Browsing by Author "Sapag, Jaime C."

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    A Cluster Randomized Controlled Trial Exploring Stigmatization and Recovery-Based Perspectives on Mental Illness and Substance Use Problems Among Primary Healthcare Providers in Toronto, Ontario
    (2023) Khenti, Akwatu; Bobbili, Sireesha J.; Lentinello, Emily; Sapag, Jaime C.; van der Maas, Mark; Sanches, Marcos; Agic, Branka; Hamilton, Hayley; Patten, Scott; Stuart, Heather; Corrigan, Patrick
    Stigma toward mental health and substance use problems (MHSUP) represents a global public health challenge that undermines the quality of mental health care. This study looked at whether an anti-stigma intervention would result in a significant decrease in stigmatizing and discriminatory attitudes among Community Health Center (CHC) staff toward individuals with MHSUP, as well as clients' experiences of MHSUP stigma with CHC staff. A study in 6 CHCs in Toronto employed a cluster-randomized trial to determine the efficacy of an anti-stigma intervention toward people with MHSUP by CHC staff. Participants included 395 staff and 90 clients across 4 waves of the study. The study employed mixed effect models to test for differences between intervention sites and control sites over time. Mixed effects regressions show significantly better improvements in stigma scales among staff in the experimental sites, suggesting the intervention was successful in improving attitudes among CHC staff toward people with MHSUP. Three of the 6 interactions for staff and 2 of 4 interactions among clients indicated that the interventions beneficially affected stigma. The quantitative data with clients was not strong in finding a reduction in stigma. This tested innovative intervention may contribute to the development of effective anti-stigma initiatives for MHSUP in primary care worldwide.
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    Capital social y promoción de la salud en América Latina
    (REVISTA DE SAUDE PUBLICA, 2007) Sapag, Jaime C.; Kawachi, Ichiro
    Latin America faces common development and health problems and equity and overcoming poverty are crucial in the search for comprehensive and high impact solutions. The article analyzes the definition of social capital, its relationship with health, its limitations and potentialities from a perspective of community development and health promotion in Latin America. High-priority challenges are also identified as well as possible ways to better measure and to strengthen social capital. Particularly, it is discussed how and why social capital may be critical in a global health promotion strategy, where empowerment and community participation, interdisciplinary and intersectorial work would help to achieve Public Health aims and a sustainable positive change for the global development. Also, some potential limitations of the social capital concept in the context of health promotion in Latin America are identified.
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    Cost of implementing the Quality Rights programme in public hospitals in Gujarat providing mental healthcare
    (2023) Chatterjee, Susmita; Pathare, Soumitra; Funk, Michelle; Drew-Bold, Natalie; Das, Palash; Chauhan, Ajay; Kalha, Jasmine; Krishnamoorthy, Sadhvi; Sapag, Jaime C.; Bobbili, Sireesha J.; Shah, Sandip; Mehta, Ritambhara; Patel, Animesh; Gandhi, Upendra; Tilwani, Mahesh; Shah, Rakesh; Sheth, Hitesh; Vankar, Ganpat; Parikh, Minakshi; Parikh, Indravadan; Rangaswamy, Thara; Bakshy, Amritkumar; Khenti, Akwatu
    Background & objectives: Investment in mental health is quite meagre worldwide, including in India. The costs of new interventions must be clarified to ensure the appropriate utilization of available resources. The government of Gujarat implemented QualityRights intervention at six public mental health hospitals. This study was aimed to project the costs of scaling up of the Gujarat QualityRights intervention to understand the additional resources needed for a broader implementation.
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    COVID-19 and resilience of healthcare systems in ten countries
    (2022) Arsenault, Catherine; Gage, Anna; Kim, Min Kyung; Kapoor, Neena R.; Akweongo, Patricia; Amponsah, Freddie; Aryal, Amit; Asai, Daisuke; Awoonor-Williams, John Koku; Ayele, Wondimu; Bedregal, Paula; Doubova, Svetlana, V; Dulal, Mahesh; Gadeka, Dominic Dormenyo; Gordon-Strachan, Georgiana; Mariam, Damen Haile; Hensman, Dilipkumar; Joseph, Jean Paul; Kaewkamjornchai, Phanuwich; Eshetu, Munir Kassa; Gelaw, Solomon Kassahun; Kubota, Shogo; Leerapan, Borwornsom; Margozzini, Paula; Mebratie, Anagaw Derseh; Mehata, Suresh; Moshabela, Mosa; Mthethwa, Londiwe; Nega, Adiam; Oh, Juhwan; Park, Sookyung; Passi-Solar, Alvaro; Perez-Cuevas, Ricardo; Phengsavanh, Alongkhone; Reddy, Tarylee; Rittiphairoj, Thanitsara; Sapag, Jaime C.; Thermidor, Roody; Tlou, Boikhutso; Guinez, Francisco Valenzuela; Bauhoff, Sebastian; Kruk, Margaret E.
