[R01] A type II hybrid implementation-effectiveness study of BECOME (BEhavioral Community-based COmbined Intervention for MEntal Health and Noncommunicable Diseases) delivered by community health workers
Ente: National Institute of Mental Health
Scadenza: 2028-04-30
Importo max: 631.957 EUR
Paese: US
Descrizione
Project Abstract
Common mental health disorders (CMDs), like depression and anxiety, and non-communicable
diseases (NCDs), like diabetes and hypertension, are highly prevalent and are the leading causes of death and
disability worldwide, especially in low-resource settings like our research site in Nepal. Comorbidity among
CMDs and NCDs is high and the relationship between these conditions is complex and multidirectional.
Several common behavioral risk factors worsen both conditions: stress, isolation, tobacco use, low physical
activity, low quality diet, and poor treatment adherence. Behavioral interventions can address these common
risk factors, and improve CMDs and NCDs. The World Health Organization's (WHO) two clinical protocols for
CMDs and NCDs recommend three behavioral interventions: a) evidence-based stress reduction (EBSR) for
stress/anxiety; b) behavioral activation (BA) for depression; and c) motivational interviewing (MI) for healthy
behaviors. Despite this potential, these interventions are rarely available in low-resource settings because of
two important gaps: 1) behavioral interventions have often been studied for one or two CMDs and NCDs,
rather than for the real-world need of an integrated intervention to simultaneously address multiple CMDs and
NCDs; and 2) these interventions have not been studied using implementation strategies that can support easy
access (i.e., making care available at or near the patient's home) and sustained implementation in real-world
settings. Based on our extensive history and long-term commitment to working in Nepal, we now propose a
hybrid implementation-effectiveness study of BECOME (BEhavioral Community-based COmbined Intervention
for MEntal Health and Noncommunicable Diseases) delivered by community health workers (CHWs) in Nepal.
Our team has a long-standing history of conducting implementation research, integrating evidence-
based care for CMDs and NCDs into existing health-care systems in Nepal, training CHWs to deliver
behavioral interventions at or near patient's homes, and conducting costing analysis. We have an extensive
history of collaborating with the Government of Nepal and have a deep understanding of social norms and
cultural factors that drive sustained healthcare delivery. The proposed study has three aims to address the
gaps identified above: Aim 1) assess the effectiveness of BECOME on depression, anxiety, and two NCDs via
a stepped-wedge cluster randomized trial (20 geographic clusters) and participants (n=600) with at least one
CMD and one NCD; Aim 2) assess implementation outcomes of BECOME using the Reach, Effectiveness,
Adoption, Implementation, and Maintenance (RE-AIM) framework at the patient, provider, and health system
levels; and Aim 3) conduct a comprehensive costing analysis to provide strategic inputs to support long-term
scale-up of BECOME. If successful, this study will provide evidence and a blueprint to the governments of
Nepal and other low-resource settings
Istituzione: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
PI: Bibhav Acharya, Sabitri Sapkota
Progetto: 5R01MH133231-04
Settori: National Institute of Mental Health
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