Browsing by Author "Susser, Ezra"

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    30 years from the Caracas Declaration: the situation of psychiatric hospitals in Latin America and the Caribbean prior, during and after the COVID-19 pandemic
    (2021) Mascayano, Franco; Alvarado, Rubén; Martínez-Viciana, Carmen; Irarázaval, Matías; Durand-Arias, Sol; Freytes, Marcela; Montenegro Cortés, Cristián; Susser, Ezra; Bruni, Andrea
    Latin America and the Caribbean (LAC) recently celebrated 30 years from the Caracas Declaration, which, in 1990, set forth the principles to transition from hospital-based mental health care into community mental health services [1]. Since then, significant efforts have been made to reduce the number of psychiatric hospital beds, increase mental health teams within general hospitals, integrate mental health into primary care, implement outpatient mental health facilities, and encourage the participation of community members in the provision and implementation of mental health care [2]. Nonetheless, progress has been uneven across countries [2]. Many large psychiatric hospitals (PHs) still exist and consume most of the scanty national mental health budgets [3]. Moreover, PH residents in LAC were poor and socially excluded even before the COVID-19 pandemic hit. The COVID-19 pandemic has worsened the living conditions of these people, especially in resource-constrained settings.
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    A case study of the development of a valid and pragmatic implementation science measure: the Barriers and Facilitators in Implementation of Task-Sharing Mental Health interventions (BeFITS-MH) measure
    (2024) Yang, Lawrence H.; Bass, Judy K.; Le, PhuongThao D.; Singh, Ritika; Gurung, Dristy; Velasco Grandón, Paola Renée; Grivel, Margaux M.; Susser, Ezra; Cleland, Charles M.; Alvarado, Rubén; Kohrt, Brandon A.; Bhana, Arvin
    Background Few implementation science (IS) measures have been evaluated for validity, reliability and utility – the latter referring to whether a measure captures meaningful aspects of implementation contexts. We present a real-world case study of rigorous measure development in IS that assesses Barriers and Facilitators in Implementation of Task-Sharing in Mental Health services (BeFITS-MH), with the objective of offering lessons-learned and a framework to enhance measurement utility. Methods We summarize conceptual and empirical work that informed the development of the BeFITS-MH measure, including a description of the Delphi process, detailed translation and local adaptation procedures, and concurrent pilot testing. As validity and reliability are key aspects of measure development, we also report on our process of assessing the measure’s construct validity and utility for the implementation outcomes of acceptability, appropriateness, and feasibility. Results Continuous stakeholder involvement and concurrent pilot testing resulted in several adaptations of the BeFITS-MH measure’s structure, scaling, and format to enhance contextual relevance and utility. Adaptations of broad terms such as “program,” “provider type,” and “type of service” were necessary due to the heterogeneous nature of interventions, type of task-sharing providers employed, and clients served across the three global sites. Item selection benefited from the iterative process, enabling identification of relevance of key aspects of identified barriers and facilitators, and what aspects were common across sites. Program implementers’ conceptions of utility regarding the measure’s acceptability, appropriateness, and feasibility clustered across several common categories. Conclusions This case study provides a rigorous, multi-step process for developing a pragmatic IS measure. The process and lessons learned will aid in the teaching, practice and research of IS measurement development. The importance of including experiences and knowledge from different types of stakeholders in different global settings was reinforced and resulted in a more globally useful measure while allowing for locally-relevant adaptation. To increase the relevance of the measure it is important to target actionable domains that predict markers of utility (e.g., successful uptake) per program implementers’ preferences. With this case study, we provide a detailed roadmap for others seeking to develop and validate IS measures that maximize local utility and impact.
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    Including culture in programs to reduce stigma toward people with mental disorders in low- and middle-income countries
    (2020) Mascayano, Franco; Toso-Salman, Josefina; Ho, Yu Chak Sunny; Dev, Saloni; Tapia, Thamara; Thornicroft, Graham; Cabassa, Leopoldo J.; Khenti, Akwatu; Sapag, Jaime; Bobbili, Sireesha J.; Alvarado, Ruben; Yang, Lawrence Hsin; Susser, Ezra
    Stigma is one of the main barriers for the full implementation of mental health services in low- and middle-income countries (LMICs). Recently, many initiatives to reduce stigma have been launched in these settings. Nevertheless, the extent to which these interventions are effective and culturally sensitive remains largely unknown. The present review addresses these two issues by conducting a comprehensive evaluation of interventions to reduce stigma toward mental illness that have been implemented in LMICs. We conducted a scoping review of scientific papers in the following databases: PubMed, Google Scholar, EBSCO, OVID, Embase, and SciELO. Keywords in English, Spanish, and Portuguese were included. Articles published from January 1990 to December 2017 were incorporated into this article. Overall, the studies were of low-to-medium methodological quality-most only included evaluations after intervention or short follow-up periods (1-3 months). The majority of programs focused on improving knowledge and attitudes through the education of healthcare professionals, community members, or consumers. Only 20% (5/25) of the interventions considered cultural values, meanings, and practices. This gap is discussed in the light of evidence from cultural studies conducted in both low and high income countries. Considering the methodological shortcomings and the absence of cultural adaptation, future efforts should consider better research designs, with longer follow-up periods, and more suitable strategies to incorporate relevant cultural features of each community.