;Department of Medical Education, California University of Science and Medicine;Department of Pharmacology and Therapeutics, Mbarara University of Science and Technology;Department of Psychiatry, Makerere University;Department of Psychiatry, Mbarara University of Science and Technology;Office of Research Administration, Mbarara University of Science and Technology;

关键词: Integration;    Mental health services;    Primary health care;    Barriers and facilitators;    Systematic review;   

DOI  :  10.1186/s13643-018-0882-7

来源: DOAJ

【 摘 要 】

Abstract Background The objective of the review was to synthesize evidence of barriers and facilitators to the integration of mental health services into PHC from existing literature. The structure of the review was guided by the SPIDER framework which involves the following: Sample or population of interest—primary care providers (PCPs); Phenomenon of Interest—integration of mental health services into primary health care (PHC); Design—influenced robustness and analysis of the study; Evaluation—outcomes included subjective outcomes (views and attitudes); and Research type—qualitative, quantitative, and mixed methods studies. Methods Studies that described mental health integration in PHC settings, involved primary care providers, and presented barriers/facilitators of mental health integration into PHC were included in the review. The sources of information included PubMed, PsycINFO, Cochrane Central Register of Controlled trials, the WHO website, and OpenGrey. Assessment of bias and quality was done using two separate tools: the Critical Appraisal Skills Program (CASP) qualitative checklist and the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies. Results Twenty studies met the inclusion criteria out of the 3353 search results. The most frequently reported barriers to integration of mental health services into PHC were (i) attitudes regarding program acceptability, appropriateness, and credibility; (ii) knowledge and skills; (iii) motivation to change; (iv) management and/or leadership; and (v) financial resources. In order to come up with an actionable approach to addressing the barriers, these factors were further analyzed along a behavior change theory. Discussion We have shown that the integration of mental health services into PHC has been carried out by various countries. The analysis from this review provides evidence to inform policy on the existing barriers and facilitators to the implementation of the mental health integration policy option. Not all databases may have been exhausted. Systematic review registration PROSPERO 2016 (Registration Number: CRD42016052000) and published in BMC Systematic Reviews August 2017.

【 授权许可】

Unknown