[Mental Health Gap Action Programme: a theoretical model of barriers to implementation by health personnel in Chocó, ColombiaPrograma de Ação para Reduzir as Lacunas em Saúde Mental: modelo teórico das barreiras de implementação por profissionais de saúde de Chocó, Colômbia]. / Programa de acción para superar las brechas en salud mental: un modelo teórico de las barreras de implementación desde el personal de salud en Chocó, Colombia.

Objectives: Mental, neurological, and substance use (MNS) disorders have a high prevalence in Colombia and there is a treatment gap. The World Health Organization (WHO) Mental Health Gap Action Programme (mhGAP) has various components. The mhGAP 2.0 Intervention Guide, aimed at improving primary health care, is a guide for the assessment and management of MNS disorders based on clinical decision-making protocols. The objective of this study was to determine the barriers that may hinder the program implementation process. Methods: A qualitative study with content analysis was conducted in three phases: i) study preparation, organization, and presentation; ii) open coding, categorization, and abstraction of contents; and iii) information analysis. The study included semi-structured interviews with 21 people involved in the provision of mental health services in Chocó (Colombia): five medical doctors, seven nurses, and three psychologists, as well as six professionals working in the administrative area of the department's health secretariats. The perceptions of these stakeholders were explored. Open-ended questions were asked to explore experiences with the process, as well as the barriers identified in practice. Results: Four different thematic categories were identified: intersectoral action, long-standing challenges, opportunities, and suitability of tools. Conclusions: A theoretical model of barriers to implementation of the mhGAP program was constructed, based on stakeholder perceptions. Controlling barriers is perceived as a possible way to contribute significantly to population health.

Objetivo: Os transtornos mentais, neurológicos e por uso de substâncias psicoativas são muito prevalentes, e há uma lacuna na atenção a esses transtornos na Colômbia. O Programa de Ação para Reduzir as Lacunas em Saúde Mental (mhGAP, na sigla em inglês) da Organização Mundial da Saúde (OMS) consta de vários componentes. Um deles é o Manual de Intervenções mhGAP 2.0, elaborado para aprimorar a atenção primária à saúde. O documento contém orientações para avaliação e manejo de transtornos mentais, neurológicos e por uso de substâncias psicoativas e foi elaborado com base em protocolos para a tomada de decisões clínicas. O objetivo do estudo foi determinar as barreiras que podem surgir no processo de implementação do programa. Métodos: Estudo qualitativo com enfoque de análise de conteúdo desenvolvido em três fases: i) preparação, organização e apresentação do estudo; ii) codificação aberta, categorização e abstração do conteúdo; e iii) análise das informações. O estudo incluiu entrevistas semiestruturadas com 21 pessoas envolvidas na prestação de serviços de saúde mental em Chocó (Colômbia): cinco profissionais da medicina, sete de enfermagem e três de psicologia, bem como seis profissionais que trabalham na área administrativa das secretarias de saúde do departamento. As percepções das partes interessadas, ou seja, do pessoal assistencial e administrativo do setor de saúde no departamento de Chocó, foram exploradas. Foram feitas perguntas abertas a fim de investigar suas experiências com o processo de atenção e as barreiras identificadas na prática. Resultados: Foram identificadas quatro categorias temáticas: intersetorialidade, desafios de longa data, possibilidades e adequação das ferramentas. Conclusões: Elaborou-se um modelo teórico sobre as barreiras de implementação do Programa mhGAP com base nas percepções das partes interessadas. O controle das barreiras é visto como uma possível forma de contribuir significativamente para a saúde da população.

Programa de acción para superar las brechas en salud mental: un modelo teórico de las barreras de implementación desde el personal de salud en Chocó, Colombia / Mental Health Gap Action Programme: a theoretical model of barriers to implementation by health personnel in Chocó, Colombia / Programa de Ação para Reduzir as Lacunas em Saúde Mental: modelo teórico das barreiras de implementação por profissionais de saúde de Chocó, Colômbia

