abstract: 'BackgroundIntegrating evidence-based mental health services into primary

  care has been identified as one strategy for overcoming the treatment

  gap in low and middle-income countries, yet their uptake into standard

  practice remains poor. The purpose of this study was to understand

  stakeholder perspectives regarding barriers and facilitators to

  integration of mental health services into primary care settings in

  Northern Iraq.MethodsUsing a convergent mixed methods study design,

  quantitative and qualitative questionnaires assessed respondent

  perceptions of implementation factors under the domains of Autonomy,

  Acceptability, Appropriateness, Feasibility, Penetration/Accessibility,

  Sustainability, and Organizational Climate. We interviewed four types of

  stakeholders: clients, providers of mental health services, non-mental

  health (MH) staff working at the centers, and center directors.

  Interviews were conducted with clients at the completion of services,

  and with all other stakeholder groups in the latter half of the first

  year of program implementation, by Kurdish-speaking interviewer pairs.

  Qualitative and quantitative data were analyzed separately and merged

  using qualitative data transformation to quantify frequency of theme and

  integrate with quantitative findings through woven narrative.Results123

  clients, 26 providers, 40 non-MH staff, and 12 directors provided data.

  Positive perceptions of the program''s acceptability, appropriateness,

  feasibility, and positive impacts were reported across all stakeholder

  levels. Providers reported that the program length (8-12 sessions) was a

  challenge. Clients described logistical challenges (e.g.:

  transportation, childcare, home duties); support from family and friends

  appeared to be critical. Lack of private space, insufficient staffing,

  and need for greater government support were also important

  issues.ConclusionsThis mixed methods study is unique in its inclusion of

  non-MH staff and director perspectives on integration of mental health

  services in primary care clinics. Their inclusion proved vital since

  they included critical human resource barriers to feasibility. Providers

  reported generally positive integration experiences but that some

  colleagues (clinic staff not involved in mental health services) were

  unsupportive. Most non-MH staff were supportive, but some did report

  negative impacts on their working environment. Future studies of

  integration of mental health services into other service platforms

  should include the perspectives of stakeholders not involved in

  provision of mental health services.'
affiliation: 'Nguyen, AJ (Corresponding Author), Univ Virginia, Curry Sch Educ \&
  Human Dev, Dept Human Serv, Charlottesville, VA 22904 USA.

  Nguyen, Amanda J., Univ Virginia, Curry Sch Educ \& Human Dev, Dept Human Serv,
  Charlottesville, VA 22904 USA.

  Rykiel, Natalie, Johns Hopkins Univ, Sch Med, Div Pulm \& Crit Care, Baltimore,
  MD 21205 USA.

  Murray, Laura; Haroz, Emily, Johns Hopkins Bloomberg Sch Publ Hlth, Dept Mental
  Hlth, Baltimore, MD 21205 USA.

  Amin, Ahmed, Wchan Org Victims Human Rights Violat, Sulaymaniyah, Iraq.

  Amin, Ahmed, Sulaimani Polytech Univ, Tech Coll Hlth, Sulaymaniyah, Iraq.

  Lee, Catherine; Bolton, Paul, Johns Hopkins Bloomberg Sch Publ Hlth, Dept Int Hlth,
  Baltimore, MD 21205 USA.'
author: Nguyen, Amanda J. and Rykiel, Natalie and Murray, Laura and Amin, Ahmed and
  Haroz, Emily and Lee, Catherine and Bolton, Paul
author-email: ajnguyen@virginia.edu
author_list:
- family: Nguyen
  given: Amanda J.
- family: Rykiel
  given: Natalie
- family: Murray
  given: Laura
- family: Amin
  given: Ahmed
- family: Haroz
  given: Emily
- family: Lee
  given: Catherine
- family: Bolton
  given: Paul
da: '2023-09-28'
doi: 10.1186/s13033-019-0330-7
files: []
issn: 1752-4458
journal: INTERNATIONAL JOURNAL OF MENTAL HEALTH SYSTEMS
keywords: Mental health; Implementation; Iraq; Primary care
keywords-plus: 'INCOME; ACCEPTABILITY; INTERVENTIONS; FEASIBILITY; DEPRESSION;

  KURDISTAN; ISSUES; IMPACT'
language: English
month: DEC 28
number: '1'
number-of-cited-references: '52'
papis_id: 7b842faee3eb84516f7f57539c107768
ref: Nguyen2019stakeholderperspecti
times-cited: '5'
title: 'Stakeholder perspectives on integration of mental health services into primary
  care: a mixed methods study in Northern Iraq'
type: Article
unique-id: WOS:000513509700001
usage-count-last-180-days: '1'
usage-count-since-2013: '3'
volume: '13'
web-of-science-categories: Psychiatry
year: '2019'