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Mathias K, Jain S, Fraser R, Davis M, Kimijima–Dennemeyer R, Pillai P, Deshpande SN, Wolters M. Improving mental ill-health with psycho-social group interventions in South Asia-A scoping review using a realist lens. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001736. [PMID: 37639400 PMCID: PMC10461838 DOI: 10.1371/journal.pgph.0001736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 07/28/2023] [Indexed: 08/31/2023]
Abstract
This scoping review aimed to synthesise current evidence related to psycho-social groups as part of community-based mental health interventions in South Asia. We used a realist lens to pay attention to the contexts and mechanisms supporting positive outcomes. We included studies published from January 2007 to February 2022 that: were based in communities in South Asia, included a group component, reported on interventions with a clear psychosocial component, targeted adults and were implemented by lay community health workers. Two reviewers extracted data on intervention components, groups and facilitators, participant demographics and enabling contexts, mechanisms and outcomes. Expert reference panels including people with lived experience of psycho-social disability, mental health professionals and policy makers confirmed the validity and relevance of initial review findings. The review examined 15 interventions represented by 42 papers. Only four interventions were solely psycho-social and nearly all included psychoeducation and economic support. Only 8 of the 46 quantitative outcome measures used were developed in South Asia. In a context of social exclusion and limited autonomy for people with psychosocial disability, psychosocial support groups triggered five key mechanisms. Trusted relationships undergirded all mechanisms, and provided a sense of inclusion, social support and of being able to manage mental distress due to improved skills and knowledge. Over time group members felt a sense of belonging and collective strength meaning they were better able to advocate for their own well-being and address upstream social health determinants. This led to outcomes of improved mental health and social participation across the realms of intrapersonal, interpersonal and community. Psychosocial groups merit greater attention as an active ingredient in community interventions and also as an effective, relevant, acceptable and scalable platform that can promote and increase mental health in communities, through facilitation by lay community health workers.
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Affiliation(s)
- Kaaren Mathias
- Herbertpur Christian Hospital, Emmanuel Hospital Association, Uttarakhand, India
- Faculty of Health, Te Kaupeka Oranga, University of Canterbury, Christchurch, New Zealand
| | - Sumeet Jain
- School of Social and Political Science, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Meghan Davis
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | | | - Pooja Pillai
- Herbertpur Christian Hospital, Emmanuel Hospital Association, Uttarakhand, India
| | - Smita N. Deshpande
- Department of Psychiatry, St John’s National Academy of Medical Sciences, Bengaluru, India
| | - Maria Wolters
- School of Informatics, University of Edinburgh, Edinburgh, United Kingdom
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Mathias K, Rawat M, Philip S, Grills N. "We've got through hard times before: acute mental distress and coping among disadvantaged groups during COVID-19 lockdown in North India - a qualitative study". Int J Equity Health 2020; 19:224. [PMID: 33334344 PMCID: PMC7745174 DOI: 10.1186/s12939-020-01345-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 12/07/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The COVID-19 crisis in India negatively impacted mental health due to both the disease and the harsh lockdown, yet there are almost no qualitative studies describing mental health impacts or the strategies of resilience used, and in particular, no reports from the most vulnerable groups. This study aimed to examine the acute mental health impacts of the COVID-19 crisis as well as coping strategies employed by disadvantaged community members in North India. METHODS We used an intersectional lens for this qualitative study set in rural Tehri Garwhal and urban Dehradun districts of Uttarakhand, India. In-depth interviews were conducted in May 2020 during lockdown, by phone and in person using purposive selection, with people with disabilities, people living in slums with psychosocial disabilities and widows (total n = 24). We used the framework method for analysis following steps of transcription and translation, familiarisation, coding, developing and then applying a framework, charting and then interpreting data. FINDINGS The participants with compounded disadvantage had almost no access to mobile phones, health messaging or health care and experienced extreme mental distress and despair, alongside hunger and loss of income. Under the realms of intrapersonal, interpersonal and social, six themes related to mental distress emerged: feeling overwhelmed and bewildered, feeling distressed and despairing, feeling socially isolated, increased events of othering and discrimination, and experiencing intersectional disadvantage. The six themes summarising coping strategies in the COVID-19 crisis were: finding sense and meaning, connecting with others, looking for positive ways forward, innovating with new practices, supporting others individually and collectively, and engaging with the natural world. CONCLUSIONS People intersectionally disadvantaged by their social identity experienced high levels of mental distress during the COVID-19 crisis, yet did not collapse, and instead described diverse and innovative strategies which enabled them to cope through the COVID-19 lockdown. This study illustrates that research using an intersectional lens is valuable to design equitable policy such as the need for access to digital resources, and that disaggregated data is needed to address social inequities at the intersection of poverty, disability, caste, religious discrimination and gender inherent in the COVID-19 pandemic in India.