[RESUMEN]. Objetivo. Los trastornos mentales, neurológicos y por consumo de sustancias psicoactivas (MNS) tienen una prevalencia alta y existe una brecha para su atención en Colombia. El Programa de acción para superar las brechas en salud mental (mhGAP, por su sigla en inglés) de la Organización Mundial de la Salud (OMS) tiene varios componentes. Uno de ellos es la Guía de intervención mhGAP 2.0, orientada a la mejora de la atención primaria en salud; se trata de una guía para la evaluación y el manejo de trastornos MNS a partir de protocolos de toma de decisiones clínicas. Se planteó como objetivo determinar las barreras que se pueden presentar en el proceso de implementación del programa. Métodos. Se realizó un estudio cualitativo con enfoque de análisis de contenido que se desarrolló en tres fases: i) preparación, organización y presentación del estudio; ii) codificación abierta, categorización y abs- tracción de los contenidos; y iii) análisis de información. El estudio incluyó la entrevista semiestructurada a 21 personas involucradas en la prestación de servicios en salud mental en Chocó (Colombia): cinco profesionales de medicina, siete de enfermería y tres de psicología, además seis profesionales que trabajaban en el área administrativa de las secretarías de salud del departamento. Se exploraron las percepciones de las partes interesadas, que eran el personal asistencial y el personal administrativo del sector salud en el departamento del Chocó. Se realizaron preguntas abiertas para explorar las experiencias con el proceso y las barreras identificadas en la práctica. Resultados. Se identificaron cuatro categorías temáticas diferentes: intersectorialidad, viejos desafíos, posibilidades e idoneidad de herramientas. Conclusiones. Se construyó un modelo teórico sobre las barreras de implementación para el Programa de mhGAP desde las percepciones de las partes interesadas. El control de las barreras se percibe como un camino posible para generar un aporte significativo para la salud poblacional.

[ABSTRACT]. Objectives. Mental, neurological, and substance use (MNS) disorders have a high prevalence in Colombia and there is a treatment gap. The World Health Organization (WHO) Mental Health Gap Action Programme (mhGAP) has various components. The mhGAP 2.0 Intervention Guide, aimed at improving primary health care, is a guide for the assessment and management of MNS disorders based on clinical decision-making protocols. The objective of this study was to determine the barriers that may hinder the program implementation process. Methods. A qualitative study with content analysis was conducted in three phases: i) study preparation, organization, and presentation; ii) open coding, categorization, and abstraction of contents; and iii) information analysis. The study included semi-structured interviews with 21 people involved in the provision of mental health services in Chocó (Colombia): five medical doctors, seven nurses, and three psychologists, as well as six professionals working in the administrative area of the department's health secretariats. The perceptions of these stakeholders were explored. Open-ended questions were asked to explore experiences with the process, as well as the barriers identified in practice. Results. Four different thematic categories were identified: intersectoral action, long-standing challenges, opportunities, and suitability of tools. Conclusions. A theoretical model of barriers to implementation of the mhGAP program was constructed, based on stakeholder perceptions. Controlling barriers is perceived as a possible way to contribute significantly to population health.

[RESUMO]. Objetivo. Os transtornos mentais, neurológicos e por uso de substâncias psicoativas são muito prevalentes, e há uma lacuna na atenção a esses transtornos na Colômbia. O Programa de Ação para Reduzir as Lacunas em Saúde Mental (mhGAP, na sigla em inglês) da Organização Mundial da Saúde (OMS) consta de vários componentes. Um deles é o Manual de Intervenções mhGAP 2.0, elaborado para aprimorar a atenção primária à saúde. O documento contém orientações para avaliação e manejo de transtornos mentais, neurológicos e por uso de substâncias psicoativas e foi elaborado com base em protocolos para a tomada de decisões clínicas. O objetivo do estudo foi determinar as barreiras que podem surgir no processo de imple- mentação do programa. Métodos. Estudo qualitativo com enfoque de análise de conteúdo desenvolvido em três fases: i) preparação, organização e apresentação do estudo; ii) codificação aberta, categorização e abstração do conteúdo; e iii) análise das informações. O estudo incluiu entrevistas semiestruturadas com 21 pessoas envolvidas na prestação de serviços de saúde mental em Chocó (Colômbia): cinco profissionais da medicina, sete de enfermagem e três de psicologia, bem como seis profissionais que trabalham na área administrativa das secretarias de saúde do departamento. As percepções das partes interessadas, ou seja, do pessoal assisten- cial e administrativo do setor de saúde no departamento de Chocó, foram exploradas. Foram feitas perguntas abertas a fim de investigar suas experiências com o processo de atenção e as barreiras identificadas na prática. Resultados. Foram identificadas quatro categorias temáticas: intersetorialidade, desafios de longa data, possibilidades e adequação das ferramentas. Conclusões. Elaborou-se um modelo teórico sobre as barreiras de implementação do Programa mhGAP com base nas percepções das partes interessadas. O controle das barreiras é visto como uma possível forma de contribuir significativamente para a saúde da população.