    Declines in health service use during the Coronavirus Disease 2019 (COVID-19) pandemic could have important effects on population health. In this study, we used an interrupted time series design to assess the immediate effect of the pandemic on 31 health services in two low-income (Ethiopia and Haiti), six middle-income (Ghana, Lao People's Democratic Republic, Mexico, Nepal, South Africa and Thailand) and high-income (Chile and South Korea) countries. Despite efforts to maintain health services, disruptions of varying magnitude and duration were found in every country, with no clear patterns by country income group or pandemic intensity. Disruptions in health services often preceded COVID-19 waves. Cancer screenings, TB screening and detection and HIV testing were most affected (26-96% declines). Total outpatient visits declined by 9-40% at national levels and remained lower than predicted by the end of 2020. Maternal health services were disrupted in approximately half of the countries, with declines ranging from 5% to 33%. Child vaccinations were disrupted for shorter periods, but we estimate that catch-up campaigns might not have reached all children missed. By contrast, provision of antiretrovirals for HIV was not affected. By the end of 2020, substantial disruptions remained in half of the countries. Preliminary data for 2021 indicate that disruptions likely persisted. Although a portion of the declines observed might result from decreased needs during lockdowns (from fewer infectious illnesses or injuries), a larger share likely reflects a shortfall of health system resilience. Countries must plan to compensate for missed healthcare during the current pandemic and invest in strategies for better health system resilience for future emergencies.
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    Developing and Testing an Evaluation Framework for Collaborative Mental Health Services in Primary Care Systems in Latin America
    (2024) Sapag, Jaime C.; Mancevski, Alexander; Perry, Andres; Norman, Cameron D.; Barnsley, Jan; Ferris, Lorraine E.; Rush, Brian
    To develop and pilot-test a feasible and meaningful evaluation framework to support the ongoing improvement and performance measurement of services and systems in Latin America regarding Collaborative Mental health Care (CMHC). This mixed methods study, guided by a developmental evaluation approach, included: (1) a critical review of the literature; (2) an environmental scan at three selected health networks in Mexico, Nicaragua and Chile; (3) a Delphi group with experts; (4) a final consultation in the three sites; and (5) a pilot-test of the framework. A comprehensive evaluation framework was developed and successfully piloted. It considers five levels, 28 dimensions and 40 domains, as well as examples of indicators and an implementation plan. This evaluation framework represents an important effort to foster accountability and quality regarding CMHC in Latin America. Recommendations to build upon current capacity and to effectively address the existing implementation challenges are further discussed.
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    Effect of COVID-19 pandemic on the implementation of a multimorbidity person-centered care model: A qualitative study from health teams' perspective
    (2022) Zamorano, Paula; Tellez, Alvaro; Munoz, Paulina; Sapag, Jaime C.; Martinez, Mayra
    The COVID-19 pandemic has abruptly changed care priority and delivery, delaying others like the multimorbidity approach. The Centro de Innovacio ' n en Salud ANCORA UC, the Health National Fund, and the Servicio de Salud Metropolitano Sur Oriente implemented a Multimorbidity Patient-Centered Care Model as a pilot study in the public health network from 2017 to 2020. Its objective was to reorganize the single diagnosis standard care into a new one based on multimorbidity integrated care. It included incorporating new roles, services, and activities according to each patient's risk stratification. This study aims to describe the perception of the health care teams regarding the impact of the COVID-19 pandemic on four main topics: how the COVID-19 pandemic affected the MCPM implementation, how participants adapted it, lessons learned, and recommendations for sustainability. We conducted a qualitative study with 35 semi-structured interviews between October and December 2020. Data analysis was codified, triangulated, and consolidated using MAXQDA 2020. Results showed that the pandemic paused the total of the implementation practically. Positive effects were the improvement of remote health care services, the activation of selfmanagement, and the cohesion of the teamwork. In contrast, frequent abrupt changes and reorganization forced by pandemic evolution were negative effects. This study revealed the magnitude of the pandemic in the cancelation of health services and identified the urgent need to restart chronic services incorporating patient-centered care in our system.