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Affiliation(s)
- Kaaren Mathias
- Burans, Herbertpur Christian Hospital, Attenbagh, Herbertpur, Uttarakhand, India.
| | - Meenal Rawat
- Burans, Herbertpur Christian Hospital, Attenbagh, Herbertpur, Uttarakhand, India
| | - Sharad Philip
- Psychiatric Rehabilitation Department, NIMHANS, Bengaluru, India
| | - Nathan Grills
- Nossal Institute, University of Melbourne and Australia- India Institute, Melbourne, Australia
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Gailits N, Mathias K, Nouvet E, Pillai P, Schwartz L. Women's freedom of movement and participation in psychosocial support groups: qualitative study in northern India. BMC Public Health 2019; 19:725. [PMID: 31182064 PMCID: PMC6558745 DOI: 10.1186/s12889-019-7019-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 05/21/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Depression, the world's leading cause of disability, disproportionately affects women. Women in India, one of the most gender unequal countries worldwide, face systemic gender disadvantage that significantly increases the risk of common mental disorders. This study's objective was to examine the factors influencing women's participation in psychosocial support groups, within an approach where community members work together to collectively strengthen their community's mental health. METHODS This community-based qualitative study was conducted from May to July 2016, across three peri-urban sites in Dehradun district, Uttarakhand, Northern India. Set within an NGO-run mental health project, data were collected through focus group discussions with individuals involved in psychosocial support groups including women with psychosocial disabilities as well as caregivers (N = 10, representing 59 women), and key informant interviews (N = 8) with community members and mental health professionals. Data were analyzed using a thematic analysis approach. RESULTS The principal barrier to participating in psychosocial support groups was restrictions on women's freedom of movement. Women in the community are not normally permitted to leave home, unless going to market or work, making it difficult for women to leave their home to participate in the groups. The restrictions emanated from the overall community's attitude toward gender relations, the women's own internalized gender expectations, and most significantly, the decision-making power of husbands and mothers-in-law. Other factors including employment and education shaped women's ability to participate in psychosocial support groups; however, the role of these additional factors must be understood in connection to a gender order limiting women's freedom of movement. CONCLUSIONS Mental health access and gender inequality are inseparable in the context of Northern India, and women's mental health cannot be addressed without first addressing underlying gender relations. Community-based mental health programs are an effective tool and can be used to strengthen communities collectively; however, attention towards the gender constraints that restrict women's freedom of movement and their ability to access care is required. To our knowledge, this is the first study to clearly document and analyze the connection between access to community mental health services in South Asia and women's freedom of movement.
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Affiliation(s)
- Nicola Gailits
- Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, Ontario, M5T 1P8, Canada.
| | - Kaaren Mathias
- Emmanuel Hospital Association, 808/92 Deepali Building, Nehru Place, Delhi, New Delhi, 110019, India
| | - Elysée Nouvet
- School of Health Studies, Western University, Labatt Health Sciences Bldg, Rm 215. 1151 Richmond St., London, ON, N6A 5B9, Canada
| | - Pooja Pillai
- Emmanuel Hospital Association, 808/92 Deepali Building, Nehru Place, Delhi, New Delhi, 110019, India
| | - Lisa Schwartz
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada
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Swendeman D, Fehrenbacher AE, Roy S, Das R, Ray P, Sumstine S, Ghose T, Jana S. Gender disparities in depression severity and coping among people living with HIV/AIDS in Kolkata, India. PLoS One 2018; 13:e0207055. [PMID: 30462688 PMCID: PMC6248946 DOI: 10.1371/journal.pone.0207055] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 10/23/2018] [Indexed: 01/11/2023] Open
Abstract
People living with HIV/AIDS (PLH) experience high rates of depression and related psychosocial risk factors that vary by gender. This study examines gender differences in depression severity among antiretroviral therapy (ART) patients (n = 362) from a large government ART clinic in Kolkata, India. Hypotheses for multiple linear regression models were guided by an integrated gendered stress process model focusing on variables reflecting social status (age, partner status), stressors (stigma), and resources (income, social support). Depressive symptoms were assessed with the Hospital Anxiety and Depression Scale (HADS); 22% of the sample reached the cutoff for severe depression, 56% moderate, and 13% mild depression. Compared to men, women reported lower income, education (50% no formal education vs. 20% men), availability of emotional and instrumental support, and were less likely to be married or cohabiting (53% women vs. 72% of men). However, more women had partners who were HIV-positive (78% women vs. 46% men). Overall, depression severity was negatively associated with availability of emotional support and self-distraction coping, and positively associated with internalized HIV/AIDS stigma, availability of instrumental support, and behavioral disengagement coping. Interactions for instrumental support by income and partner status by age varied significantly by gender. Analyses stratified by gender indicated that: 1) Frequently seeking instrumental support from others was protective for men at all income levels, but only for high-income women; and 2) having a partner was protective for men as they aged, but not for women. These results suggest that gender disparities in depression severity are created and maintained by women’s lower social status and limited access to resources. The effect of stigma on depression severity did not vary by gender. These findings may inform the tailoring of future interventions to address mental health needs of PLH in India, particularly gender disparities in access to material and social resources for coping with HIV. Trial Registration: ClinicalTrials.gov registration #NCT02118454, registered April 2014.
