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Xiang D, Xia X, Liang D. Developing and evaluating an interprofessional shared decision-making care model for patients with perinatal depression in maternal care in urban China: a study protocol. BMC PRIMARY CARE 2023; 24:230. [PMID: 37919671 PMCID: PMC10623702 DOI: 10.1186/s12875-023-02179-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 10/11/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND The majority of patients with perinatal depression (PND) in China do not receive adequate treatment. As forming a therapeutic alliance with patients is crucial for depression treatment, shared decision-making (SDM) shows promise in promoting patients' uptake of evidence-based mental health services, but its impact on patient outcomes and implementation in real-world maternal care remain uncertain. Therefore, this study aims to develop and evaluate an interprofessional shared decision-making (IP-SDM) model for PND to enhance maternal mental health services. METHODS This study contains four research phases: feasibility testing (Phase 1), toolkit development (Phase 2), usability evaluation (Phase 3), and effectiveness evaluation (Phase 4). During the development stage, focus group interviews will be conducted with expectant and new mothers, as well as maternal care providers for feasibility testing. A toolkit, including a patient decision aid along with its user guide and training materials, will be developed based on the findings of Phase 1 and syntheses of up-to-date evidence and appraised by the Delphi method. Additionally, a cognitive task analysis will be used for assessing the usability of the toolkit. During the evaluation stage, a prospective randomized controlled trial embedded in a mixed methods design will be used to evaluate the effectiveness and cost-effectiveness of the IP-SDM care model. The study targets to recruit 410 expectant and new mothers who screen positive for depression. They will be randomly assigned to either an intervention group or a control group in a 1:1 ratio. Participants in the intervention group will receive decision aid, decision coaching, and clinical consultation, in addition to usual services, while the control group will receive usual services. The primary outcome is the quality of decision-making process, and the secondary outcomes include SDM, mental health service utilization and costs, depressive symptoms, and health-related quality of life. In-depth interviews will be used to explore the facilitating and hindering factors of SDM. DISCUSSION This study will develop an IP-SDM care model for PND that can be implemented in maternal care settings in China. This study will contribute to the understanding of how SDM impacts mental health outcomes and facilitate the integration of mental health services into maternal care. TRIAL REGISTRATION ChiCTR2300072559. Registered on 16 June 2023.
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Affiliation(s)
- Defang Xiang
- School of Public Health, National Health Commission Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Xian Xia
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.
| | - Di Liang
- School of Public Health, National Health Commission Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China.
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Ambikile JS, Iseselo MK. Challenges to the provision of home care and support for people with severe mental illness: Experiences and perspectives of patients, caregivers, and healthcare providers in Dar es Salaam, Tanzania. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001518. [PMID: 36963044 PMCID: PMC10021743 DOI: 10.1371/journal.pgph.0001518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/02/2023] [Indexed: 06/18/2023]
Abstract
A balance between hospital-based and community-based services is needed to effectively provide mental health services for people with mental illness. As an essential part of community mental health services, home-based care plays an important role in meeting patients' needs, and should, therefore, be appropriately provided. To achieve this, there is a need to understand the challenges faced and take relevant actions to address them. This study aimed to explore challenges to home care and support for people with mental illness in Temeke district, Dar es Salaam. We used a descriptive qualitative study approach to explore challenges to home care and support for people with mental illness among patients, their caregivers, and healthcare providers. The purposeful sampling method was used to recruit participants at Temeke hospital, data was collected using in-depth interviews and focus group discussions, and analysis was performed using a content analysis framework. Four main themes highlighting challenges encountered in the provision of home care and support for individuals with mental illness were revealed. They include poor understanding of mental illness, abandonment of patients' care responsibilities, disputes over preferred treatment, and lack of outreach services for mental health. Participants also provided suggestions to improve home care and support for people with mental illness. Home care for people with mental illness is affected by poor knowledge of the mental illness, social stigma, and lack of outreach visits. There is a need for the provision of health education regarding mental illness, stigma reduction programs, and funding and prioritization for outreach home visits to improve home care and support for people with mental illness. Further research is needed to determine the magnitude of these challenges and factors that can facilitate the provision of support in similar settings.
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Affiliation(s)
- Joel Seme Ambikile
- Department of Clinical Nursing, Muhimbili University of Health & Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Masunga K. Iseselo
- Department of Clinical Nursing, Muhimbili University of Health & Allied Sciences (MUHAS), Dar es Salaam, Tanzania
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Luo BA, Li S, Chen S, Qin LL, Chen YW, Shu ML, Liao XY. Mental health resources and its equity in Central South of China: A case study of Hunan Province. PLoS One 2022; 17:e0272073. [PMID: 36223340 PMCID: PMC9555637 DOI: 10.1371/journal.pone.0272073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 07/12/2022] [Indexed: 11/06/2022] Open
Abstract
Objectives Mental health resources are an important basis for coping with mental health services. The equity is an important index of a reasonable allocation of health resources. This study aims to evaluate the mental health resources and its equity allocation in Hunan Province, which is one of the typical central south areas of China, so as to provide reference for the development of mental health in China and other areas. Methods Data related to mental health resources was obtained from the Project of Mental Health Resources in Hunan Province, which was conducted by the Department of Hunan Mental Health Center in 2019. The Gini coefficient, the Theil index and other indicators were employed to quantitatively evaluate the equity of mental health resources’ allocation. Results By the end of 2018, there were a total of 141 mental health institutions in Hunan Province of China, the bed density was 5.31 beds per 10,000 people, the ratio of doctors to nurses was 2.20, the number of outpatients of mental health institutions was 1288,047 per year. The mental health resources’ allocation in terms of demographic dimension were in a preferred status with the Gini values all less than 0.3, and the Gini values for mental health resources`allocation in terms of geographical dimension ranged from 0.24 to 0.35. The Theil index for mental health allocation in terms of demographic dimension was lower than 0.05, and the Theil index for mental health allocation in terms of geographical dimension ranged from 0.04 to 0.11. Conclusions The shortage of mental health resources is still the priority issue to be increased and optimized by policy-makers in Hunan in the future, especially the human resources. Moreover, the utilization of mental health resources was low though its equity was fair. Policy-makers need to consider the high utilization and geographical accessibility of health resources among different regions to ensure people in different regions could get access to available health services.
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Affiliation(s)
- Bang-An Luo
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
- Department of Mental Health, Brain Hospital of Hunan Province, Changsha, Hunan, China
| | - Sheng Li
- Department of Social Medicine and Health Management, School of Medicine, Hunan Normal University, Changsha, China
| | - Si Chen
- Department of Social Medicine and Health Management, School of Medicine, Hunan Normal University, Changsha, China
| | - Lu-Lu Qin
- Department of Social Medicine and Health Management, School of Medicine, Hunan Normal University, Changsha, China
- * E-mail: (LLQ); (YWC)
| | - Yi-Wei Chen
- Department of Neurology, Xiangya Third Hospital, Central South University, Changsha, China
- * E-mail: (LLQ); (YWC)
| | - Man-Ling Shu
- Department of Social Medicine and Health Management, School of Medicine, Hunan Normal University, Changsha, China
| | - Xin-Yi Liao
- Department of Social Medicine and Health Management, School of Medicine, Hunan Normal University, Changsha, China
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Kohrt BA, Turner EL, Gurung D, Wang X, Neupane M, Luitel NP, Kartha MR, Poudyal A, Singh R, Rai S, Baral PP, McCutchan S, Gronholm PC, Hanlon C, Lempp H, Lund C, Thornicroft G, Gautam K, Jordans MJD. Implementation strategy in collaboration with people with lived experience of mental illness to reduce stigma among primary care providers in Nepal (RESHAPE): protocol for a type 3 hybrid implementation effectiveness cluster randomized controlled trial. Implement Sci 2022; 17:39. [PMID: 35710491 PMCID: PMC9205129 DOI: 10.1186/s13012-022-01202-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 04/10/2022] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND There are increasing efforts for the integration of mental health services into primary care settings in low- and middle-income countries. However, commonly used approaches to train primary care providers (PCPs) may not achieve the expected outcomes for improved service delivery, as evidenced by low detection rates of mental illnesses after training. One contributor to this shortcoming is the stigma among PCPs. Implementation strategies for training PCPs that reduce stigma have the potential to improve the quality of services. DESIGN In Nepal, a type 3 hybrid implementation-effectiveness cluster randomized controlled trial will evaluate the implementation-as-usual training for PCPs compared to an alternative implementation strategy to train PCPs, entitled Reducing Stigma among Healthcare Providers (RESHAPE). In implementation-as-usual, PCPs are trained on the World Health Organization Mental Health Gap Action Program Intervention Guide (mhGAP-IG) with trainings conducted by mental health specialists. In RESHAPE, mhGAP-IG training includes the added component of facilitation by people with lived experience of mental illness (PWLE) and their caregivers using PhotoVoice, as well as aspirational figures. The duration of PCP training is the same in both arms. Co-primary outcomes of the study are stigma among PCPs, as measured with the Social Distance Scale at 6 months post-training, and reach, a domain from the RE-AIM implementation science framework. Reach is operationalized as the accuracy of detection of mental illness in primary care facilities and will be determined by psychiatrists at 3 months after PCPs diagnose the patients. Stigma will be evaluated as a mediator of reach. Cost-effectiveness and other RE-AIM outcomes will be assessed. Twenty-four municipalities, the unit of clustering, will be randomized to either mhGAP-IG implementation-as-usual or RESHAPE arms, with approximately 76 health facilities and 216 PCPs divided equally between arms. An estimated 1100 patients will be enrolled for the evaluation of accurate diagnosis of depression, generalized anxiety disorder, psychosis, or alcohol use disorder. Masking will include PCPs, patients, and psychiatrists. DISCUSSION This study will advance the knowledge of stigma reduction for training PCPs in partnership with PWLE. This collaborative approach to training has the potential to improve diagnostic competencies. If successful, this implementation strategy could be scaled up throughout low-resource settings to reduce the global treatment gap for mental illness. TRIAL REGISTRATION ClinicalTrials.gov, NCT04282915 . Date of registration: February 25, 2020.
