Abstract

Despite an increasing demand for mental health services in sub-Saharan Africa, few professionals are available to meet these needs. In the last few decades, task shifting using non-specialist workers has been increasingly employed to deliver physical and mental health treatment services. While evidence suggests task shifting is effective for mental health service provision, few studies have examined the literature in sub-Saharan Africa. This systematic review includes 14 intervention studies utilizing task shifting for mental health interventions in sub-Saharan Africa. Researchers conducted a rigorous systematic search using four databases: Academic Search Complete, MEDLINE, Global Health, and PsychINFO. In addition to PRISMA guidelines, this review also developed a Methodological Quality Rating Scale and an Outcome Attainment Index to analyze the data. Our systematic search generated 2,071 articles with 14 included in the review. Methodological rigor scores ranged from 7 to 12 on a 12-point scale (mean = 9.9, median = 10), with nearly half of studies (43%) not using a control group in their intervention study. Individual interventions were found to have slightly higher rigor compared with group interventions, while multisite interventions were found to have significantly higher rigor compared with single site studies. Initial evidence suggests that task shifting interventions are a valuable tool for implementing mental health services in settings with limited professionals. However, current studies are faced with methodological challenges, particularly by lacking comparison groups and detailed fidelity guidelines. Additionally, studies can be strengthened by including multiple sites in the intervention and ensuring appropriate cultural adaptation of services.

摘要

尽管撒哈拉以南非洲地区对精神卫生服务的需求不断增长，但很少有专业人员可以满足这些需求。在过去的几十年中，越来越多地采用非专业人员的任务转移来提供身心健康治疗服务。尽管有证据表明任务转移对提供精神卫生服务有效，但很少有研究对撒哈拉以南非洲的文献进行了研究。这份系统的综述包括14项干预研究，这些研究利用任务转移对撒哈拉以南非洲地区的心理健康进行干预。研究人员使用四个数据库进行了严格的系统搜索：Academic Search Complete，MEDLINE，Global Health和PsychINFO。除了PRISMA准则，这项审查还制定了方法学质量等级量表和结果获得指数来分析数据。我们的系统搜索产生了2,071篇文章，其中14篇被纳入评论。方法学上的严谨评分在12分制中从7到12不等（平均= 9.9，中位数= 10），其中将近一半的研究（43％）未在干预研究中使用对照组。与组干预相比，发现个体干预的严谨度略高于组干预，而与单站点研究相比，多站点干预的严谨度更高。初步证据表明，任务转移干预措施是在专业人员有限的环境中实施心理健康服务的宝贵工具。但是，当前的研究面临方法论上的挑战，特别是缺少比较组和详细的保真度准则。此外，可以通过在干预措施中包括多个地点并确保对服务进行适当的文化适应来加强研究。