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Affiliation(s)
- Dallas Swendeman
- Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, United States of America
- Center for HIV Identification, Prevention & Treatment Services (CHIPTS), University of California, Los Angeles, California, United States of America
- Center of Expertise in Women’s Health, Gender, and Empowerment, University of California Global Health Institute, San Francisco, California, United States of America
- * E-mail: (DS); (SJ)
| | - Anne E. Fehrenbacher
- Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, United States of America
| | - Soma Roy
- Sonagachi Research & Training Institute, Durbar Mahila Samanwaya Committee, Kolkata, India
| | - Rishi Das
- Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, United States of America
| | - Protim Ray
- Sonagachi Research & Training Institute, Durbar Mahila Samanwaya Committee, Kolkata, India
| | - Stephanie Sumstine
- Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, United States of America
- Center of Expertise in Women’s Health, Gender, and Empowerment, University of California Global Health Institute, San Francisco, California, United States of America
| | - Toorjo Ghose
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Smarajit Jana
- Sonagachi Research & Training Institute, Durbar Mahila Samanwaya Committee, Kolkata, India
- * E-mail: (DS); (SJ)
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Devine A, Ignacio R, Prenter K, Temminghoff L, Gill-Atkinson L, Zayas J, Marco MJ, Vaughan C. "Freedom to go where I want": improving access to sexual and reproductive health for women with disabilities in the Philippines. REPRODUCTIVE HEALTH MATTERS 2017; 25:55-65. [PMID: 28784061 DOI: 10.1080/09688080.2017.1319732] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Women with disabilities experience a range of violations of their sexual and reproductive rights. The Philippines ratified the United Nations Convention on the Rights of Persons with Disabilities and have laws in place to promote the rights to sexual and reproductive health and protection from violence. However, limited resourcing, and opposition to such laws undermine access to these rights for all women. Inadequate disability inclusion within policy and programming, and limited disability awareness of services, further impedes women with disabilities from attaining these rights. The W-DARE project (Women with Disability taking Action on REproductive and sexual health) was a three-year participatory action research program designed to (1) understand the sexual and reproductive health experiences and needs of women with disabilities; and (2) improve access to quality sexual and reproductive health, including violence response services, for women with disabilities in the Philippines. In response to the highlighted need for more information about sexual and reproductive health and greater access to services, the W-DARE team developed and implemented a pilot intervention focused on peer-facilitated Participatory Action Groups (PAGs) for women with disabilities. This paper focuses on the qualitative findings from the evaluation of this PAG intervention.
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Affiliation(s)
- Alexandra Devine
- a Senior Research Officer, Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Raquel Ignacio
- b Research Assistance, Social Development Research Centre, De La Salle University , Manila , Philippines
| | - Krystle Prenter
- c Research Intern, Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne , Melbourne , VIC , Australia
| | - Lauren Temminghoff
- c Research Intern, Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne , Melbourne , VIC , Australia
| | - Liz Gill-Atkinson
- d Research Assistant, Gender and Women's Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne , VIC , Australia
| | - Jerome Zayas
- b Research Assistance, Social Development Research Centre, De La Salle University , Manila , Philippines.,e Inclusive Development Advisor, Inclusive Development and Empowerment Agenda , Manila , Philippines
| | - Ma Jesusa Marco
- f Research Fellow, Social Development Research Centre, De La Salle University , Manila , Philippines
| | - Cathy Vaughan
- g Senior Lecturer, Gender and Women's Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne , VIC , Australia
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Lindkvist M, Feldman I. Assessing outcomes for cost-utility analysis in mental health interventions: mapping mental health specific outcome measure GHQ-12 onto EQ-5D-3L. Health Qual Life Outcomes 2016; 14:134. [PMID: 27644119 PMCID: PMC5028925 DOI: 10.1186/s12955-016-0535-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 09/09/2016] [Indexed: 01/22/2023] Open
Abstract
Background Many intervention-based studies aiming to improve mental health do not include a multi-attribute utility instrument (MAUI) that produces quality-adjusted life-years (QALYs) and it limits the applicability of the health economic analyses. This study aims to develop ‘crosswalk’ transformation algorithm between a measure for psychological distress General Health Questionnaire (GHQ-12) and MAUI EuroQoL (EQ-5D-3L). Methods The study is based on a survey questionnaire sent to a random sample in four counties in Sweden in 2012. The survey included GHQ-12 and EQ-5D instruments, as well as a question about self-rated health. The EQ-5D index was calculated using the UK and the Swedish tariff values. Two OLS models were used to estimate the EQ-5D health state values using the GHQ-12 as exposure, based on the respondents (n = 17, 101) of two counties. The algorithms were applied to the data from two other counties, (n = 15, 447) to check the predictive capacity of the models. Results The final models included gender, age, self-rated health and GHQ-12 scores as a quantitative variable. The regression equations explained 40 % (UK tariff) and 46 % (Swedish tariff) of the variances. The model showed a satisfying predictive capacity between the observed and the predicted EQ-5D index score, with Pearson correlation = 0.65 and 0.69 for the UK and Swedish models, respectively. Conclusion The algorithms developed in this study can be used to determine cost-effectiveness of services or interventions that use GHQ-12 as a primary outcome where the utility measures are not collected.
