Barriers and facilitators to implementation of evidence-based task-sharing mental health interventions in low- and middle-income countries: a systematic review using implementation science frameworks

Background Task-sharing is a promising strategy to expand mental healthcare in low-resource settings, especially in low- and middle-income countries (LMICs). Research on how to best implement task-sharing mental health interventions, however, is hampered by an incomplete understanding of the barriers and facilitators to their implementation. This review aims to systematically identify implementation barriers and facilitators in evidence-based task-sharing mental health interventions using an implementation science lens, organizing factors across a novel, integrated implementation science framework. Methods PubMed, PsychINFO, CINAHL, and Embase were used to identify English-language, peer-reviewed studies using search terms for three categories: “mental health,” “task-sharing,” and “LMIC.” Articles were included if they: focused on mental disorders as the main outcome(s); included a task-sharing intervention using or based on an evidence-based practice; were implemented in an LMIC setting; and included assessment or data-supported analysis of barriers and facilitators. An initial conceptual model and coding framework derived from the Consolidated Framework for Implementation Research and the Theoretical Domains Framework was developed and iteratively refined to create an integrated conceptual framework, the Barriers and Facilitators in Implementation of Task-Sharing Mental Health Interventions (BeFITS-MH), which specifies 37 constructs across eight domains: (I) client characteristics, (II) provider characteristics, (III) family and community factors, (IV) organizational characteristics, (V) societal factors, (VI) mental health system factors, (VII) intervention characteristics, and (VIII) stigma. Results Of the 26,935 articles screened (title and abstract), 192 articles underwent full-text review, yielding 37 articles representing 28 unique intervention studies that met the inclusion criteria. The most prevalent facilitators occur in domains that are more amenable to adaptation (i.e., the intervention and provider characteristics domains), while salient barriers occur in domains that are more challenging to modulate or intervene on—these include constructs in the client characteristics as well as the broader societal and structural levels of influence (i.e., the organizational, mental health system domains). Other notable trends include constructs in the family and community domains occurring as barriers and as facilitators roughly equally, and stigma constructs acting exclusively as barriers. Conclusions Using the BeFITS-MH model we developed based on implementation science frameworks, this systematic review provides a comprehensive identification and organization of barriers and facilitators to evidence-based task-sharing mental health interventions in LMICs. These findings have important implications for ongoing and future implementation of this critically needed intervention strategy, including the promise of leveraging task-sharing intervention characteristics as sites of continued innovation, the importance of but relative lack of engagement with constructs in macro-level domains (e.g., organizational characteristics, stigma), and the need for more delineation of strategies for task-sharing mental health interventions that researchers and implementers can employ to enhance implementation in and across levels. Trial registration PROSPERO CRD42020161357

Auditor Choice and the Informativeness of 10-K Reports

This study provides new evidence on the influential role of external auditors in enhancing the informativeness of form 10-K annual reports to shareholders. Specifically, we find that the client’s choice of a Big 4 auditor (PwC, EY, KPMG, and Deloitte) versus a non-Big 4 auditor contributes to cross-sectional variations in 10-K disclosure volume. We also document that the benefit of enhanced disclosures provided by Big 4 auditors is more pronounced for audit clients with poorer accrual quality and those with higher information asymmetry. Furthermore, we introduce the portion of 10-K length unexplained by operating complexity and observable client characteristics as a new proxy for audit firm effort. Specifically, we find that abnormally long disclosures are associated with higher audit fees and longer audit report lag, which implies that an incremental level of audit effort can be inferred from the discretionary component of 10-K disclosures. As audit effort is costly, a greater volume of 10-K disclosures can be expected to be associated with an improvement in the quality of financial reporting. Overall, our findings show that auditors play more than a simple attestation role in the financial reporting process, and that the quality of financial reporting in a company’s 10-K annual report is a joint product of the effort and decisions of both a company’s managers and its auditors.

Becoming Job-Ready? Narratives of Local Welfare-to-Work Programs and Client Experiences Across Differing Economic Contexts in California

Previous research on welfare-to-work exits has focused on individual client characteristics rather than local economic contexts. Drawing on a qualitative comparative case study design, this study enhances our understanding on how welfare-to-work organizational narratives and client experiences of becoming job-ready are shaped across two different economic contexts. In the disadvantaged economic context, a punitive welfare-to-work narrative is operational resulting in clients accepting precarious work. In the more privileged economic context, the individual responsibility narrative dominates as clients struggle to make ends meet. Our findings highlight how regional economic factors shape organizational narratives and impel clients to accept precarious low wage working conditions and unstable housing. Thus, there is a need for alternatives to welfare-to-work, such as unconditional, Universal Basic Income.