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Affiliation(s)
- Brandon A. Kohrt
- grid.253615.60000 0004 1936 9510Division of Global Mental Health, Department of Psychiatry, George Washington University, Washington D.C., USA
| | - Elizabeth L. Turner
- grid.26009.3d0000 0004 1936 7961Department of Biostatistics and Bioinformatics and Duke Global Health Institute, Duke University, Durham, NC USA
| | - Dristy Gurung
- Transcultural Psychosocial Organization Nepal (TPO Nepal), Pokhara, Nepal
| | - Xueqi Wang
- grid.26009.3d0000 0004 1936 7961Department of Biostatistics and Bioinformatics and Duke Global Health Institute, Duke University, Durham, NC USA
| | - Mani Neupane
- Transcultural Psychosocial Organization Nepal (TPO Nepal), Pokhara, Nepal
| | - Nagendra P. Luitel
- Transcultural Psychosocial Organization Nepal (TPO Nepal), Kathmandu, Nepal
| | - Muralikrishnan R. Kartha
- grid.13097.3c0000 0001 2322 6764King’s Health Economics, IOPPN, King’s College London, London, UK
| | - Anubhuti Poudyal
- grid.21729.3f0000000419368729Department of Sociomedical Sciences, Columbia University, New York, NY USA ,grid.253615.60000 0004 1936 9510Division of Global Mental Health, Department of Psychiatry, George Washington University, Washington, D.C., 20036 USA
| | - Ritika Singh
- grid.253615.60000 0004 1936 9510Division of Global Mental Health, Department of Psychiatry, George Washington University, Washington, D.C., 20036 USA
| | - Sauharda Rai
- grid.34477.330000000122986657Jackson School of International Studies and Department of Global Health, University of Washington, Seattle, USA
| | - Phanindra Prasad Baral
- grid.500537.4Non-communicable Disease and Mental Health Section, Epidemiology and Disease Control Division (EDCD), Department of Health Services (DoHS), Ministry of Health and Population (MoHP), Kathmandu, Nepal
| | - Sabrina McCutchan
- grid.26009.3d0000 0004 1936 7961Duke Global Health Institute, Duke University, Durham, NC USA
| | - Petra C. Gronholm
- grid.13097.3c0000 0001 2322 6764Centre for Global Mental Health and Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Charlotte Hanlon
- grid.13097.3c0000 0001 2322 6764Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK ,grid.7123.70000 0001 1250 5688Department of Psychiatry, School of Medicine and Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Heidi Lempp
- grid.13097.3c0000 0001 2322 6764Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, UK
| | - Crick Lund
- grid.13097.3c0000 0001 2322 6764Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK ,grid.7836.a0000 0004 1937 1151Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Graham Thornicroft
- grid.13097.3c0000 0001 2322 6764Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Kamal Gautam
- Transcultural Psychosocial Organization Nepal (TPO Nepal), Kathmandu, Nepal
| | - Mark J. D. Jordans
- grid.13097.3c0000 0001 2322 6764Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, Center for Global Mental Health, King’s College London, London, UK
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What factors influence engagement with primary mental health care services? A qualitative study of service user perspectives in rural communities of Mexico. SSM - MENTAL HEALTH 2022. [DOI: 10.1016/j.ssmmh.2022.100125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Mbwayo A, Kumar M, Mathai M, Mutavi T, Nungari J, Gathara R, McKay M, Ssewamala F, Hoagwood K, Petersen I, Bhana A, Huang KY. Strengthening System and Implementation Research Capacity for Child Mental Health and Family Well-being in Sub-Saharan Africa. GLOBAL SOCIAL WELFARE : RESEARCH, POLICY & PRACTICE 2022; 9:37-53. [PMID: 35330916 PMCID: PMC8939896 DOI: 10.1007/s40609-021-00204-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/05/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Children in Sub-Saharan Africa (SSA) experience high rates of mental health problems, and the region has limited access to mental health resources and research capacity to address the needs. Despite the success of numerous evidence-based interventions (EBIs) and emerging methodology from the field of implementation science for addressing child mental health needs, most EBIs and implementation science methodology have not been applied in SSA contexts. The SMART-Africa Center aims to address these child welfare, mental health, services, and EBI implementation research gaps by establishing a regional trans-disciplinary collaborative center and studying strategies to strengthening mental health system and implementation research capacity. Our paper describes the overall framework and strategies that SMART-Africa team developed to strengthen capacity in three SSA countries (Ghana, Kenya, and Uganda) while focusing on its contextualization for the Kenyan school-community mental health settings. Methods to document the progress and impacts are also described. METHODS The design of the system and research strengthening activities is guided by a SMART-Africa Capacity Building framework. Two areas of capacity are focused. Mental health system capacity focuses on building political wills, leadership, transdisciplinary partnership, and stakeholders' global competency in evidence child mental health policy, intervention, and service implementation research. Implementation research capacity building focuses on building researchers' implementation research competency by carrying out an EBI implementation research (using a Hybrid Type II effectiveness-implementation). For illustration purpose, we describe how the system strengthening strategies has been applied in Kenya, and how the mixed methods design applied to assess the value and impacts of the capacity building activities. Feedback data and evaluation data collection using qualitative and quantitative methods for both areas of capacity building are still ongoing. Data will be analyzed and compared across countries in 2020-2021. CONCLUSION Our work has shown some feasibility of applying the theory-guided system strengthening model in improving child mental health service system and research capacity in one of the three SMART-Africa partnering countries. Our mental health landscape and resource mapping in Kenya also illustrated that capacity building in SSA countries involved complex dynamic, history, and some overlap efforts with multiple partnerships, and these are critical to consider in training activity and evaluation design.