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Affiliation(s)
- Marie Lindkvist
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden.,Department of Statistics, Umeå University, Umeå, Sweden
| | - Inna Feldman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
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Strachan CE, Nuwa A, Muhangi D, Okui AP, Helinski MEH, Tibenderana JK. What drives the consistent use of long-lasting insecticidal nets over time? A multi-method qualitative study in mid-western Uganda. Malar J 2016; 15:44. [PMID: 26821799 PMCID: PMC4730749 DOI: 10.1186/s12936-016-1101-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 01/14/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The distribution of long-lasting insecticidal nets (LLINs) through universal coverage campaigns is a widely adopted approach for the prevention of malaria at scale. While post-distribution surveys play a valuable role in determining cross-sectional levels of LLIN retention and use, as well as frequently cited reasons for non-use, few studies have explored the consistency of LLIN use over time, within the expected lifespan of the net, and the factors which may drive this. METHODS In this qualitative study, 74 in-depth interviews were conducted with (male) household heads and (female) caregivers of children in LLIN recipient households, as well as community health workers, in Buliisa, Hoima and Kiboga districts in Uganda, 25-29 months following a LLIN mass campaign distribution. A triangulation approach to data analysis was taken, incorporating thematic analysis, most significant change and positive deviance. RESULTS The factors found to be most influential in encouraging long-term LLIN use were positive experience of net use prior to the distribution, and appreciation or awareness of a range of benefits arising from their use, including protection from malaria as well as importantly, other health, lifestyle, social and economic benefits. Social support from within the community was also identified as an important factor in determining continued use of LLINs. Net use appeared to be more consistent amongst settled urban and rural communities, compared with fishing, pastoralist, refugee and immigrant communities. CONCLUSIONS A multitude of interplaying factors encouraged consistent LLIN use in this setting. Whilst the protection of malaria remains a powerful motivator, social and behaviour change (SBC) strategies should also capitalize on the non-malaria benefits of net use that provide a long-term rationale for consistent use. Where supplies are available, SBC campaigns should promote replacement options, emphasizing ongoing net care and replacement as a household responsibility, thus reducing dependence on free distributions. The triangulation approach to qualitative data analysis enabled increased confidence in the validity of findings and an enhanced contextual understanding of the factors promoting consistent net use in mid-western Uganda. The approach should be considered when designing future studies to explore factors driving net retention and use trends.
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Affiliation(s)
- Clare E Strachan
- Malaria Consortium Africa Office, Plot 25, Upper Naguru East Rd, P.O. Box 8045, Kampala, Uganda. .,Independent public health consultant, 74a Elderfield Road, London, E5 0LF, UK.
| | - Anthony Nuwa
- Malaria Consortium Africa Office, Plot 25, Upper Naguru East Rd, P.O. Box 8045, Kampala, Uganda.
| | - Denis Muhangi
- Department of Social Work and Social Administration, Makerere University, P.O. Box 7062, Kampala, Uganda.
| | - Albert P Okui
- National Malaria Control Programme, Ministry of Health, Plot 6, Lourdel Rd, P.O. Box 7272, Kampala, Uganda.
| | - Michelle E H Helinski
- Malaria Consortium Africa Office, Plot 25, Upper Naguru East Rd, P.O. Box 8045, Kampala, Uganda. .,European and Developing Countries Clinical Trials Partnership, P.O. Box 93015, 2509 AA, The Hague, The Netherlands.
| | - James K Tibenderana
- Malaria Consortium Africa Office, Plot 25, Upper Naguru East Rd, P.O. Box 8045, Kampala, Uganda.
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Marshall Z, Dechman MK, Minichiello A, Alcock L, Harris GE. Peering into the literature: A systematic review of the roles of people who inject drugs in harm reduction initiatives. Drug Alcohol Depend 2015; 151:1-14. [PMID: 25891234 DOI: 10.1016/j.drugalcdep.2015.03.002] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 02/20/2015] [Accepted: 03/01/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND People who inject drugs have been central to the development of harm reduction initiatives. Referred to as peer workers, peer helpers, or natural helpers, people with lived experience of drug use leverage their personal knowledge and skills to deliver harm reduction services. Addressing a gap in the literature, this systematic review focuses on the roles of people who inject drugs in harm reduction initiatives, how programs are organized, and obstacles and facilitators to engaging people with lived experience in harm reduction programs, in order to inform practice and future research. METHODS This systematic review included searches for both peer reviewed and gray literature. All titles and abstracts were screened by two reviewers. A structured data extraction tool was developed and utilized to systematically code information concerning peer roles and participation, program characteristics, obstacles, and facilitators. RESULTS On the basis of specific inclusion criteria 164 documents were selected, with 127 peer-reviewed and 37 gray literature references. Data extraction identified key harm reduction program characteristics and forms of participation including 36 peer roles grouped into five categories, as well as obstacles and facilitators at systemic, organizational, and individual levels. CONCLUSIONS Research on harm reduction programs that involve people with lived experience can help us better understand these approaches and demonstrate their value. Current evidence provides good descriptive content but the field lacks agreed-upon approaches to documenting the ways peer workers contribute to harm reduction initiatives. Implications and ten strategies to better support peer involvement in harm reduction programs are identified.
