Melbourne School of Population and Global Health - Theses
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ItemA Cultural Adaptation of the World Health Organization’s Mental Health Gap Intervention Guide for use in Community Healthcare Centres, in Shenzhen, China( 2022-11)Over the last decade, China has instigated substantive national health system reform and established a new primary healthcare sector. Shenzhen, China’s flagship of innovation, rapidly developed a network of Community Healthcare Centres (CHC), doubled its medical workforce and now aspires to provide high quality person-centred care. Newly appointed doctors, however, have received limited mental health training and are insufficiently equipped to identify and manage depression. Against a backdrop of high depression prevalence and limited mental health literacy, most depression cases continue to go undetected and untreated. The World Health Organization’s (WHO) Mental Health Gap Intervention Guide (mhGAP- IG.v2), is a decision-support tool for non-specialists, to support assessment, management and follow-up of priority mental, neurological and substance use disorders, including depressive disorder. mhGAP-IG.v2 offers CHCs an evidence-based training resource, however, it requires adaptation to take account of China’s unique healthcare system and cultural context for mental health services. This PhD study is the first in China to involve primary healthcare in the adaptation of the depression component of mhGAP-IG.v2 for the community healthcare context. Designed as a mixed-methods study, it applies the Theoretical Domains Framework (TDF), innovative mental health workshops and the Delphi approach to: 1) explore the current barriers and enablers to depression care in the CHC setting; 2) to compare the mhGAP-IG.v2 against the current clinical practice; and 3) to elicit consensus among primary care doctors to inform the adaption of mhGAP-IG.v2. This research presents the proposed adaptation of mhGAP-IG.v2 for each step of assessment, management, and follow-up of depression. Proposed adaptations include: modifications of the format and content of symptom listings to reflect the cultural nuances; country-specific healthcare priorities and a life course approach for primary care; restructuring of the management section to better reflect CHC role as a key coordinator of intersectoral care; and full replacement of the follow-up section with action-oriented templates for a mental health treatment plan and follow-up review summary to support patient-centred care. Supplementary charts provide additional guidance for person-centred enquiry, the use of assessment instruments and managing patient information. Family members are incorporated as a vital resource to care. Increased attention to suicidal risk is emphasised throughout. The final form of the adapted depression component of mhGAP-IG.v2 will require further development and input from multiple stakeholders at local and national level.