Does Engagement Partners’ Effort Affect Audit Quality? With a Focus on the Effects of Internal Control System

An audit team includes engagement partners, CPAs, and staff. Among them, partners play a vital role in performing tasks that require expertise and experience, such as analyzing and understanding the industry, and supervising the overall audit process. In detail, the partners establish an audit plan, determine the overall audit time, provide the audit input ratio of the engagement team, and review the audit reports. This study examines for association between the partner’s audit hour ratio and audit quality depending on the client firms’ characteristics. Although the role of partners is important, the information about partner audit hours is limited. However, the Korean government requires audit firms to disclose the partner hour information in the audit report starting in the 2014 fiscal year. By the disclosure, it is possible to examine the association between partner audit hours and audit quality. In this study, the information on partner audit hour is hand-collected from the firms’ business reports. Using 6340 observations from 2014 to 2017, the partner audit hour ratio is associated with audit quality, under the characteristics of client firms. Firms’ risks are adopted for client characteristics, and we focused on the operation of internal control. The internal control operation level is measured by the following: (1) the ratio of internal control personnel and (2) experience of the internal control personnel in the accounting and IT departments. The result suggests that for the firms where internal control is not effectively operated, partners make more effort to enhance audit quality.

The Association between Audit Office Team Diversity and Audit Quality

Surveys and field studies find that high-performing teams are diverse teams. Diverse teams value different perspectives and encourage the participation of team members through psychological safety, leading to higher team performance. This paper argues that team diversity is an office-level characteristic that is distinguishable from other characteristics studied in the prior auditing literature and that has an incremental effect on audit quality. I find a positive association between team diversity and audit quality that is robust to controlling for other audit office and client characteristics. Further, this positive association is stronger for more complex and non-routine audit engagements. These findings should be of interest to regulators who regulate how the auditing industry attracts and retains talent worldwide. In addition, these findings should be informative to audit committees who make auditor selection decisions and to investors and accounting researchers interested in the relation between audit team personnel and audit quality.

Does the Length of the Cooling-off Period Affect Audit Quality?

This paper examines the association between the length of the cooling-off period and audit quality: (1) when partners rotate back and (2) during the cooling-off period, ahead of an extension to the minimum cooling-off period requirement in Australia. Using multiple measures of audit quality, we find some evidence of a positive association between the cooling-off period length and audit quality when partners rotate back, yet evidence of a negative association between the two, during the cooling-off period. We also find that auditor and client characteristics-such as partner busyness, client knowledge, geographic proximity, and client importance-play important roles in determining the cooling-off period length and whether a partner rotates back onto a client. Overall, we provide timely evidence that extending the cooling-off period only marginally enhances audit quality when a partner rotates back onto a client, and evidence of an unintended consequence of this policy during the cooling-off period.

Client Characteristics related Critical Success Factors for Public-Private Partnerships in South Africa

The implementation of the Public-Private Partnership (PPP) projects in South Africa has grown steadily since the late 1990s. However, these partnerships do not realise their potential with a decline in PPP transactions over the past decade. The drivers of success for PPP projects have become a subject of investigation to understand the downward trend. This study evaluates the different critical success factors pertinent to client characteristics that influence PPP projects in South Africa. The study followed a qualitative research inquiry that employs a grounded theory (G.T.) approach involving semi-structured interviews with nine professionals involved in PPP projects selected using a snowball sampling technique. Interviews were conducted on video conferencing and through phone calls. Seven responses were considered relevant to the research, and two were considered irrelevant and were disregarded. An in-depth analysis of the data gathered was conducted through a selective coding process using NVivo. The analysis revealed the research’s emergent themes: client experience and in-house technical capabilities; client risk attitude; client willingness to be involved and trust in the private sector, available financial markets, and political support and stability. By applying the framework established, the chances of success and decline in the use of PPP projects can be considerably improved in South Africa through greater engagement between the public and private sectors in infrastructure investment and delivery. The study’s main limitation is the smallness of the sample size and the use of the snowball sampling technique in which the initial respondents are likely to refer to other respondents who share similar points of view and beliefs. To counter this limitation, the researchers ensured that the convenient sample of initial subjects comprised professionals from different backgrounds.