PACES: a primary care tool to detect mental health disorders in Indigenous Colombians.

INTRODUCTION: The aim of this research was to present the process of intercultural creation and validation, in addition to the analysis of the psychometric properties of the Parenting, Behavior, Emotions and Suicide risk scale. METHODS: A cross-sectional study, cultural adaptation and validation with an ethnic approach were carried out by expert judges in mental health; subsequently, the instrument was applied, and a factorial analysis was carried out, and it was established that there was agreement between the instrument results and two expert perspectives regarding spiritual disharmony. The sample consisted of 168 families of children and young people (54.8% women, 45.2% men), with a mean age of 11.2 years, in Colombia. Regarding the geographical location, 44% were from Guajira, 44.6% were from Nariño and 11.3% were from Vaupés, from the Wayuu, Awá and Emberá communities, respectively. RESULTS: The scale showed high reliability (Chronbach's α=0.911), and in the factorial analysis the following parenting domains were formed from the parents: involvement, monitoring and bond, from boys, girls and young people; suicidal risk perceived by caregivers and perceived by children and young people; in addition to a total mental health risk. The questions that inquired about hallucinations and seizures did not show grouping in any factor, and two questions were eliminated. Similarly, a high inter-rater concordance was shown, with a higher Cohen's κ coefficient for all domains. CONCLUSION: There are few intercultural and early detection studies of parenting and mental health problems in children and youth that have an ethnic approach. It is observed that the instrument serves as a means of monitoring mental health issues in children and adolescents, as well as the parenting practices employed in their socialization, from both the perspective of caregivers and the young individuals themselve. This study indicates that the scale is an adequate tool, quick and easy to administer in first-level care settings.

Vulnerability factors in conflict-related mental health.

INTRODUCTION: Societies marked by armed conflict face huge challenges in mental health care provision due to lowered resources and destruction of infrastructure along with an increased need for care. This especially affects the vulnerable groups already facing bigger challenges in terms of higher disease burden and limited access to care. AIM: To examine how the association between conflict-related trauma and mental health is affected by different factors affecting the individual's vulnerability, and to address the provision of and barriers in access to mental health services in conflict and post-conflict contexts. MATERIALS AND METHODS: Scoping literature review based on a focused literature search in PubMed and DIGNITY Documentation Centre and Library. RESULTS: Population mental health may be affected by violence and by general hardship by (1) causing new mental health conditions, predominantly PTSD, depression and anxiety, and (2) exacerbating pre-existing mental health conditions. Violence, stigmatization, social and physical capital, gender and access to health care were identified as the main vulnerability factors affecting the association between conflict and mental health conditions. DISCUSSION AND CONCLUSION: The associations between violence, vulnerability and mental health might be overlapping and multi-directed. Vulnerability is considered an effect-modifier on the associations between conflict/trauma and mental health.

Traducción y adaptación de la Escala de Continuidad de Servicios de Salud Mental de Alberta en un contexto latinoamericano

Introducción: La continuidad de atención es considerada como un proceso que involucra una atención ordenada, un movimiento ininterrumpido de personas entre los diversos elementos del sistema de prestación de servicios. No existe evidencia suficiente en cuanto a instrumentos de medición en Iberoamérica. Por lo anterior, el objetivo del presente estudio consiste en describir el proceso de traducción, adaptación cultural a un contexto latinoamericano, así como la consistencia interna y validez de constructo de la Escala de Continuidad de Servicios de Salud Mental de Alberta (ACSS-MH). Método: Este instrumento fue sometido a la evaluación de validez de contenido por expertos y este fue aplicado a una población rural en un contexto colombiano. Se realizaron pruebas de consistencia interna y validez de constructo para cada una de las partes de la escala. Resultados: Bajo el consenso del experto, se realizan cambios en algunos ítems, buscando una mejor adaptabilidad del instrumento a las características lingüísticas del español, sin perder de vista el objetivo de evaluación de cada uno de los ítems del cuestionario original. El resultado del análisis de la parte A convergió en 5 componentes que explican el 69,69% de la varianza con 24 ítems; de igual forma, el análisis de la parte B agrupó 13 ítems en cuatro componentes, los cuales explican el 72.02% de la varianza. Conclusiones: este instrumento podría ser implementado para mejorar la prestación de los servicios en salud mental en contextos latinoamericanos, donde la continuidad del cuidado ha presentado importantes dificultades.