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Affiliation(s)
- Anne Mbwayo
- University of Nairobi, Department of Psychiatry, Nairobi, Kenya
| | - Manasi Kumar
- University of Nairobi, Department of Psychiatry, Nairobi, Kenya
| | - Muthoni Mathai
- University of Nairobi, Department of Psychiatry, Nairobi, Kenya
| | - Teresia Mutavi
- University of Nairobi, Department of Psychiatry, Nairobi, Kenya
| | | | | | - Mary McKay
- Washington University in St. Louis, St. Louis, USA
| | | | | | | | - Arvin Bhana
- South African Medical Research Council, Cape Town, South Africa
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Abujaber N, Vallières F, McBride KA, Sheaf G, Blum PT, Wiedemann N, Travers Á. Examining the evidence for best practice guidelines in supportive supervision of lay health care providers in humanitarian emergencies: A systematic scoping review. J Glob Health 2022; 12:04017. [PMID: 35265328 PMCID: PMC8876157 DOI: 10.7189/jogh.12.04017] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Nadeen Abujaber
- Trinity Centre for Global Health, School of Psychology, Trinity College Dublin, College Green, Dublin, Ireland
| | - Frédérique Vallières
- Trinity Centre for Global Health, School of Psychology, Trinity College Dublin, College Green, Dublin, Ireland
| | - Kelly A McBride
- International Federation of Red Cross and Red Crescent Societies, Copenhagen, Denmark
| | - Greg Sheaf
- Trinity Centre for Global Health, School of Psychology, Trinity College Dublin, College Green, Dublin, Ireland
| | - Pia Tingsted Blum
- International Federation of Red Cross and Red Crescent Societies, Copenhagen, Denmark
| | - Nana Wiedemann
- International Federation of Red Cross and Red Crescent Societies, Copenhagen, Denmark
| | - Áine Travers
- Trinity Centre for Global Health, School of Psychology, Trinity College Dublin, College Green, Dublin, Ireland
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Kohrt BA, Jordans MJD, Turner EL, Rai S, Gurung D, Dhakal M, Bhardwaj A, Lamichhane J, Singla DR, Lund C, Patel V, Luitel NP, Sikkema KJ. Collaboration With People With Lived Experience of Mental Illness to Reduce Stigma and Improve Primary Care Services: A Pilot Cluster Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2131475. [PMID: 34730821 PMCID: PMC8567115 DOI: 10.1001/jamanetworkopen.2021.31475] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
IMPORTANCE Collaboration with people with lived experience of mental illness (PWLE), also referred to as service users, is a growing priority to reduce stigma and improve mental health care. OBJECTIVE To examine feasibility and acceptability of conducting an antistigma intervention in collaboration with PWLE during mental health training of primary care practitioners (PCPs). DESIGN, SETTING, AND PARTICIPANTS This pilot cluster randomized clinical trial was conducted from February 7, 2016, to August 10, 2018, with assessors, PCPs, and patients blinded to group assignment. The participants were PCPs and primary care patients diagnosed with depression, psychosis, or alcohol use disorder at primary care facilities (the cluster unit of randomization) in Nepal. Statistical analysis was performed from February 2020 to February 2021. INTERVENTIONS In the control group, PCPs were trained on the World Health Organization Mental Health Gap Action Programme-Intervention Guide (mhGAP-IG). In the Reducing Stigma Among Healthcare Providers (RESHAPE) group, the mhGAP-IG trainings for PCPs were cofacilitated by PWLE who presented recovery testimonials through photographic narratives. MAIN OUTCOMES AND MEASURES Prespecified feasibility and acceptability measures were adequacy of randomization, retention rates, intervention fidelity, data missingness, and safety. Outcome measures for PCPs included the Social Distance Scale (SDS), accuracy of diagnoses of mental illness in standardized role-plays using the Enhancing Assessment of Common Therapeutic factors tool (ENACT), and accuracy of diagnosis with actual patients. The primary end point was 16 months posttraining. RESULTS Among the overall sample of 88 PCPs, 75 (85.2%) were men and 67 (76.1%) were upper caste Hindus; the mean (SD) age was 36.2 (8.8) years. Nine of the PCPs (10.2%) were physicians, whereas the remaining 79 PCPs (89.8%) were health assistants or auxiliary health workers. Thirty-four facilities were randomized to RESHAPE or the control group. All eligible PCPs participated: 43 in RESHAPE and 45 in the control group, with 76.7% (n = 33) and 73.3% (n = 33) retention at end line, respectively. Due to PCP dropout, 29 facilities (85.3%) were included in end line analysis. Of 15 PWLE trained as cofacilitators, 11 (73.3%) participated throughout the 3 months of PCP trainings. Among PCPs, mean SDS changes from pretraining to 16 months were -10.6 points (95% CI, -14.5 to -6.74 points) in RESHAPE and -2.79 points (-8.29 to 2.70 points) in the control group. Role-play-based diagnoses with ENACT were 78.1% (25 of 32) accurate in RESHAPE and 66.7% (22 of 33) in the control group. Patient diagnoses were 72.5% (29 of 40) accurate by PCPs in RESHAPE compared with 34.5% (10 of 29) by PCPs in the control group. There were no serious adverse events. CONCLUSIONS AND RELEVANCE This pilot cluster randomized clinical trial found that procedures were feasible and acceptable for PCPs to be trained by PWLE. These pilot results will help inform a full trial to evaluate benefits of collaboration with PWLE during training of PCPs to reduce stigma and improve diagnostic accuracy. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02793271.
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Affiliation(s)
- Brandon A. Kohrt
- Department of Psychiatry and Behavioral Sciences, The George Washington University, Washington, DC
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Mark J. D. Jordans
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
- Center for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- University of Amsterdam, Amsterdam, the Netherlands
| | - Elizabeth L. Turner
- Duke Global Health Institute, Duke University, Durham, North Carolina
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | - Sauharda Rai
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
- Jackson School of International Studies, Department of Global Health, University of Washington, Seattle
| | - Dristy Gurung
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
- Center for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Manoj Dhakal
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
- School of Public Health, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Anvita Bhardwaj
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Daisy R. Singla
- Campbell Family Mental Health Research Institute, Centre of Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Lunenfeld Tanenbaum Research Institute, Toronto, Ontario, Canada
| | - Crick Lund
- Center for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts
- Sangath, Goa, India
| | | | - Kathleen J. Sikkema
- Duke Global Health Institute, Duke University, Durham, North Carolina
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York
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Mapping services at two Nairobi County primary health facilities: identifying challenges and opportunities in integrated mental health care as a Universal Health Coverage (UHC) priority. Ann Gen Psychiatry 2021; 20:37. [PMID: 34404421 PMCID: PMC8371839 DOI: 10.1186/s12991-021-00359-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/06/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION There is a need to scale-up mental health service provision in primary health care. The current extent of integration of mental health in primary care is pertinent to promoting and augmenting mental health at this level. We describe a facility mapping exercise conducted in two low-income/primary health facilities in Kenya to identify existing barriers and facilitators in the delivery of mental health services in general and specifically for peripartum adolescents in primary health care as well as available service resources, cadres, and developmental partners on the ground. METHOD AND MEASURES This study utilized a qualitative evidence synthesis through mapping facility-level services and key-stakeholder interviews. Services-related data were collected from two facility in-charges using the Nairobi City County Human Resource Health Strategy record forms. Additionally, we conducted 10 key informant interviews (KIIs) with clinical officers (Clinicians at diploma level), Nurses, Community Health Assistants (CHAs), Prevention of Mother-to-child Transmission of HIV Mentor Mothers (PMTCTMs), around both general and adolescent mental health as well as psychosocial services they offered. Using the World Health Organization Assessments Instrument for Mental Health Systems (WHO-AIMS) as a guideline for the interview, all KII questions were structured to identify the extent of mental health integration in primary health care services. Interview transcripts were then systematically analyzed for common themes and discussed by the first three authors to eliminate discrepancies. RESULTS Our findings show that health care services centered around physical health were offered daily while the mental health services were still vertical, offered weekly through specialist services by the Ministry of Health directly or non-governmental partners. Despite health care workers being aware of the urgent need to integrate mental health services into routine care, they expressed limited knowledge about mental disorders and reported paucity of trained mental health personnel in these sites. Significantly, more funding and resources are needed to provide mental health services, as well as the need for training of general health care providers in the identification and treatment of mental disorders. Our stakeholders underscored the urgency of integrating mental health treatment, prevention, and well-being promotive activities targeting adolescents especially peripartum adolescent girls. CONCLUSION There is a need for further refining of the integrated care model in mental health services and targeted capacity-building for health care providers to deliver quality services.
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Kalimashe L, du Plessis E. Mental healthcare users' self-reported medication adherence and their perception of the nursing presence of registered nurses in primary healthcare. Health SA 2021; 26:1618. [PMID: 34394970 PMCID: PMC8335782 DOI: 10.4102/hsag.v26i0.1618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 06/02/2021] [Indexed: 11/24/2022] Open
Abstract
Background Medication adherence remains a challenge in the management of mental healthcare users (MHCUs), despite it being regarded as crucial for better health outcomes. Nurses at primary healthcare (PHC) facilities can play an important role through nursing presence in enhancing MHCUs’ medication adherence. Aim This article aimed to investigate the relationship between MHCUs’ self-reported medication adherence and their perception of the nursing presence by registered nurses in PHC. Setting An urban health district in Gauteng province, South Africa. Methods A quantitative, descriptive correlational, cross-sectional design was used. The sample included 180 MHCUs. Data were collected using the Medication Adherence Rating Scale and the Presence of Nursing Scale. Results The overall adherence level of respondents was partially adherent, with an average score of 6.45 out of a total score of 10. Respondents also reported a low level of perceived nursing presence demonstrated by registered nurses, with an average score of 72.2 out of 125. The results indicated a positive correlation between respondents’ self-reported medication adherence and their perceived nursing presence of registered nurses as evidenced by the positive value of the correlation coefficient of 0.69 with a corresponding significance probability value of 0.000 (r = 0.69; p = 0.00). Conclusion The level of perceived nursing presence demonstrated by registered nurses played a significant role in influencing MHCUs’ level of medication adherence. The registered nurses can improve MHCUs’ medication adherence by demonstrating nursing presence skills such as good listening skills and taking care of MHCUs as individuals and not as a disease. Contribution The results of this study confirm that there is a correlation between nursing presence and medication adherence. This holds significant value for future research in nursing presence. These findings also provide registered nurses in PHC with a valuable tool to improve medication adherence, namely nursing presence.