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    Evaluation of collaborative mental health services in Latin America: Theoretical and methodological basis
    (2024) Sapag, Jaime C.; Rush, Brian
    Objectives: Approaches to collaborative mental health care (CMHC) have been implemented in many countries to strengthen the accessibility and delivery of mental health services in primary care. However, there are not well-defined frameworks to evaluate CMHC models. The purpose of this article is to identify, contextualize and discuss relevant health services research approaches, theory, and evaluation models for the development of an appropriate evaluation framework in order to foster effective CMHC in Latin America.Methods: A comprehensive literature review informed a critical analysis of relevant theories and alternative methods to be considered in the development of the framework.Results: Specific health services research frameworks are discussed in the context of evaluating CMHC. Two theoretical perspectives - collaboration theory and systems theory - and three evaluation models- realistic, developmental and collaborative - are analyzed in terms of their relevance. Methodological implications are identified.Conclusion: An appropriate evaluation framework for CMHC in Latin America needs to reflect theoretical and contextual considerations and relevant evaluation approaches and methods, including key dimensions and attributes/variables, core indicators, and recommendations for implementation.
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    Inequality on the frontline: A multi-country study on gender differences in mental health among healthcare workers during the COVID-19 pandemic
    (2024) Czepiel, Diana; Mccormack, Clare; da Silva, Andrea T. C.; Seblova, Dominika; Moro, Maria F.; Restrepo-Henao, Alexandra; Martinez, Adriana M.; Afolabi, Oyeyemi; Alnasser, Lubna; Alvarado, Ruben; Asaoka, Hiroki; Ayinde, Olatunde; Balalian, Arin; Ballester, Dinarte; Barathie, Josleen A. l.; Basagoitia, Armando; Basic, Djordje; Burrone, Maria S.; Carta, Mauro G.; Durand-Arias, Sol; Eskin, Mehmet; Fernandez-Jimenez, Eduardo; Frey, Marcela I. F.; Gureje, Oye; Isahakyan, Anna; Jaldo, Rodrigo; Karam, Elie G.; Khattech, Dorra; Lindert, Jutta; Martinez-Ales, Gonzalo; Mascayano, Franco; Mediavilla, Roberto; Gonzalez, Javier A. Narvaez; Nasser-Karam, Aimee; Nishi, Daisuke; Olaopa, Olusegun; Ouali, Uta; Puac-Polanco, Victor; Ramirez, Dorian E.; Ramirez, Jorge; Rivera-Segarra, Eliut; Rutten, Bart P. F.; Santaella-Tenorio, Julian; Sapag, Jaime C.; Seblova, Jana; Soto, Maria T. S.; Tavares-Cavalcanti, Maria; Valeri, Linda; Sijbrandij, Marit; Susser, Ezra S.; Hoek, Hans W.; van der Ven, Els
    Healthcare workers (HCWs) were at increased risk for mental health problems during the COVID-19 pandemic, with prior data suggesting women may be particularly vulnerable. Our global mental health study aimed to examine factors associated with gender differences in psychological distress and depressive symptoms among HCWs during COVID-19. Across 22 countries in South America, Europe, Asia and Africa, 32,410 HCWs participated in the COVID-19 HEalth caRe wOrkErS (HEROES) study between March 2020 and February 2021. They completed the General Health Questionnaire-12, the Patient Health Questionnaire-9 and questions about pandemic-relevant exposures. Consistently across countries, women reported elevated mental health problems compared to men. Women also reported increased COVID-19-relevant stressors, including insufficient personal protective equipment and less support from colleagues, while men reported increased contact with COVID-19 patients. At the country level, HCWs in countries with higher gender inequality reported less mental health problems. Higher COVID-19 mortality rates were associated with increased psychological distress merely among women. Our findings suggest that among HCWs, women may have been disproportionately exposed to COVID-19-relevant stressors at the individual and country level. This highlights the importance of considering gender in emergency response efforts to safeguard women's well-being and ensure healthcare system preparedness during future public health crises.
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    Perceived importance and interest in research by Chilean primary care providers
    (2023) García-Huidobro Munita, Diego Nicolás; Aracena Álvarez, Marcela; Bravo Valenzuela, Paulina Fabiola; González, Karla; Soto, Mauricio; von Borries, Pamela; Sapag, Jaime C.