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Affiliation(s)
- Z Marshall
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University, Health Sciences Centre, 300 Prince Philip Drive, St. John's, NL, Canada A1B 3V6.
| | - M K Dechman
- Department of Anthropology and Sociology, Cape Breton University, PO Box 5300, 1250 Grand Lake Road, Sydney, NS, Canada B1P 6L2.
| | - A Minichiello
- Department of Anthropology and Sociology, Cape Breton University, PO Box 5300, 1250 Grand Lake Road, Sydney, NS, Canada B1P 6L2.
| | - L Alcock
- Health Sciences Library, Memorial University, St John's, NL, Canada A1B 3V6.
| | - G E Harris
- Faculty of Education, G. A. Hickman Building, Memorial University, St. John's, NL, Canada A1B 3X8.
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Mishra D, Nair SR. Systematic literature review to evaluate and characterize the health economics and outcomes research studies in India. Perspect Clin Res 2015; 6:20-33. [PMID: 25657899 PMCID: PMC4314843 DOI: 10.4103/2229-3485.148802] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Aim: This systematic literature review was conducted to identify, evaluate, and characterize the variety, quality, and intent of the health economics and outcomes research studies being conducted in India. Materials and Methods: Studies published in English language between 1999 and 2012 were retrieved from Embase and PubMed databases using relevant search strategies. Two researchers independently reviewed the studies as per Cochrane methodology; information on the type of research and the outcomes were extracted. Quality of reporting was assessed for model-based health economic studies using a published 100-point Quality of Health Economic Studies (QHES) instrument. Results: Of 546 studies screened, 132 were included in the review. The broad study categories were cost-effectiveness analyses [(CEA) 54 studies], cost analyses (19 studies), and burden of illness [(BOI) 18 studies]. The outcomes evaluated were direct and indirect costs, and incremental cost-effectiveness ratio (ICER), quality-adjusted life years (QALYs), and disability-adjusted life years (DALYs). Direct medical costs assessed cost of medicines, monitoring costs, consultation and hospital charges, along with direct non-medical costs (travel and food for patients and care givers). Loss of productivity and loss of income of patients and care givers were identified as the components of indirect cost. Overall, 33 studies assessed the quality of life (QoL), and the WHO Quality of Life-BREF (WHOQOL-BREF) was the most commonly used instrument. Quality assessment for modeling studies showed that most studies were of high quality [mean (range) QHES score to be 75.5 (34-93)]. Conclusions: This review identified various patterns of pharmacoeconomic studies and good-quality CEA studies. However, there is a need for better assessment of utilization of healthcare resources in India.
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Affiliation(s)
- Divya Mishra
- Associate Medical Director, Oncology, Asia Medical Sciences Group, Quintiles Research (India) Private Limited (QRPL), New Delhi, India
| | - Sunita R Nair
- Head, Knowledge Services, Capita India Private Limited, Mumbai, Maharashtra, India
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Moodley J. Women's mental health: coping mechanisms in the context of poverty. JOURNAL OF PSYCHOLOGY IN AFRICA 2014. [DOI: 10.1080/14330237.2014.906078] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Jacqueline Moodley
- Centre for Social Development in Africa, University of Johannesburg, Johannesburg, South Africa
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Lee SJ, Li L, Lin C, Tuan LA. Challenges facing HIV-positive persons who use drugs and their families in Vietnam. AIDS Care 2014; 27:283-7. [PMID: 25285396 DOI: 10.1080/09540121.2014.963015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
It is hypothesized that persons who use drugs (PWUD) in Vietnam who are also HIV-positive may face additional challenges in psychosocial outcomes, and these challenges may extend to their family members. In this study, we examined depressive symptoms, stigma, social support, and caregiver burden of HIV-positive PWUD and their family members, compared to the outcomes of HIV-negative PWUD and their family members. Baseline, 3-month, and 6-month assessment data were gathered from 83 PWUD and 83 family members recruited from four communes in Phú Thọ Province, Vietnam. For PWUD, although we observed a general decline in overall stigma over time for both groups, HIV-positive PWUD consistently reported significantly higher overall stigma for all three periods. Depressive symptoms among family members in both groups declined over time; however, family members of HIV-positive PWUD reported higher depressive symptoms across all three periods. In addition, family members of HIV-positive PWUD reported lower levels of tangible support across all three periods. Caregiver burden among family members of HIV-positive PWUD increased significantly over time, whereas the reported burden among family members of HIV-negative PWUD remained relatively unchanged. The findings highlight the need for future interventions for PWUD and family members, with targeted and culturally specific strategies to focus on the importance of addressing additional stigma experienced by PWUD who are HIV-positive. Such challenges may have direct negative impact on their family members' depressive symptoms, tangible support, and caregiver burden.