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Affiliation(s)
- Lillian Kalimashe
- Department of Health, Faculty of Health Sciences, West Rand Health District, Gauteng Department of Health, Johannesburg, South Africa
| | - Emmerentia du Plessis
- NuMIQ Research Focus Area, Faculty of Health Science, North-West University, Potchefstroom, South Africa
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Mugo C, Seeh D, Guthrie B, Moreno M, Kumar M, John-Stewart G, Inwani I, Ronen K. Association of experienced and internalized stigma with self-disclosure of HIV status by youth living with HIV. AIDS Behav 2021; 25:2084-2093. [PMID: 33389374 PMCID: PMC8768004 DOI: 10.1007/s10461-020-03137-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2020] [Indexed: 01/07/2023]
Abstract
We examined patterns of disclosure among youth living with HIV (YLHIV) in Kenya, and the association between self-disclosure and antiretroviral therapy adherence, stigma, depression, resilience, and social support. Of 96 YLHIV, 78% were female, 33% were ages 14-18, and 40% acquired HIV perinatally. Sixty-three (66%) YLHIV had self-disclosed their HIV status; 67% to family and 43% to non-family members. Older YLHIV were 75% more likely to have self-disclosed than those 14-18 years. Of the 68 either married or ever sexually active, 45 (66%) did not disclose to their partners. Those who had self-disclosed were more likely to report internalized stigma (50% vs. 21%, prevalence ratio [PR] 2.3, 1.1-4.6), experienced stigma (26% vs. 3%, PR 11.0, 1.4-86), and elevated depressive symptoms (57% vs. 30%, PR 1.8, 1.0-3.1). The association with stigma was stronger with self-disclosure to family than non-family. Support should be provided to YLHIV during self-disclosure to mitigate psychosocial harms.
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Affiliation(s)
- Cyrus Mugo
- Department of Research and Programs, Kenyatta National Hospital, P.O. Box 20723-00202, Nairobi, Kenya.
- Department of Epidemiology, University of Washington, Seattle, WA, 98104, USA.
| | - David Seeh
- Department of Research and Programs, Kenyatta National Hospital, P.O. Box 20723-00202, Nairobi, Kenya
| | - Brandon Guthrie
- Department of Global Health, University of Washington, Seattle, WA, 98104, USA
- Department of Epidemiology, University of Washington, Seattle, WA, 98104, USA
| | - Megan Moreno
- School of Medicine and Public Health, University of Wisconsin, Madison, WI, 53705, USA
| | - Manasi Kumar
- Department of Psychiatry, University of Nairobi, P.O. Box 19676-00202, Nairobi, Kenya
| | - Grace John-Stewart
- Department of Global Health, University of Washington, Seattle, WA, 98104, USA
- Department of Epidemiology, University of Washington, Seattle, WA, 98104, USA
- Department of Pediatrics, University of Washington, Seattle, WA, 98104, USA
- Department of Medicine, University of Washington, Seattle, WA, 98104, USA
| | - Irene Inwani
- Department of Pediatrics, Kenyatta National Hospital, P.O. Box 20723-00202, Nairobi, Kenya
| | - Keshet Ronen
- Department of Global Health, University of Washington, Seattle, WA, 98104, USA
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12
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Promoting Recovery in Mental Illness: The Perspectives of Patients, Caregivers, and Community Members in Dar es Salaam, Tanzania. PSYCHIATRY JOURNAL 2020; 2020:3607414. [PMID: 32566637 PMCID: PMC7298341 DOI: 10.1155/2020/3607414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 05/29/2020] [Indexed: 11/18/2022]
Abstract
Background Promoting mental health and care in the community setting leads to the recovery of patients with mental illness. Although recovery in mental health is a complex phenomenon, caregivers and community members have important roles to play in the recovery process for patients with mental illness. Little is documented on how recovery is promoted in the community setting. This study explored the experience of patients, caregivers, and community members on how recovery can be realized in a patient with severe mental illness in Dar es Salaam. Methods We conducted four focus group discussions (FGDs): two with caregivers and the other two with community members. Also, six in-depth interviews were held with patients with mental illness. Participants were purposively selected based on the type of information needed. Both FGD and in-depth interviews were digitally recorded and transcribed. Qualitative content analysis was used to analyze data. Findings. Four themes emerged from this study, which include promoting patients' participation in household activities, improving patients' support system, promoting patients' self-care management, and providing safety and protection among patients with mental illness. However, financial, psychological, and establishing care and support centers and professional supports emerged as subthemes from patients' support system. Conclusion Caregivers and community members are significant stakeholders for promoting recovery for people with mental illness. The current study reveals that patients' involvement in home activities, promoting self-care management, improving patients' support systems, and providing safety and protection are important factors that promote recovery for people with mental illness. Advocating mental health awareness for caregivers and community members will bridge the gap to enhance the recovery for people with mental illness. Further research is needed in this area to explore the health care providers' perspectives on the recovery process of mental illness in the hospital setting.
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Kohrt BA, Turner EL, Rai S, Bhardwaj A, Sikkema KJ, Adelekun A, Dhakal M, Luitel NP, Lund C, Patel V, Jordans MJD. Reducing mental illness stigma in healthcare settings: Proof of concept for a social contact intervention to address what matters most for primary care providers. Soc Sci Med 2020; 250:112852. [PMID: 32135459 PMCID: PMC7429294 DOI: 10.1016/j.socscimed.2020.112852] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 02/08/2020] [Accepted: 02/11/2020] [Indexed: 11/24/2022]
Abstract
Initiatives for integration of mental health services into primary care are underway through the World Health Organization's mental health Gap Action Programme (mhGAP) and related endeavors. However, primary healthcare providers' stigma against persons with mental illness is a barrier to success of these programs. Therefore, interventions are needed to reduce stigma among primary healthcare providers. We developed REducing Stigma among HealthcAre ProvidErs (RESHAPE), a theoretically-grounded intervention that draws upon the medical anthropology conceptual framework of "what matters most." RESHAPE addresses three domains of threats to what matters most: survival, social, and professional. In a proof-of-concept study, mental health service users and aspirational healthcare providers (primary healthcare providers actively incorporating mental health services) were trained to co-facilitate the RESHAPE intervention embedded within mhGAP training in Nepal. Two trainings with the RESHAPE anti-stigma component were held with 41 primary healthcare providers in Nepal. Evaluation of the training included four focus groups and 25 key informant interviews. Stigmatizing attitudes and role play-based clinical competency, assessed with the ENhancing Assessment of Common Therapeutic factors tool (ENACT), were evaluated pre-training and followed-up at four and 16 months. The study was conducted from February 2016 through June 2017. In qualitative interviews, primary healthcare providers described changes in perceptions of violence (survival threats) and the ability to treat mental illness effectively (professional threats). Willingness to interact with a person with mental illness increased from 54% pre-training to 81% at 16 months. Observed clinical competency increased from 49% pre-training to 93% at 16-months. This proof-of-concept study supports reducing stigma by addressing what matters most to healthcare providers, predominantly through mitigating survival and professional threats. Additional efforts are needed to address social threats. These findings support further exploration of service user and aspirational figure involvement in mhGAP trainings based on a "what matters most" conceptual framework.
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Affiliation(s)
- Brandon A Kohrt
- Department of Psychiatry and Behavioral Sciences, The George Washington University, Washington, DC, USA; Duke Global Health Institute, Duke University, Durham, USA.
| | - Elizabeth L Turner
- Duke Global Health Institute, Duke University, Durham, USA; Department of Biostatistics and Bioinformatics, Duke University, Durham, USA.
| | - Sauharda Rai
- Jackson School of International Studies and Department of Global Health, University of Washington, Seattle, USA; Transcultural Psychosocial Organization Nepal TPO - Nepal, Baluwatar, Nepal.
| | - Anvita Bhardwaj
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA.
| | - Kathleen J Sikkema
- Duke Global Health Institute, Duke University, Durham, USA; Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, USA.
| | - Adesewa Adelekun
- Department of Psychiatry, University of California, Los Angeles, USA.
| | - Manoj Dhakal
- Transcultural Psychosocial Organization Nepal TPO - Nepal, Baluwatar, Nepal.
| | - Nagendra P Luitel
- Transcultural Psychosocial Organization Nepal TPO - Nepal, Baluwatar, Nepal.
| | - Crick Lund
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa; Center for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA; Department of Global Health and Population, Harvard TH Chan School of Public Health, Harvard University, Boston, USA; Sangath, Goa, India.
| | - Mark J D Jordans
- Center for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
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Esponda GM, Hartman S, Qureshi O, Sadler E, Cohen A, Kakuma R. Barriers and facilitators of mental health programmes in primary care in low-income and middle-income countries. Lancet Psychiatry 2020; 7:78-92. [PMID: 31474568 DOI: 10.1016/s2215-0366(19)30125-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/11/2019] [Accepted: 03/12/2019] [Indexed: 12/19/2022]
Abstract
Integration of services into primary health care for people with common mental disorders is considered a key strategy to improve access to mental health care in low-income and middle-income countries, yet services at the primary care level are largely unavailable. We did a systematic review to understand the barriers and facilitators in the implementation of mental health programmes. We searched five databases and included studies published between Jan 1, 1990, and Sept 1, 2017, that used qualitative methods to assess the implementation of programmes for adults with common mental disorders at primary health-care settings in low-income and middle-income countries. The Critical Appraisal Skills Programme Qualitative Checklist was used to assess the quality of eligible papers. We used the so-called best fit framework approach to synthesise findings according to the Consolidated Framework for Implementation Research. We identified 24 papers for inclusion. These papers described the implementation of nine programmes in 11 countries. Key factors included: the extent to which an organisation is ready for implementation; the attributes, knowledge, and beliefs of providers; complex service user needs; adaptability and perceived advantage of interventions; and the processes of planning and evaluating the implementation. Evidence on implementation of mental health programmes in low-income and middle-income countries is scarce. Synthesising results according to the Consolidated Framework for Implementation Research helped to identify key areas for future action, including investment in primary health-care strengthening, capacity building for health providers, and increased support to address the social needs of service users.