    Background: Primary care providers (PCPs) are relevant stakeholders for primary care research (PCR). Objective: We report the perceived importance and interest in PCR of a national sample of Chilean PCPs. Methods: We conducted a cross-sectional study targeting Chilean PCPs. An electronic survey assessing perceived relevance of PCR, research training and experience, training interests, and demographics was disseminated through emails and WhatsApp messages. Descriptive statistics were used to summarize data. Logistic regression models were used to estimate adjusted probabilities and 95% confidence intervals for high interest in PCR, high interest in using research methods, and high interest in receiving research training, and predictors of these outcomes. Results: A total of 387 providers completed the online survey. Only 26.4% of PCPs had research experience as a principal or co-investigator. However, most clinicians perceived PCR as very important (92.5%) and were interested in using research methods (90.7%) and receiving training (94.3%). There were no statistically significant differences in these perceptions between provider’s discipline, role, sex, age, and geographical location after adjusting for covariates. Conclusions: Despite few Chilean PCPs have research training, a large majority perceive it as important, are interested in using it in their practice and would like to receive training.
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    Programa de Acción Mundial para Superar las Brechas en Salud Mental (mhGAP) en Chile: aprendizajes y desafíos para América Latina y el Caribe
    (2021) Sapag, Jaime C.; Alvarez Huenchulaf, Cinthia; Campos, Alvaro; Corona, Francisca; Pereira, Milena; Veliz, Veronica; Soto Brandt, Gonzalo; Irarrazaval, Matias; Gomez, Mauricio; Abaakouk, Zohra
    Objectives. Present the methodology for comprehensive evaluation of the implementation of the Mental Health Global Action Programme (mhGAP) in Chile and describe the program's results.
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    Reducing stigma toward mental illness and substance use issues in primary health care in Chile: Protocol of a cluster controlled trial study
    (2022) Sapag, Jaime C.; Traub, Carolina; Velasco, Paola R.; Arratia, Tamara; Alvarado, Ruben; Aracena, Marcela; Poblete, Fernando C.; Villarroel, Luis; Bravo, Paulina; Alvarez-Huenchulaf, Cinthia; Jofre Escalona, Ana; Vargas-Malebran, Nelson; Bobbili, Sireesha; Bustamante, Ines; Khenti, Akwatu; Corrigan, Patrick W.
    Background: Chile is implementing a Community Mental Health Model with a strong role of primary health care (PHC). PHC has great potential to early detection and provision of accessible and coordinated services to people who present mental illness and/or substance use issues (MISUI). However, stigma toward people with MISUI among PHC professionals is a significant barrier to accessing good quality of care. A wealth of literature supports the importance of reducing stigma for this population. The main goal of this research project is to determine the effectiveness of a comprehensive anti-stigma intervention in reducing stigmatizing attitudes and behaviors among PHC providers toward individuals with MISUI in the Chilean context, using Centros de Salud Familiar (CESFAMs) as the point of intervention. Methods: The intervention is based on an initiative that was previously developed in Canada and then also pilot-tested in Lima, Peru, with the Center for Addiction and Mental Health (Ontario, Canada). The model will be culturally adapted with CESFAM PHC provider and user inputs to be relevant and valid to Chile. The 18-month intervention includes five (5) components that are simultaneously implemented in CESFAMs: (1) Develop a Team of Local Champions in each intervention CESFAM, comprising PHC providers and users; (2) Analysis of Internal CESFAM Policies, Procedures, and Protocols to determine areas of improvement in service delivery for individuals with MISUI; (3) Raising Awareness of stigma toward MISUI using various forms of media within the CESFAM; (4) Innovative Contact-Based Education workshops on anti-stigma and recovery principles, co-lead by academic/clinical trainers and a person with lived experience of MISUI; and (5) Recovery-Based Arts, a multi-week arts workshop for PHC providers and users to produce artwork related to MISUI and recovery, culminating in an exhibition to showcase artwork for the CESFAM providers, users, and community. The expected intervention outcomes are the following: Participation in the experimental group will result in a significant decrease in stigmatizing attitudes among PHC providers toward individuals with MISUI compared with the control group as measured by the Chilean version of the Opening Minds Scale for Health Care Providers Scale (OMS-HC); Participation in the experimental group will result in a significant decrease of PHC users experiences of stigma conveyed by PHC providers compared with the control group as measured by the Internalized Stigma of Mental Illness (ISMI) scale, validated for the Chilean population. The changes in attitudes and behaviors within the experimental group will be sustained over time as measured at 6 months-follow-up. To evaluate the effectiveness of this 18-month intervention, a 4-year, two-arm, cluster-randomized controlled trial is proposed, with CESFAMs being the unit of randomization (or "cluster "). Implementation Science approach will be taken to measure relevant implementation outcomes for each component of the intervention, and through qualitative data collection with CESFAM providers and authorities. Data analysis will be carried out using SAS 9.4 (specifically, using POC MIXED and PROC GENMOD) and R 3.5. Mixed-effect modeling will used for both PHC provider and user data, which will include individuals and CESFAMs as random effects and group (intervention/control) as fixed effects.
