Cat Fung and Professor Stefan Priebe, Principal Investigator, with the research team in Colombia in November 2017.

我们如何为低成本健康状况的人们（LMICS）提供低成本和可持续的干预措施，在那里通常有限的资金和服务来提供专业的心理健康服务？这对于满足Sustainable Development Goalsaround health, specifically 3.4 which targets promoting mental health and wellbeing.

Instead of establishing new and expensive services for people with severe mental illnesses, we refined and tested interventions that use already existing resources in relationships with healthcare professionals (DIALOG+, an approach to make routine meetings effective), in families (multi-family groups) and in communities (befriending through volunteers).

我们在四大洲六个国家 /地区的研究表明，这些干预措施是可行的，对患者有利和有益。因此，以资源为导向的干预措施提出了一种现实的选择，可以改善LMIC中患有严重精神疾病的人的护理。

Background

精神疾病给受影响个人带来巨大困扰的社会带来了重大负担，卫生服务的成本很高。在LMIC中，由于缺乏人力和财务资源来为受精神疾病影响的人们提供专门的心理保健服务，这可能会使情况变得更糟。以资源为导向的方法支持患者从自己内部的现有资源以及与家人，朋友和社区的关系中吸收的方法，可以帮助人们克服精神障碍的困扰并在低资源环境中可持续实施。

NIHR全球卫生研究小组开发心理保健的心理心理干预措施（the GLOBE study) explored how three resource-oriented interventions could be used to support mental health care in six LMICs.

1. 对话框+is an intervention delivered on a tablet computer which is designed to make routine meetings between patients and mental health professionals therapeutically effective.
2. 多户家庭团体将几个患者，他们的家人或朋友和医疗保健专业人员组合在一起，通过分享支持和经验来促进相互学习。
3. 志愿者与链接成为与个别患者或小组中的无薪志愿者联系，以提供心理，实践和社会支持。

如何进行研究

We conducted 13 studies incorporating both randomized controlled trials (RCTs), open controlled trials and open non-controlled trials in six countries: Argentina, Bosnia-Herzegovina, Colombia, Pakistan, Peru and Uganda. The interventions were all delivered over a period of 6 months, with the option to receive a further 6 months of flexible sessions in Bosnia and Herzegovina, Colombia and Uganda. Both quantitative and qualitative data were collected to explore whether the interventions were effective, feasible and acceptable to participants.

An additional three 3-month non-controlled studies were conducted in Bosnia and Herzegovina, Colombia and Uganda and recruited 117 patients from primary care clinics with chronic physical conditions. The results showed significant improvements with large effects on quality of life and symptoms of anxiety and depression after three monthly meetings.

关键发现

改善生活质量：

• 在至少6个月内接受三项干预措施之一的参与者报告了更好的主观生活质量。

减少症状：

• Most countries saw a reduction in psychological symptoms after participants received one of the three interventions.
• 在接受多户家庭干预的患者中，波斯尼亚和黑塞哥维那和哥伦比亚的院前化率降低了。

Feasibility and acceptability:

• 所有干预措施都能以最少的培训成功地以无效的成本成功实施。
• 在阿根廷，由于持续的COVID-19限制，对话框+是远程交付的，这被证明是一种可行且可接受的干预方式。
• Intervention sessions were generally well attended and positively experienced by participants, who reported that they boosted self-esteem (DIALOG+), reduced stigma (Volunteer Befriending), and were a safe space to allow for shared learning (Multi-family Groups).

Conclusions

Resource-oriented interventions are a feasible and effective treatment for patients with mental illnesses in a range of resource-limited contexts. Whilst all interventions were beneficial, their precise effect varied and some interventions made a substantial difference to the quality of life of patients, much larger than seen in studies conducted in higher-income countries. DIALOG+, Multi-family Groups and Volunteer Befriending are all scalable solutions. They are less resource-intensive than other interventions as they are low-cost, require minimal training to implement and do not require specialized services. DIALOG+ is able to be delivered remotely, which can be beneficial in situations limiting mobility, for example, any future restrictions imposed by the COVID-19 pandemic. Further research is required to assess how the interventions may be scaled up in other LMICs with similar settings.

Links to further information

Please visit the project website for more information on the partners, activities, and outputs, including all scientific publications:https://www.qmul.ac.uk/nihr-ghrg/

For more information and to access the DIALOG+ intervention:https://www.elft.nhs.uk/dialog

对话框+ Globe动画视频：https://youtu.be/h1kxj_gsx4y

ISRCTN注册该博客指的是：

Bosnia and Herzegovina:

1. ISRCTN13347129：在波斯尼亚和黑塞哥维那进行的一项研究，以测试一种称为对话+的干预措施，旨在改善患有严重精神疾病社区中的人们的护理
2. ISRCTN51290984：波斯尼亚和黑塞哥维那的一项研究，以测试一种名为志愿者支持的干预措施，旨在改善患有严重精神疾病社区中的人们的护理
3. ISRCTN1347355：波斯尼亚和黑塞哥维那的一项研究，以测试家庭参与干预措施，旨在改善患有严重精神疾病社区中的人们的护理
4. ISRCTN17003451: A research study in Bosnia and Herzegovina to test the acceptability and feasibility of an intervention called DIALOG+, adapted to improve care for people in primary care with poor physical and mental health

Colombia:

1. ISRCTN83333181: A research study in Colombia to test an intervention called DIALOG+, designed to improve care for people living in the community with severe mental illness.
2. ISRCTN72241383: A research study in Colombia to test an intervention called Volunteer Support, designed to improve care for people living in the community with severe mental illness
3. ISRCTN11440755: A research study in Colombia to test a Family Involvement intervention, designed to improve care for people living in the community with severe mental illness
4. ISRCTN14018729: A research study in Colombia to test the acceptability and feasibility of an intervention called DIALOG+, adapted to improve care for people in primary care with poor physical and mental health

乌干达：

1. ISRCTN25146122: A research study in Uganda to test an intervention called DIALOG+, designed to improve care for people living in the community with severe mental illness
2. ISRCTN78948497: A research study in Uganda to test a Family Involvement intervention, designed to improve care for people living in the community with severe mental illness
3. ISRCTN86689958: A research intervention in Uganda to test an intervention called Volunteer Support, designed to improve care for people living in the community with severe mental illness
4. ISRCTN50335796：乌干达的一项研究，以测试称为Dialog+的干预措施的可接受性和可行性，旨在改善身体和心理健康不良的初级保健人员的护理

Argentina:

1. ISRCTN38851969: A research study in Argentina to test an intervention called DIALOG+ designed to improve care for people living in the community with severe mental illness

秘鲁：

1. ISRCTN38360953:研究在秘鲁来测试一个干预called DIALOG+ designed to improve care for people living in the community with severe mental illness

Pakistan:

1. ISRCTN14528579:一个interven在巴基斯坦的研究来测试tion called DIALOG+, designed to improve care for people living in the community with common mental disorders
2. ISRCTN12299326: A research study in Pakistan to test a family involvement intervention, designed to improve care for people living in the community with common mental health conditions

Acknowledgement

This research was funded by the National Institute for Health and Care Research (NIHR) (NIHR Global Health Group on Developing Psycho-Social Interventions) grant number 16/137/97, using UK aid from the UK Government to support global health research. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the UK Department of Health and Social Care.