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Affiliation(s)
- Sung-Jae Lee
- a Semel Institute for Neuroscience and Human Behavior, Center for Community Health , University of California , Los Angeles , CA , USA
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Li L, Hien NT, Liang LJ, Lin C, Tuan NA. Correlated outcomes of a pilot intervention for people injecting drugs and their family members in Vietnam. Drug Alcohol Depend 2014; 134:348-354. [PMID: 24305572 PMCID: PMC3881285 DOI: 10.1016/j.drugalcdep.2013.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 11/01/2013] [Accepted: 11/02/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND The interrelationship between the well-being of injecting drug users (IDUs) and their family environment has been widely documented. However, few intervention programs have addressed the needs of both IDUs and their family members. METHODS This study describes a randomized intervention pilot targeting 83 IDUs and 83 of their family members from four communes in Phú Thọ province, Vietnam. The IDUs and family members in the intervention condition received multiple group sessions, with the intent to improve psychological well-being and family relationships. The intervention outcomes (depressive symptoms and family relations) were evaluated at baseline, 3-month and 6-month follow-up assessments. RESULTS Depressive symptoms and family relations reported by IDUs were found to be correlated to those reported by their family members. Overall, significant intervention effects on depressive symptoms and family relations were observed for both IDUs and family members. A similar improvement pattern in family relations emerged for both the IDU and family member samples, although the intervention effect of reducing depressive symptoms was more sustainable for family members at the 6-month assessment when compared to the IDU sample. CONCLUSION The intervention pilot addressed challenges faced by IDUs and their family members and revealed correlated outcomes for the two groups. Findings suggest a vital need to include family members in future drug prevention and harm reduction intervention efforts.
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Affiliation(s)
- Li Li
- Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California, 10920 Wilshire Blvd., Suite 350, Los Angeles, CA 90024, USA.
| | - Nguyen Tran Hien
- National Institute of Hygiene and Epidemiology, 1 Yersin, Hanoi 10000, Vietnam
| | - Li-Jung Liang
- Department of Medicine Statistics Core, University of California, 911 Broxton Ave., Los Angeles, CA 90095, U.S.A
| | - Chunqing Lin
- Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California, 10920 Wilshire Blvd., Suite 350, Los Angeles, CA 90024, U.S.A
| | - Nguyen Anh Tuan
- National Institute of Hygiene and Epidemiology, 1 Yersin, Hanoi 10000, Vietnam
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van Ginneken N, Tharyan P, Lewin S, Rao GN, Meera SM, Pian J, Chandrashekar S, Patel V. Non-specialist health worker interventions for the care of mental, neurological and substance-abuse disorders in low- and middle-income countries. Cochrane Database Syst Rev 2013:CD009149. [PMID: 24249541 DOI: 10.1002/14651858.cd009149.pub2] [Citation(s) in RCA: 284] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Many people with mental, neurological and substance-use disorders (MNS) do not receive health care. Non-specialist health workers (NSHWs) and other professionals with health roles (OPHRs) are a key strategy for closing the treatment gap. OBJECTIVES To assess the effect of NSHWs and OPHRs delivering MNS interventions in primary and community health care in low- and middle-income countries. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (including the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register) (searched 21 June 2012); MEDLINE, OvidSP; MEDLINE In Process & Other Non-Indexed Citations, OvidSP; EMBASE, OvidSP (searched 15 June 2012); CINAHL, EBSCOhost; PsycINFO, OvidSP (searched 18 and 19 June 2012); World Health Organization (WHO) Global Health Library (searched 29 June 2012); LILACS; the International Clinical Trials Registry Platform (WHO); OpenGrey; the metaRegister of Controlled Trials (searched 8 and 9 August 2012); Science Citation Index and Social Sciences Citation Index (ISI Web of Knowledge) (searched 2 October 2012) and reference lists, without language or date restrictions. We contacted authors for additional studies. SELECTION CRITERIA Randomised and non-randomised controlled trials, controlled before-and-after studies and interrupted-time-series studies of NSHWs/OPHR-delivered interventions in primary/community health care in low- and middle-income countries, and intended to improve outcomes in people with MNS disorders and in their carers. We defined an NSHW as any professional health worker (e.g. doctors, nurses and social workers) or lay health worker without specialised training in MNS disorders. OPHRs included people outside the health sector (only teachers in this review). DATA COLLECTION AND ANALYSIS Review authors double screened, double data-extracted and assessed risk of bias using standard formats. We grouped studies with similar interventions together. Where feasible, we