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Affiliation(s)
- Georgina Miguel Esponda
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
| | - Sarah Hartman
- Clinical Psychology Department, Clark University, Worcester, Massachusetts, MA, USA
| | - Onaiza Qureshi
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Euan Sadler
- Health Service and Population Research Department, King's Improvement Science and Centre for Implementation Science, King's College London, London, UK; Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Alex Cohen
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Ritsuko Kakuma
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Shidhaye R, Murhar V, Muke S, Shrivastava R, Khan A, Singh A, Breuer E. Delivering a complex mental health intervention in low-resource settings: lessons from the implementation of the PRIME mental healthcare plan in primary care in Sehore district, Madhya Pradesh, India. BJPsych Open 2019; 5:e63. [PMID: 31352917 PMCID: PMC6669881 DOI: 10.1192/bjo.2019.53] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The PRogramme for Improving Mental health care (PRIME) designed, implemented and evaluated a comprehensive mental healthcare plan (MHCP) for Sehore district, Madhya Pradesh, India.AimsTo provide quantitative measures of outputs related to implementation processes, describe the role of contextual factors that facilitated and impeded implementation processes, and discuss what has been learned from the MHCP implementation. METHOD A convergent parallel mixed-methods design was used. The quantitative strand consisted of process data on mental health indicators whereas the qualitative strand consisted of in-depth interviews and focus group discussions with key stakeholders involved in PRIME implementation. RESULTS The implementation of the MHCP in Sehore district in Madhya Pradesh, India, demonstrated that it is feasible to establish structures (for example Mann-Kaksha) and operationalise processes to integrate mental health services in a 'real-world' low-resource primary care setting. The key lessons can be summarised as: (a) clear 'process maps' of clinical interventions and implementation steps are helpful in monitoring/tracking the progress; (b) implementation support from an external team, in addition to training of service providers, is essential to provide clinical supervision and address the implementation barriers; (c) the enabling packages of the MHCP play a crucial role in strengthening the health system and improving the context/settings for implementation; and (d) engagement with key community stakeholders and incentives for community health workers are necessary to deliver services at the community-platform level. CONCLUSIONS The PRIME implementation model could be used to scale-up mental health services across India and similar low-resource settings.Declaration of interestNone.
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Affiliation(s)
- Rahul Shidhaye
- Senior Research Scientist and Associate Professor,Center for Chronic Conditions and Injuries, Public Health Foundation of India,India
| | | | | | | | - Azaz Khan
- Intervention Coordinator, PRIME, Sangath,India
| | | | - Erica Breuer
- Alan J Flisher Centre for Public Mental Health,University of Cape Town,South Africa; andConjoint Lecturer,University of Newcastle,Australia
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Mutiso VN, Musyimi CW, Rebello TJ, Ogutu MO, Ruhara R, Nyamai D, Pike KM, Ndetei DM. Perceived impacts as narrated by service users and providers on practice, policy and mental health system following the implementation of the mhGAP-IG using the TEAM model in a rural setting in Makueni County, Kenya: a qualitative approach. Int J Ment Health Syst 2019; 13:56. [PMID: 31423149 PMCID: PMC6693225 DOI: 10.1186/s13033-019-0309-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 08/05/2019] [Indexed: 11/13/2022] Open
Abstract
Background A team approach is key to reduction of the mental health treatment gap. It requires collaborative effort of all formal and informal community based service providers and the consumers of the services. Qualitative evaluations of such an approach add value to the quantitative evaluations. Methods A qualitative study was conducted among 205 participants. These were grouped into a total of 19 focus group discussions for community health workers (CHW), traditional healers (TH), faith healers (FH) and patients. For nurses and clinical officers we held 10 key informant interviews and three key informant discussions. We aimed to document personal perceptions as expressed in narratives on mental health following a community based application of the WHO mental health treatment Gap-intervention guideline (mhGAP-IG) using the TEAM model. We also aimed to document how the narratives corroborated key findings on the quantitative wing of the TEAM model. Results There were three categories of perceptions: (i) patient-related, (ii) health provider-related and, (iii) health system related. The patient related narratives were linked to improvement in their mental and physical health, increased mental health awareness, change in lifestyle and behavior, enhanced social functioning and an increase in family productivity. Health provider perceptions were related to job satisfaction, capacity building and increased interest in mental health training. Mental health system related narratives included effectiveness and efficiency in service delivery and increase in number of referrals at the primary health care facilities. Conclusion The TEAM is a feasible model for the implementation of the mhGAP-IG. It led to positive perceptions and narratives by service provides and service consumers. The qualitative findings corroborated the quantitative findings of TEAM.
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Affiliation(s)
- Victoria N Mutiso
- Africa Mental Health Research and Training Foundation, Matumbato Road, Mawensi Gardens, Upper Hill, Nairobi, Kenya
| | - Christine W Musyimi
- Africa Mental Health Research and Training Foundation, Matumbato Road, Mawensi Gardens, Upper Hill, Nairobi, Kenya
| | | | - Michael O Ogutu
- Africa Mental Health Research and Training Foundation, Matumbato Road, Mawensi Gardens, Upper Hill, Nairobi, Kenya
| | - Ruth Ruhara
- Africa Mental Health Research and Training Foundation, Matumbato Road, Mawensi Gardens, Upper Hill, Nairobi, Kenya
| | - Darius Nyamai
- Africa Mental Health Research and Training Foundation, Matumbato Road, Mawensi Gardens, Upper Hill, Nairobi, Kenya
| | - Kathleen M Pike
- 2Global Mental Health Program, Columbia University, New York, USA
| | - David M Ndetei
- Africa Mental Health Research and Training Foundation, Matumbato Road, Mawensi Gardens, Upper Hill, Nairobi, Kenya.,3Department of Psychiatry, University of Nairobi, Nairobi, Kenya
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Karuga RN, Mireku M, Muturi N, McCollum R, Vallieres F, Kumar M, Taegtmeyer M, Otiso L. Supportive supervision of close-to-community providers of health care: Findings from action research conducted in two counties in Kenya. PLoS One 2019; 14:e0216444. [PMID: 31141509 PMCID: PMC6541245 DOI: 10.1371/journal.pone.0216444] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 04/22/2019] [Indexed: 11/19/2022] Open
Abstract
Background Close-to-community (CTC) providers of health care are a crucial workforce for delivery of high-quality and universal health coverage. There is limited evidence on the effect of training supervisors of this cadre in supportive supervision. Our study aimed to demonstrate the effects of a training intervention on the approach to and frequency of supervision of CTC providers of health care. Methods We conducted a context analysis in 2013 in two Kenyan counties to assess factors that influenced delivery of community health services. Supervision was identified a priority factor that needed to be addressed to improve community health services. Supervision was inadequate due to lack of supervisor capacity in supportive approaches and lack of supervision guidelines. We designed a six-day training intervention and trained 48 purposively selected CTC supervisors on the educative, administrative and supportive components of supportive supervision, problem solving and advocacy and provided them with checklists to guide supervision sessions. We administered quantitative questionnaires to supervisors to assess changes in supervision frequency before and after the training and then explored perspectives on the intervention with community health volunteers (CHVs) and their supervisors using qualitative in-depth interviews. Results Six months after the intervention, we observed that supervisors had shifted the supervision approach from being controlling and administrative to coaching, mentorship and problem solving. Changes in the frequency of supervision were found in Kitui only, whereby significant decreases in group supervision were met with increases in accompanied home visit supervision. Supervisors and CHVs reported the intervention was helpful and it responded to capacity gaps in supervision of CHVs. Conclusion Our intervention responded to capacity gaps in supervision and contributed to enhanced supervision capacity among supervisors. Supervisors found the curriculum acceptable and useful in improving supervision skills.