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    Social capital and mental health in low income urban communities in Santiago, Chile
    (2008) Poblete, Fernando C.; Sapag, Jaime C.; Bossert, Thomas J.
    Background- Many studies suggest that social capital, defined as those intangible resources of a society or community (trust, participation and reciprocity), that might facilitate collective action, can be associated with positive health effects. Aim: To explore the relationship between social capital an the level of mental health, in urban communities of Santiago, Chile. Material and methods: In a qualitative-quantitative cross-sectional design, two low income neighborboods in the municipality of Puente Alto were selected. Interviews to key agents and focus groups, as well as surveys (407) to adults from a representative random sample of households, were conducted, measuring social capital using a locally devised questionnaire and mental health using the General Health Questionnaire (GHQ-12 instrument). A qualitative analysis based on the grounded theory and a quantitative analysis through correlations and simple and logistic regression models were applied. Results. The quantitative analysis found an association between female gender education and having a chronic disease, with low levels of mental health. At the same time, the trust component of social capital might be associated with a better mental bealth status. Qualitatively all the components of social capital were identified as important for a better mental health. Conclusions. This study suggests the existence of a positive relationship between social capital and mental health. Developing trust in a community might be a useful tool to work in mental health at the community level.
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    Stigma towards people with mental disorders: perceptions of devaluation and discrimination in a sample of Chilean workers
    (2019) Teresa Solis-Soto, Maria; Soledad Burrone, Maria; Reginatto, Gabriel; Sapag, Jaime C.; Alvarado, Ruben
    Introduction. Mental disorders represent one of the main causes of disease burden in the adult population. Negative public attitudes and behaviors toward people with mental disorders negatively affect the treatment, recovery, and social inclusion of those affected. Chile laks surveys on workers that address this issue. Objective. To describe the perceptions of devaluation and discrimination towards people with mental disorders in a sample of Chilean workers. Method. A cross-sectional study was carried out with 1516 workers in the formal sector of four regions of Chile (Metropolitan Region [RM], Bio Bio [VIII], Valparaiso [V] and Coquimbo [IV]). The perception of discrimination and devaluation was explored through a modified version of the The perceived Devaluation-Discrimination Scale (PDD) comprising 15 questions. The relationship of each question with sociodemographic variables (age, sex, years of study, and region) and type of economic activity was assessed. Results. The study found a high percentage of perceptions of devaluation and discrimination in most aspects considered, particularly those related to hiring a person who has been hospitalized due to a mental illness (85%), feeling sorry for people with severe mental illnesses (80%), and the unwillingness to marry a person with a mental illness (78%). Significant differences were observed in the opinions by sociodemographic variables and region of residence. Discussion and conclusion. The perception of Chilean workers has high levels of stigma towards people living with mental disorders. It is necessary and urgent to develop effective anti-stigma public policies to promote a more inclusive, tolerant society.
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    Tobacco smoking in urban neighborhoods: Exploring social capital as a protective factor in Santiago, Chile
    (OXFORD UNIV PRESS, 2010) Sapag, Jaime C.; Poblete, Fernando C.; Eicher, Caitlin; Aracena, Marcela; Caneo, Constanza; Vera, Gloria; Martinez, Mayra; Hoyos, Rodrigo; Villarroel, Luis; Bradford, Elizabeth
    Research examining the relationship between social capital and health in Latin America has been limited. The aim of this study is to evaluate the association between social capital and tobacco use in four low-income neighborhoods in Santiago, Chile.
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    Validation of the Opening Minds Scale and patterns of stigma in Chilean primary health care
    (2019) Sapag, Jaime C.; Klabunde, Rachel; Villarroel, Luis; Velasco, Paola R.; Alvarez, Cinthia; Parra, Claudia; Bobbili, Sireesha J.; Mascayano, Franco; Bustamante, Ines; Alvarado, Ruben; Corrigan, Patrick
    Objectives