combined data to obtain an overall estimate of effect. MAIN RESULTS The 38 included studies were from seven low- and 15 middle-income countries. Twenty-two studies used lay health workers, and most addressed depression or post-traumatic stress disorder (PTSD). The review shows that the use of NSHWs, compared with usual healthcare services: 1. may increase the number of adults who recover from depression or anxiety, or both, two to six months after treatment (prevalence of depression: risk ratio (RR) 0.30, 95% confidence interval (CI) 0.14 to 0.64; low-quality evidence); 2. may slightly reduce symptoms for mothers with perinatal depression (severity of depressive symptoms: standardised mean difference (SMD) -0.42, 95% CI -0.58 to -0.26; low-quality evidence); 3. may slightly reduce the symptoms of adults with PTSD (severity of PTSD symptoms: SMD -0.36, 95% CI -0.67 to -0.05; low-quality evidence); 4. probably slightly improves the symptoms of people with dementia (severity of behavioural symptoms: SMD -0.26, 95% CI -0.60 to 0.08; moderate-quality evidence); 5. probably improves/slightly improves the mental well-being, burden and distress of carers of people with dementia (carer burden: SMD -0.50, 95% CI -0.84 to -0.15; moderate-quality evidence); 6. may decrease the amount of alcohol consumed by people with alcohol-use disorders (drinks/drinking day in last 7 to 30 days: mean difference -1.68, 95% CI -2.79 to -0.57); low-quality evidence).It is uncertain whether lay health workers or teachers reduce PTSD symptoms among children. There were insufficient data to draw conclusions about the cost-effectiveness of using NSHWs or teachers, or about their impact on people with other MNS conditions. In addition, very few studies measured adverse effects of NSHW-led care - such effects could impact on the appropriateness and quality of care. AUTHORS' CONCLUSIONS Overall, NSHWs and teachers have some promising benefits in improving people's outcomes for general and perinatal depression, PTSD and alcohol-use disorders, and patient- and carer-outcomes for dementia. However, this evidence is mostly low or very low quality, and for some issues no evidence is available. Therefore, we cannot make conclusions about which specific NSHW-led interventions are more effective.
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Affiliation(s)
- Nadja van Ginneken
- Centre for Global Mental Health, London School of Hygiene & Tropical Medicine, Keppel St, London, UK, WC1E 7HT
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Goujon N, Devine A, Baker SM, Sprunt B, Edmonds TJ, Booth JK, Keeffe JE. A comparative review of measurement instruments to inform and evaluate effectiveness of disability inclusive development. Disabil Rehabil 2013; 36:804-12. [PMID: 23930646 DOI: 10.3109/09638288.2013.821178] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE A review of existing measurement instruments was conducted to examine their suitability to measure disability prevalence and assess quality of life, protection of disability rights and community participation by people with disabilities, specifically within the context of development programs in low and middle-income countries. METHODS From a search of PubMed and the grey literature, potentially relevant measurement instruments were identified and examined for their content and psychometric properties, where possible. Criteria for inclusion were: based on the WHO's International Classification of Functioning Disability and Health (ICF), used quantitative methods, suitable for population-based studies of disability inclusive development in English and published after 1990. Characteristics of existing instruments were analysed according to components of the ICF and quality of life domains. RESULTS Ten instruments were identified and reviewed according to the criteria listed above. Each version of instruments was analysed separately. Only three instruments included a component on quality of life. Domains from the ICF that were addressed by some but not all instruments included the environment, technology and communication. CONCLUSION The measurement instruments reviewed covered the range of elements required to measure disability-inclusion within development contexts. However no single measurement instrument has the capacity to measure both disability prevalence and changes in quality of life according to contemporary disability paradigms. The review of measurement instruments supports the need for developing an instrument specifically intended to measure disability inclusive practice within development programs. Implications for Rehabilitation Surveys and tools are needed to plan disability inclusive development. Existing measurement tools to determine prevalence of disability, wellbeing, rights and access to the community were reviewed. No single validated tool exists for population-based studies, uses quantitative methods and the components of the ICF to measure prevalence of disability, well-being of people with disability and their access to their communities. A measurement tool that reflects the UNCRPD and addresses all components of the ICF is needed to assist in disability inclusive development, especially in low and mid resource countries.