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Affiliation(s)
| | - Maryline Mireku
- LVCT Health, Department of Research and Strategic Information, Nairobi, Kenya
| | - Nelly Muturi
- LVCT Health, Department of Research and Strategic Information, Nairobi, Kenya
| | - Rosalind McCollum
- Liverpool School of Tropical Medicine, Department of International Public Health, Liverpool, United Kingdom
| | - Frederique Vallieres
- Centre for Global Health, School of Psychology, Trinity College, Dublin, Ireland
| | - Meghan Kumar
- Liverpool School of Tropical Medicine, Department of International Public Health, Liverpool, United Kingdom
| | - Miriam Taegtmeyer
- Liverpool School of Tropical Medicine, Department of International Public Health, Liverpool, United Kingdom
| | - Lilian Otiso
- LVCT Health, Department of Research and Strategic Information, Nairobi, Kenya
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Naidoo S, Naidoo D, Govender P. Community healthcare worker response to childhood disorders: Inadequacies and needs. Afr J Prim Health Care Fam Med 2019; 11:e1-e10. [PMID: 31038346 PMCID: PMC6556913 DOI: 10.4102/phcfm.v11i1.1871] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 12/08/2018] [Accepted: 12/20/2018] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Community healthcare workers (CHWs) play a vital role in linking health facilities and communities where there is a high prevalence of childhood disorders. However, there is limited literature on whether this cadre of workers is adequately prepared for this task. AIM This study explored the training needs of CHWs working in the field of childhood disorders and disabilities to improve the future training of CHWs and service delivery. SETTING This study was conducted in an urban district in KwaZulu-Natal, South Africa. METHODS This qualitative study used purposive sampling to recruit 28 CHWs and 4 key informants working in health facilities in one district of the KwaZulu-Natal Province in South Africa. Data were collected via semi-structured interviews and focus groups. Interviews were conducted in the first language (isiZulu) of the CHWs. Data were analysed thematically. Ethical clearance was obtained from a Biomedical Science Research Ethics Committee. RESULTS There was an evident lack of knowledge and skill in managing childhood disorders and disabilities by CHWs. Enablers and restrictors affecting service delivery were highlighted. Moreover, the training needs of CHWs have raised critical concerns because of the variable nature of training and perceived inadequate preparation for service delivery. The challenges raised were also generic to the holistic role of CHWs and not particularly specific to the CHW role in childhood disorders and disabilities. CONCLUSION Training of CHWs in childhood disorders may assist in improving CHWs' competence and confidence in the field, which may enhance service delivery and thus may assist in contributing towards improving healthcare for children at this level of care.
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Affiliation(s)
- Shanturi Naidoo
- School of Health Sciences, University of KwaZulu-Natal, Durban.
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Abstract
The Lancet Commission summarises some of the history of mental health concepts, recent developments in scientific understanding, mental health programmes and threats to progress, and proposes a way forward. Although ostensibly aiming to reframe global mental health within the paradigm of sustainable development, in practice it has taken a narrower academic perspective rather than a generic approach to health and social sector reform, leading to much less of an integrated implementation focus than would have been useful.
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Affiliation(s)
- Rachel Jenkins
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.,BA (Hons), MB, BChir, MD (Cantab), Institute of Psychiatry, Health Services Research, de Crespigny Park, London SE5 8AF, UK.
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Wakida EK, Okello ES, Rukundo GZ, Akena D, Alele PE, Talib ZM, Obua C. Health system constraints in integrating mental health services into primary healthcare in rural Uganda: perspectives of primary care providers. Int J Ment Health Syst 2019; 13:16. [PMID: 30949234 PMCID: PMC6429816 DOI: 10.1186/s13033-019-0272-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 03/14/2019] [Indexed: 12/13/2022] Open
Abstract
Background The World Health Organization issued recommendations to guide the process of integrating mental health services into primary healthcare. However, there has been general as well as context specific shortcomings in the implementation of these recommendations. In Uganda, mental health services are intended to be decentralized and integrated into general healthcare, but, the services are still underutilized especially in rural areas. Purpose The purpose of this study was to explore the health systems constraints to the integration of mental health services into PHC in Uganda from the perspective of primary health care providers (PHCPs). Methods This was a cross sectional qualitative study guided by the Supporting the Use of Research Evidence (SURE) framework. We used a semi-structured interview guide to gain insight into the health systems constraints faced by PHCPs in integrating mental health services into PHC. Results Key health systems constraints to integrating mental health services into PHC identified included inadequate practical experience during training, patient flow processes, facilities, human resources, gender related factors and challenges with accessibility of care. Conclusion There is need to strengthen the training of healthcare providers as well as improving the health care system that supports health workers. This would include periodic mental healthcare in-service training for PHCPs; the provision of adequate processes for outreach, and receiving, referring and transferring patients with mental health problems; empowering PHCPs at all levels to manage and treat mental health problems and adequately provide the necessary medical supplies; and increase the distribution of health workers across the health facilities to address the issue of high workload and compromised quality of care provided. Electronic supplementary material The online version of this article (10.1186/s13033-019-0272-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Edith K Wakida
- 1Department of Psychiatry, Mbarara University of Science and Technology, P. O. Box 1410, Mbarara, Uganda
| | - Elialilia S Okello
- Mwanza Intervention Trials Unit, Tanzania National Institute for Medical, Mwanza Centre, Mwanza, Tanzania
| | - Godfrey Z Rukundo
- 1Department of Psychiatry, Mbarara University of Science and Technology, P. O. Box 1410, Mbarara, Uganda
| | - Dickens Akena
- 3Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda
| | - Paul E Alele
- 4Department of Pharmacology and Therapeutics, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Zohray M Talib
- Department of Medical Education, California University of Science and Medicine, San Bernardino, CA USA.,6Mbarara University of Science and Technology, Mbarara, Uganda
| | - Celestino Obua
- 7Department of Pharmacology and Therapeutics and Vice Chancellor, Mbarara University of Science and Technology, Mbarara, Uganda
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Lehoux P, Roncarolo F, Silva HP, Boivin A, Denis JL, Hébert R. What Health System Challenges Should Responsible Innovation in Health Address? Insights From an International Scoping Review. Int J Health Policy Manag 2019; 8:63-75. [PMID: 30980619 PMCID: PMC6462209 DOI: 10.15171/ijhpm.2018.110] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 11/10/2018] [Indexed: 11/25/2022] Open
Abstract
Background: While responsible innovation in health (RIH) suggests that health innovations could be purposefully designed to better support health systems, little is known about the system-level challenges that it should address. The goal of this paper is thus to document what is known about health systems’ demand for innovations.
Methods: We searched 8 databases to perform a scoping review of the scientific literature on health system challenges published between January 2000 and April 2016. The challenges reported in the articles were classified using the dynamic health system framework. The countries where the studies had been conducted were grouped using the human development index (HDI). Frequency distributions and qualitative content analysis were performed.
Results: Up to 1391 challenges were extracted from 254 articles examining health systems in 99 countries. Across countries, the most frequently reported challenges pertained to: service delivery (25%), human resources (23%), and leadership and governance (21%). Our analyses indicate that innovations tend to increase challenges associated to human resources by affecting the nature and scope of their tasks, skills and responsibilities, to exacerbate service delivery issues when they are meant to be used by highly skilled providers and call for accountable governance of their dissemination, use and reimbursement. In countries with a low and medium HDI, problems arising with infrastructure, logistics and equipment were described in connection with challenges affecting procurement, supply and distribution systems. In countries with a medium and high HDI, challenges included a growing demand for drugs and new technology and the management of rising costs. Across all HDI groups, the need for flexible information technologies (IT) solutions to reach rural areas was underscored.
