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      Methodological approaches to situational analysis in global mental health: a scoping review

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          Abstract

          Global inequity in access to and availability of essential mental health services is well recognized. The mental health treatment gap is approximately 50% in all countries, with up to 90% of people in the lowest-income countries lacking access to required mental health services. Increased investment in global mental health (GMH) has increased innovation in mental health service delivery in LMICs. Situational analyses in areas where mental health services and systems are poorly developed and resourced are essential when planning for research and implementation, however, little guidance is available to inform methodological approaches to conducting these types of studies. This scoping review provides an analysis of methodological approaches to situational analysis in GMH, including an assessment of the extent to which situational analyses include equity in study designs. It is intended as a resource that identifies current gaps and areas for future development in GMH. Formative research, including situational analysis, is an essential first step in conducting robust implementation research, an essential area of study in GMH that will help to promote improved availability of, access to and reach of mental health services for people living with mental illness in low- and middle-income countries (LMICs). While strong leadership in this field exists, there remain significant opportunities for enhanced research representing different LMICs and regions.

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          Most cited references36

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          The use of triangulation in qualitative research.

          Triangulation refers to the use of multiple methods or data sources in qualitative research to develop a comprehensive understanding of phenomena (Patton, 1999). Triangulation also has been viewed as a qualitative research strategy to test validity through the convergence of information from different sources. Denzin (1978) and Patton (1999) identified four types of triangulation: (a) method triangulation, (b) investigator triangulation, (c) theory triangulation, and (d) data source triangulation. The current article will present the four types of triangulation followed by a discussion of the use of focus groups (FGs) and in-depth individual (IDI) interviews as an example of data source triangulation in qualitative inquiry.
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            Defining equity in health.

            To propose a definition of health equity to guide operationalisation and measurement, and to discuss the practical importance of clarity in defining this concept. Conceptual discussion. Setting, Patients/Participants, and Main results: not applicable. For the purposes of measurement and operationalisation, equity in health is the absence of systematic disparities in health (or in the major social determinants of health) between groups with different levels of underlying social advantage/disadvantage-that is, wealth, power, or prestige. Inequities in health systematically put groups of people who are already socially disadvantaged (for example, by virtue of being poor, female, and/or members of a disenfranchised racial, ethnic, or religious group) at further disadvantage with respect to their health; health is essential to wellbeing and to overcoming other effects of social disadvantage. Equity is an ethical principle; it also is consonant with and closely related to human rights principles. The proposed definition of equity supports operationalisation of the right to the highest attainable standard of health as indicated by the health status of the most socially advantaged group. Assessing health equity requires comparing health and its social determinants between more and less advantaged social groups. These comparisons are essential to assess whether national and international policies are leading toward or away from greater social justice in health.
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              Challenges and Opportunities for Implementing Integrated Mental Health Care: A District Level Situation Analysis from Five Low- and Middle-Income Countries

              Background Little is known about how to tailor implementation of mental health services in low- and middle-income countries (LMICs) to the diverse settings encountered within and between countries. In this paper we compare the baseline context, challenges and opportunities in districts in five LMICs (Ethiopia, India, Nepal, South Africa and Uganda) participating in the PRogramme for Improving Mental health carE (PRIME). The purpose was to inform development and implementation of a comprehensive district plan to integrate mental health into primary care. Methods A situation analysis tool was developed for the study, drawing on existing tools and expert consensus. Cross-sectional information obtained was largely in the public domain in all five districts. Results The PRIME study districts face substantial contextual and health system challenges many of which are common across sites. Reliable information on existing treatment coverage for mental disorders was unavailable. Particularly in the low-income countries, many health service organisational requirements for mental health care were absent, including specialist mental health professionals to support the service and reliable supplies of medication. Across all sites, community mental health literacy was low and there were no models of multi-sectoral working or collaborations with traditional or religious healers. Nonetheless health system opportunities were apparent. In each district there was potential to apply existing models of care for tuberculosis and HIV or non-communicable disorders, which have established mechanisms for detection of drop-out from care, outreach and adherence support. The extensive networks of community-based health workers and volunteers in most districts provide further opportunities to expand mental health care. Conclusions The low level of baseline health system preparedness across sites underlines that interventions at the levels of health care organisation, health facility and community will all be essential for sustainable delivery of quality mental health care integrated into primary care.
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                Author and article information

                Journal
                Glob Ment Health (Camb)
                Glob Ment Health (Camb)
                GMH
                Global Mental Health
                Cambridge University Press (Cambridge, UK )
                2054-4251
                2019
                13 June 2019
                : 6
                : e11
                Affiliations
                [1 ]Department of Psychiatry, University of British Columbia , Vancouver, British Columbia, Canada
                [2 ]Department of Occupational Science and Occupational Therapy, University of Toronto , Toronto, Ontario, Canada
                [3 ]Department of Psychiatry, University of Melbourne , Melbourne, Victoria, Australia
                [4 ]Department of Psychiatry and Health Management & Policy, University of Michigan , Ann Arbor, Michigan, USA
                [5 ]Department of Family Medicine, Boston University , Boston, Massachusetts, USA
                [6 ]Department of Psychiatry and Behavioral Sciences, University of California Davis , Sacramento, California, USA
                [7 ]Department of Psychiatry, University of Alberta , Alberta, Canada
                [8 ]Shanghai CDC for Mental Health , Division of Training and Health Education, Shanghai, China
                [9 ]Department of Psychiatry, University of Toronto , Toronto, Ontario, Canada
                [10 ]Peking University , Institute of Population Research, Beijing, China
                [11 ]Department of Psychiatry, Queen's University , Kingston, Ontario, Canada
                [12 ]Hongkou District Mental Health Center , Shanghai, China
                [13 ]Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine
                Author notes
                [* ]Address for correspondence: J. K. Murphy, Department of Psychiatry, University of British Columbia , Vancouver, British Columbia, Canada. (Email: jill.murphy@ 123456ubc.ca )
                Article
                S2054425119000098 00009
                10.1017/gmh.2019.9
                6582459
                31258925
                34072e55-6183-4cdf-b686-82811e03c594
                © The Author(s) 2019

                This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 11 September 2018
                : 08 April 2019
                : 22 May 2019
                Page count
                Figures: 1, Tables: 5, References: 56, Pages: 13
                Categories
                Other
                Review

                equity,formative research,global mental health,methods,situational analysis

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