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Affiliation(s)
- Nicolas Goujon
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne , East Melbourne, VIC , Australia and
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15
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Meeting the needs of women who use drugs and alcohol in North-east India - a challenge for HIV prevention services. BMC Public Health 2012; 12:825. [PMID: 23013114 PMCID: PMC3490718 DOI: 10.1186/1471-2458-12-825] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 09/24/2012] [Indexed: 12/04/2022] Open
Abstract
Background The North-east Indian states of Manipur and Nagaland consistently report relatively high HIV prevalence. The targeted HIV prevention interventions in these two states are mostly delivered by non-government organizations (NGOs), and prevention of HIV transmission by injecting drug use is their main focus. Most injecting drug users (IDUs) are male, and the services are primarily tailored to meet their needs, which are not necessarily the same as those for women. This qualitative study describes the health service needs of women who use drugs and alcohol in Manipur and Nagaland, with the goal of identifying strategies and activities that can be implemented by NGOs wanting to improve their reach among vulnerable women. Methods In 2009-10, semi-structured in-depth interviews were conducted with 27 key informants and nine focus group discussions (FGDs) with women who use drugs and alcohol, and two FGDs with male IDUs. The thematic areas covered included: the context of female drug and alcohol use; drug and alcohol use patterns; HIV risk behaviours; barriers and facilitators of service use; perceived health needs; and expressed health service needs. The data were recorded, transcribed, translated and thematically analysed. Results The most problematic substance for women from Nagaland was alcohol, and for women from Manipur it was heroin. The most commonly identified health problems were primarily related to the women’s drug and alcohol use, reproductive health and mental health. Other problems of major concern included social exclusion, violence, children’s welfare, and financial difficulties. The expressed service needs of these women were women-only integrated health services, women-only detoxification and rehabilitation services, mental health services, desensitization of mainstream health workers, free access to medicines, assistance to meet basic needs, and a safe place for engaging in sex work. Conclusion The expressed health and other service needs of women who use drugs and alcohol in Manipur and Nagaland do not match the services currently provided by HIV prevention NGOs, and this may, in part, account for the relatively poor uptake of these services by women. Strategies and activities that can be implemented by NGOs to strengthen their reach to vulnerable women are identified. However, many of these women’s needs are beyond the scope of services typically offered by HIV prevention NGOs, and require a coordinated multi-sectoral response.
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Nyamathi A, Salem BE, Meyer V, Ganguly KK, Sinha S, Ramakrishnan P. Impact of an Asha intervention on depressive symptoms among rural women living with AIDS in India: comparison of the Asha-Life and Usual Care program. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2012; 24:280-293. [PMID: 22676466 PMCID: PMC3677948 DOI: 10.1521/aeap.2012.24.3.280] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The purpose of this randomized pilot study is to conduct an intervention with 68 rural women living with AIDS to compare the effectiveness of two different programs on depressive symptoms. The trial was designed to assess the impact of the Asha-Life intervention engaging with an HIV-trained village woman, Asha (Accredited Social Health Activist), to participate in the care of women living with AIDS (WLA), along with other health care providers compared to a Usual Care group. Two high prevalence HIV/AIDS villages in rural Andhra Pradesh, which were demographically alike and served by distinct Public Health Centers, were selected randomly from a total of 16 villages. The findings of this study demonstrated that the Asha-Life participants significantly reduced their depressive symptom scores compared to the Usual Care participants. Moreover, women living with AIDS who demonstrated higher depressive symptom scores at baseline had greater reduction in their depressive symptoms than women with lower scores.
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Affiliation(s)
- Adeline Nyamathi
- School of Nursing, Room 2-250, Factor Building, Los Angeles, CA 90095-1702, USA.
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Das S, Leibowitz GS. Mental health needs of people living with HIV/AIDS in India: a literature review. AIDS Care 2010; 23:417-25. [DOI: 10.1080/09540121.2010.507752] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Shankar Das
- a Center for Health and Social Sciences, Tata Institute of Social Sciences, School of Health Systems Studies , Mumbai , India
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Mental health promotion for the widows of injecting drug users in north-east India. Int Psychiatry 2009; 6:73-74. [PMID: 31508000 PMCID: PMC6734909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The prevalence of HIV is high in the north-east Indian states of Manipur and Nagaland. The major route of HIV transmission is injecting drug use. Most injecting drug users (IDUs) are male and about 40% are married. The widows of IDUs are among the most disadvantaged people. Many are HIV-infected and experiencing poverty, poor health, social isolation and discrimination, all factors likely to compromise their mental health. Some widows are engaging in HIV risk behaviours, including alcohol and drug misuse, sex work and unprotected sex. There is increasing recognition of the links between poverty and mental health status and risk of HIV infection. People with poor mental health are more likely to engage in HIV risk behaviours.
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Herrman H, Kermode M, Devine A, Chandra P. Mental health promotion for the widows of injecting drug users in north-east India. Int Psychiatry 2009. [DOI: 10.1192/s1749367600000655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The prevalence of HIV is high in the north-east Indian states of Manipur and Nagaland. The major route of HIV transmission is injecting drug use. Most injecting drug users (IDUs) are male and about 40% are married. The widows of IDUs are among the most disadvantaged people. Many are HIV-infected and experiencing poverty, poor health, social isolation and discrimination, all factors likely to compromise their mental health. Some widows are engaging in HIV risk behaviours, including alcohol and drug misuse, sex work and unprotected sex. There is increasing recognition of the links between poverty and mental health status and risk of HIV infection. People with poor mental health are more likely to engage in HIV risk behaviours.
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