Conclusion: Highlighting challenges that are common across countries, this study suggests that RIH should aim to reduce the cost of innovation production processes and attend not only to the requirements of the immediate clinical context of use, but also to the vulnerabilities of the broader system wherein innovations are deployed. Policy-makers should translate system-level demand signals into innovation development opportunities since it is imperative to foster innovations that contribute to the success and sustainability of health systems
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Affiliation(s)
- Pascale Lehoux
- Department of Health Management, Evaluation and Policy, School of Public Health, University of Montreal, Montreal, QC, Canada
| | - Federico Roncarolo
- Institute of Public Health Research of University of Montreal (IRSPUM), University of Montreal, Montreal, QC, Canada
| | - Hudson Pacifico Silva
- Institute of Public Health Research of University of Montreal (IRSPUM), University of Montreal, Montreal, QC, Canada
| | - Antoine Boivin
- Department of Family Medicine, University of Montreal, Montreal, QC, Canada.,Canada Research Chair on Patient and Public Partnership, Montreal, QC, Canada
| | - Jean-Louis Denis
- Department of Health Management, Evaluation and Policy, School of Public Health, University of Montreal, Montreal, QC, Canada
| | - Réjean Hébert
- School of Public Health, University of Montreal, Montreal, QC, Canada
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Lovero KL, Lammie SL, van Zyl A, Paul SN, Ngwepe P, Mootz JJ, Carlson C, Sweetland AC, Shelton RC, Wainberg ML, Medina-Marino A. Mixed-methods evaluation of mental healthcare integration into tuberculosis and maternal-child healthcare services of four South African districts. BMC Health Serv Res 2019; 19:83. [PMID: 30704459 PMCID: PMC6357439 DOI: 10.1186/s12913-019-3912-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 01/17/2019] [Indexed: 11/25/2022] Open
Abstract
Background The South African National Mental Health Policy Framework and Strategic Plan 2013–2020 was adopted to address the country’s substantial burden and inadequate treatment of mental illness. It outlines measures toward the goal of full integration of mental health services into primary care by 2020. To evaluate progress and challenges in implementation, we conducted a mixed-methods assessment of mental health service provision in tuberculosis and maternal-child healthcare services of four districts in South Africa. Methods Forty clinics (ten per district) were purposively selected to represent both urban and rural locations. District-level program managers (DPMs) for mental health, tuberculosis, and maternal-child healthcare were qualitatively interviewed about district policy and procedures for management of mental illness and challenges in integrating mental health services into primary care. Clinic nurses and mental health practitioners (MHPs) completed a quantitative questionnaire to assess their engagement with stepped care for patients with mental illness. Qualitative and quantitative data were collected concurrently and compared to triangulate progress in implementation of integrated services. Results A total of 59 nurses and 17 MHPs completed questionnaires, and nine DPMs were interviewed (total n = 85). DPMs indicated that nurses should screen for mental illness at every patient visit, although only 43 (73%) nurses reported conducting universal screening and 26 (44%) reported using a specific screening tool. For patients who screen positive for mental illness, DPMs described a stepped-care approach in which MHPs diagnose patients and then treat or refer them to specialized care. However, only 7 (41%) MHPs indicated that they diagnose mental illness and 14 (82%) offer any treatment for mental illness. Addressing challenges to current integration efforts, DPMs highlighted 1) insufficient funding and material resources, 2) poor coordination at the district administrative level, and 3) low mental health awareness in district administration and the general population. Conclusions Though some progress has been made toward integration of mental health services into primary care settings, there is a substantial lack of training and clarity of roles for nurses and MHPs. To enhance implementation, increased efforts must be directed toward improving district-level administrative coordination, mental health awareness, and financial and material resources.
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Affiliation(s)
- Kathryn L Lovero
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 1051 Riverside Drive #24, New York, NY, 10032, USA
| | - Samantha L Lammie
- Emory University School of Medicine, 1648 Pierce Dr NE, Atlanta, GA, 30307, USA.,Foundation for Professional Development, 173 Mary Rd, Die Wilgers, Pretoria, 0184, South Africa
| | - André van Zyl
- Foundation for Professional Development, 173 Mary Rd, Die Wilgers, Pretoria, 0184, South Africa
| | - Sharon N Paul
- Foundation for Professional Development, 173 Mary Rd, Die Wilgers, Pretoria, 0184, South Africa
| | - Phuti Ngwepe
- Foundation for Professional Development, 173 Mary Rd, Die Wilgers, Pretoria, 0184, South Africa
| | - Jennifer J Mootz
- Emory University School of Medicine, 1648 Pierce Dr NE, Atlanta, GA, 30307, USA
| | - Catherine Carlson
- School of Social Work, University of Alabama, 3026 Little Hall, Box 870314, Tuscaloosa, AL, 35487-0314, USA
| | - Annika C Sweetland
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 1051 Riverside Drive #24, New York, NY, 10032, USA
| | - Rachel C Shelton
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 W. 168th St. #941, New York, NY, 10032, USA
| | - Milton L Wainberg
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 1051 Riverside Drive #24, New York, NY, 10032, USA
| | - Andrew Medina-Marino
- Foundation for Professional Development, 173 Mary Rd, Die Wilgers, Pretoria, 0184, South Africa.
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Kumar M, Kuria MW, Othieno CJ, Falkenström F. Improving psychotherapies offered in public hospitals in Nairobi, Kenya: extending practice-based research model for LMICs. Int J Ment Health Syst 2018; 12:76. [PMID: 30555529 PMCID: PMC6288907 DOI: 10.1186/s13033-018-0254-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 11/24/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Psychotherapy and mental health services in Nairobi's public hospitals are increasing. Rather than prematurely imposing psychotherapy protocols developed in Western countries to Kenya, we argue that first studying psychological interventions as they are practiced may generate understanding of which psychological problems are common, what interventions therapists use, and what seems to be effective in reducing psychiatric problems in a lower and middle income country like Kenya. METHOD We present preliminary findings from a process-outcome study involving 345 patients from two public institutions, Kenyatta National and Mathare National Hospitals. We asked our patients to fill out a brief personal information questionnaire, Clinical Outcomes in Routine Evaluation-Outcome Measure (Evans et al. in Br J Psychiatry 180:51-60, 2002, and the Session Alliance Inventory (Falkenström et al. in Psychol Assess 27:169-183, 2015) after each session. We present descriptives for CORE-OM, patient-therapist concordance on the SAI, and using longitudinal mixed-effects model, test change in CORE-OM over time with various therapy and patient factors as predictors in regression analyses. RESULTS The majority of patients who attended the outpatient care clinics were young males. Our regression analysis suggested that patients with depression reported higher initial distress levels (2.75 CORE-OM scores, se = 1.11, z = 2.48, p = 0.013, 95% CI 0.57-4.93) than patients with addictions, anxiety, or psychosis. Older clients improved slower (0.08 CORE-OM scores slower improvement per session per year older age; se = 0.03, z = 3.02 p = 0.003, 95% CI 0.03, 0.14). Female patients reported higher initial distress than men (2.62 CORE-OM scores, se = 1.00, z = 2.61, p = 0.009, 95% CI 0.65, 4.58). However, interns had patients who reported significantly higher initial distress (3.24 CORE-OM points, se = 0.90, z = 3.60, p < 0.001, 95% CI 1.48, 5.00), and improved more over time (- 1.20 CORE-OM scores per session, se = 0.51, z = - 2.35, p = 0.019, 95% CI - 2.20, - 0.20) than patients seeing mental health practitioners. The results showed that at average alliance, CORE-OM decreased by 1.74 points per session (se = 0.21, p < 0.001). For each point higher on the SAI at session 2, the CORE-OM decreased by an additional 0.58 points per session (se = 0.25, p = 0.02). DISCUSSION Our objective was to study psychotherapies as they are practiced in naturalistic settings. The overall significant finding is that our participants report improvement in their functioning mental health condition and distress reduced as psychotherapy progressed. There were many more male than female participants in our sample; younger patients improved more than older ones; and while interns had patients with higher distress, their patients improved better than those patients attended by professionals. CONCLUSIONS These are preliminary observations to consider for a larger sample follow-up study. Before changing practices, evaluating the existing practices by mapping clinical outcomes is a helpful route.
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Affiliation(s)
- Manasi Kumar
- Department of Psychiatry, College of Health Sciences, University of Nairobi, P.O. Box 19676, Nairobi, 00202 Kenya
- Research Department of Clinical Health and Educational Psychology, University College London, Gower Street, London, WC1E 6BT UK
| | - Mary Wangari Kuria
- Department of Psychiatry, College of Health Sciences, University of Nairobi, P.O. Box 19676, Nairobi, 00202 Kenya
| | - Caleb Joseph Othieno
- Department of Psychiatry, College of Health Sciences, University of Nairobi, P.O. Box 19676, Nairobi, 00202 Kenya
| | - Fredrik Falkenström
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
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Wakida EK, Talib ZM, Akena D, Okello ES, Kinengyere A, Mindra A, Obua C. Barriers and facilitators to the integration of mental health services into primary health care: a systematic review. Syst Rev 2018; 7:211. [PMID: 30486900 PMCID: PMC6264616 DOI: 10.1186/s13643-018-0882-7] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 11/12/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The objective of the review was to synthesize evidence of barriers and facilitators to the integration of mental health services into PHC from existing literature. The structure of the review was guided by the SPIDER framework which involves the following: Sample or population of interest-primary care providers (PCPs); Phenomenon of Interest-integration of mental health services into primary health care (PHC); Design-influenced robustness and analysis of the study; Evaluation-outcomes included subjective outcomes (views and attitudes); and Research type-qualitative, quantitative, and mixed methods studies. METHODS Studies that described mental health integration in PHC settings, involved primary care providers, and presented barriers/facilitators of mental health integration into PHC were included in the review. The sources of information included PubMed, PsycINFO, Cochrane Central Register of Controlled trials, the WHO website, and OpenGrey. Assessment of bias and quality was done using two separate tools: the Critical Appraisal Skills Program (CASP) qualitative checklist and the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies. RESULTS Twenty studies met the inclusion criteria out of the 3353 search results. The most frequently reported barriers to integration of mental health services into PHC were (i) attitudes regarding program acceptability, appropriateness, and credibility; (ii) knowledge and skills; (iii) motivation to change; (iv) management and/or leadership; and (v) financial resources. In order to come up with an actionable approach to addressing the barriers, these factors were further analyzed along a behavior change theory. DISCUSSION We have shown that the integration of mental health services into PHC has been carried out by various countries. The analysis from this review provides evidence to inform policy on the existing barriers and facilitators to the implementation of the mental health integration policy option. Not all databases may have been exhausted. SYSTEMATIC REVIEW REGISTRATION PROSPERO 2016 (Registration Number: CRD42016052000 ) and published in BMC Systematic Reviews August 2017.
