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.

中文翻译：

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在智利和巴西对精神病患者实施基于社区的社会心理干预试点：用户观点的比较分析

背景 很少有研究为基于证据的干预措施的调整提供明确的理由和接受程度。为了解决这一差距，我们描述了关键时间干预-任务转移 (CTI-TS) 中依赖于上下文的适应，这是一项针对巴西里约热内卢和智利圣地亚哥的精神病患者的手动康复计划。从用户的角度检查了适应性的影响——结合任务转移方法和修改基于社区的服务提供模式。方法 对 CTI-TS 用户深度访谈的二次分析（n= 9 在巴西；n= 15 在智利）进行了。使用框架方法，我们按主题比较了每个站点的参与者如何感知 CTI-TS 的主要适应组件。结果 两个站点的用户都赞赏轮班工作人员提供个性化、灵活且相关的支持。他们希望 CTI-TS 更长，并且难以长期维持干预益处。在智利，对任务转移提供者的耻辱感和职业等级观念比在巴西更为深刻。在家庭和社区（智利）以及社区心理健康中心（巴西）参与以社区为基础的服务提供受到各种个人、家庭、财务和社会因素的影响。独特的是，社区暴力是参与巴西的一个重大障碍。结论 CTI-TS 的主要改编是根据圣地亚哥和里约热内卢不同的心理健康系统和社会背景进行的。对这些适应性的用户体验的评估提供了通过为工人配对创建专门角色、针对持续的干预效果和解决社会文化障碍，在该地区实施和扩大任务转移和面向社区的干预措施的见解。