Objective: Describe the process of translation, cultural adaptation to Colombia, as well as the internal consistency and construct validity of the Alberta Continuity of Services Scale for Mental Health (ACSS-MH). Methods: This instrument was subdued to the evaluation of validity of the content by experts and this was applied to a rural population in a Colombian context. Were performed tests of internal consistency and construct validity for each of the parts of the scale. Results: Under the consensus of the expert, it is made changes on some items, looking for a better adaptability of the instrument to the linguistic characteristics of Spanish, without losing sight of the evaluation objective of each one of the items on the original questionnaire. The result of the analysis of part A converged in 5 components that explain the 69.69% of the variance with 24 Items; Similarly, the analysis of part B grouped 13 items into four components, which explain the 72.02% of the variance. Discussion: This scale could be implemented to improve the provision of mental health services in Latin American contexts, where continuity of care has presented significant difficulties.

Exploración de las características psicométricas del inventario de estrés ocupacional - OSI para el contexto colombiano / Exploration of the psychometric characteristics of the inventory of occupational stress - OSI for the Colombian context

Resumen Objetivo: Brindar una herramienta en el contexto colombiano que permita evaluar el estrés desde una perspectiva de afrontamiento, se busca explorar las características psicométricas del inventario de estrés ocupacional-OSI. Método: El diseño utilizado fue transversal de tipo descriptivo - correlacional. Para este fin, respondieron el cuestionario 500 adultos trabajadores (hombres y mujeres) de empresas públicas y privadas de Colombia, con edades entre los 17 y 71 años. Se ana lizaron las propiedades psicométricas relacionadas con la dificultad y discriminación de los ítems a través de la prueba t, la confiabilidad a través del coeficiente de Cronbach y la validez factorial mediante un análisis de máxima verosimilitud con rotación varimax. Resultados: Indican que el inventario de estrés ocupacional-OSI posee alta confiabilidad (a = 0.88) y homogeneidad parcial en las escalas y subescalas que componen el instrumento, las cuales explican el 43 % de la varianza total en el comportamiento del estrés ocupacional. Conclusión: El inventario de estrés ocupacional-OSI es una herramienta potencialmente útil para evaluar el estrés en población colombiana.

Abstract Objective: To provide a tool that allows stress evaluation from a coping perspective to explore the psychometric characteristics of the occupational stress-OSI in Colombian context. Method: A de scriptive cross - sectional design - correlational. For exploring the psychometric characteristics of the occupational stress-OSI, 500 adult male workers, between 17 and 71 years of age from public and private companies in Colombia were sampled through a questionnaire. The psychometric properties related to the difficulty and discrimination of the items through the T- test, the reli ability through the Cronbach coefficient and the factorial validity through a maximum likelihood analysis with varimax rotation. Results: The occupational stress-OSI inventory has high reliability (a = 0.88) and partial homogeneity in the scales and subscales that make up the instrument, which explain 43 % of the total variance in the behavior of occupational stress. Conclusion: The occupational stress inventory-OSI is a potentially useful tool to evaluate stress in the Colombian population.

Validación del programa de intervención para el consumo abusivo de alcohol: pactos por la vida / Validation of an intervention program against alcohol abuse: pacts for life

Resumen El objetivo de este estudio era evaluar los alcances de la aplicación del programa de prevención del consumo abusivo y la dependencia alcohólica "Pactos por la Vida" propuesto por Flórez-Alarcón y Vélez (2012), en la modificación de factores asociados al consumo de drogas en un Municipio Pequeño. Los instrumentos usados para la evaluación cuantitativa y cualitativa de los alcances del programa fueron: entrevista en profundidad, diarios de campo, mapeo, encuestas y registros de observación directa. Se realizaron análisis cualitativos del material obtenido y comparaciones de medias de las medidas asociadas con el consumo de alcohol; además de incluir un cuadro de análisis de la eficacia del programa. Se concluye que la estrategia es probablemente efectiva, y que en su aplicación a Municipios pequeños requiere de un ajuste.

Abstract The aim of this study was to assess the scope of the implementation of the "Pacts for Life" program, designed to prevent alcohol abuse and dependence (Flórez-Alarcón & Velez, 2012), in modifying factors associated to drug use in a small municipality. Instruments used for the quantitative and qualitative assessment were: in-depth interview, field notes, mapping, surveys and direct observation records. Qualitative analysis of the material obtained and comparison of means of measurements associated with alcohol consumption were performed; and an analysis of the effectiveness of the program is included. We conclude that the strategy is probably effective, and that its application to small municipalities requires adjustment.