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Affiliation(s)
- Edith K. Wakida
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Zohray M. Talib
- Department of Medical Education, California University of Science and Medicine, California, USA
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Dickens Akena
- Africa Center for Systematic Reviews and Knowledge Translation, College of Health Sciences Makerere University, Kampala, Uganda
- Department of Psychiatry, Makerere University, Kampala, Uganda
| | | | - Alison Kinengyere
- Department of Psychiatry, Makerere University, Kampala, Uganda
- Library, Africa Center for Systematic Reviews and Knowledge Translation, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Arnold Mindra
- Office of Research Administration, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Celestino Obua
- Department of Pharmacology and Therapeutics, Mbarara University of Science and Technology, Mbarara, Uganda
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Falkenström F, Kuria M, Othieno C, Kumar M. Working alliance predicts symptomatic improvement in public hospital-delivered psychotherapy in Nairobi, Kenya. J Consult Clin Psychol 2018; 87:46-55. [PMID: 30431300 DOI: 10.1037/ccp0000363] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Although patient-therapist collaboration (working alliance) has been studied extensively in Europe and America, it is unknown to what extent the importance of working alliance for psychotherapy outcome generalizes to lower- and middle-income countries. Additionally, there is a need for more studies on the alliance using methods that are robust to confounders of its effect on outcome. METHOD In this study, 345 outpatients seeking care at the 2 public psychiatric hospitals in Nairobi, Kenya, filled out the Session Alliance Inventory (SAI) and the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) during each session. The effect of alliance on next-session psychological distress was modeled using the random intercept cross-lagged panel model, which estimates a cross-lagged panel model on within- and between-subjects disaggregated data. RESULTS Changes in the working alliance from session to session significantly predicted change in psychological distress by the next session, with an increase of 1 point of the SAI in a given session resulting in a decrease of 1.27 points on the CORE-OM by the next session (SE = .60, 95% confidence interval [-2.44, -.10]). This finding represents a medium-sized standardized regression coefficient of between .16 and .21. Results were generally robust to sensitivity tests for stationarity, missing data assumptions, and measurement error. CONCLUSION Results affirm cross-cultural stability of the session-by-session reciprocal effects model of alliance and psychological distress-symptoms as seen in a Kenyan psychiatric outpatient sample, using the latest developments in cross-lagged panel modeling. A limitation of the study is its naturalistic design and lack of control over several variables. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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Affiliation(s)
| | - Mary Kuria
- Department of Psychiatry, University of Nairobi
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26
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Mutiso VN, Gitonga I, Musau A, Musyimi CW, Nandoya E, Rebello TJ, Pike KM, Ndetei DM. A step-wise community engagement and capacity building model prior to implementation of mhGAP-IG in a low- and middle-income country: a case study of Makueni County, Kenya. Int J Ment Health Syst 2018; 12:57. [PMID: 30356953 PMCID: PMC6191998 DOI: 10.1186/s13033-018-0234-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 10/06/2018] [Indexed: 12/26/2022] Open
Abstract
Background The World Health Organization developed the Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) as guidelines for innovative utilization of available resources in low- and middle-income countries (LMICs) in order to accelerate the reduction of the mental health treatment gap. The mhGAP-IG calls for each country to contextualize the guide to their social, cultural and economic context. The objective of this paper is to describe a model for a stepwise approach for implementation of mhGAP-IG in a rural Kenyan setting using existing formal and informal community resources and health systems. Methods We conducted an analysis of mental health services in Makueni County, one of the 47 counties in Kenya, in order to understand the existing gaps and opportunities in a low-resource setting. We conducted stakeholder analysis and engagement through interactive dialogue in order for them to appreciate the importance of mental health to their communities. Through the process of participatory Theory of Change, the stakeholders gave their input on the process between the initiation and the end of the process for community mental health development, with the aim of achieving buy-in and collective ownership of the whole process. We adapted the mhGAP-IG to the local context and trained local human resources in skills necessary for the implementation of mhGAP-IG and for monitoring and evaluating the process using instruments with good psychometric properties that have been used in LMICs. Results We were able to demonstrate the feasibility of implementing the mhGAP-IG using existing and trained community human resources using a multi-stakeholder approach. We further demonstrated the feasibility to transit seamlessly from research to policy and practice uptake using our approach. Conclusions An inclusive model for low resource settings is feasible and has the potential to bridge the gap between research, policy and practice. A major limitation of our study is that we did not engage a health economist from the beginning in order to determine the cost-effectiveness of our proposed model, occasioned by lack of resources to hire a suitable one.
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Affiliation(s)
- Victoria N Mutiso
- Africa Mental Health Research and Training Foundation, Matumbato Road, Off Elgon Road, Mawensi Gardens, Nairobi, Kenya
| | - Isaiah Gitonga
- Africa Mental Health Research and Training Foundation, Matumbato Road, Off Elgon Road, Mawensi Gardens, Nairobi, Kenya
| | - Abednego Musau
- Africa Mental Health Research and Training Foundation, Matumbato Road, Off Elgon Road, Mawensi Gardens, Nairobi, Kenya
| | - Christine W Musyimi
- Africa Mental Health Research and Training Foundation, Matumbato Road, Off Elgon Road, Mawensi Gardens, Nairobi, Kenya
| | - Eric Nandoya
- Africa Mental Health Research and Training Foundation, Matumbato Road, Off Elgon Road, Mawensi Gardens, Nairobi, Kenya
| | | | - Kathleen M Pike
- 2Global Mental Health Program, Columbia University, New York, USA
| | - David M Ndetei
- Africa Mental Health Research and Training Foundation, Matumbato Road, Off Elgon Road, Mawensi Gardens, Nairobi, Kenya.,3University of Nairobi, Nairobi, Kenya
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Suchman L, Hart E, Montagu D. Public-private partnerships in practice: collaborating to improve health finance policy in Ghana and Kenya. Health Policy Plan 2018; 33:777-785. [PMID: 29905855 PMCID: PMC6097457 DOI: 10.1093/heapol/czy053] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2018] [Indexed: 01/11/2023] Open
Abstract
Social health insurance (SHI), one mechanism for achieving universal health coverage, has become increasingly important in low- and middle-income countries (LMICs) as they work to achieve this goal. Although small private providers supply a significant proportion of healthcare in LMICs, integrating these providers into SHI systems is often challenging. Public-private partnerships in health are one way to address these challenges, but we know little about how these collaborations work, how effectively, and why. Drawing on semi-structured interviews conducted with National Health Insurance (NHI) officials in Kenya and Ghana, as well as with staff from several international NGOs (INGOs) representing social franchise networks that are partnering to increase private provider accreditation into the NHIs, this article examines one example of public-private collaboration in practice. We found that interviewees initially had incomplete knowledge about the potential for cross-sector synergy, but both sides were motivated to work together around shared goals and the potential for mutual benefit. The public-private relationship then evolved over time through regular face-to-face interactions, reciprocal feedback, and iterative workplan development. This process led to a collegial relationship that also has given small private providers more voice in the health system. In order to sustain this relationship, we recommend that both public and private sector representatives develop formalized protocols for working together, as well as less formal open channels for communication. Models for aggregating small private providers and delivering them to government programmes as a package have potential to facilitate public-private partnerships as well, but there is little evidence on how these models work in LMICs thus far.
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Affiliation(s)
- Lauren Suchman
- Institute for Global Health Sciences, University of California San Francisco, 550 16th Street, 3rd Floor Box 1224, San Francisco, USA
| | - Elizabeth Hart
- Department of Sociology University of California Davis, 1 Shields Avenue, Davis, USA
| | - Dominic Montagu
- Institute for Global Health Sciences, University of California San Francisco, 550 16th Street, 3rd Floor Box 1224, San Francisco, USA
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Mental Health Diagnostic Frameworks, Imputed Causes of Mental Illness, and Alternative Treatments in Northern Tanzania: Exploring Mental Health Providers' Perspectives. Cult Med Psychiatry 2018; 42:483-503. [PMID: 29392517 DOI: 10.1007/s11013-018-9565-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In Tanzania, a nation with a large mental health treatment gap, local stakeholders' perspectives are critical for informing effective treatment. The practice-based perspectives of mental health providers may be particularly instructive. Existing foundational literature on the professional population in this region is scarce. We conducted semi-structured interviews with 29 mental health providers in northern Tanzania. Interviews focused on three topics: use of international diagnostic frameworks for mental illness, beliefs about causes of mental health concerns, and alternative treatments sought by clients. Interview data were coded and analyzed using consensual qualitative research and the constant comparative method. Usage of diagnostic frameworks varied widely. Providers believed frameworks accurately described many patients but neglected somatic symptoms and contained diagnoses that they had never witnessed. Providers described supernatural and spiritual attributions of mental illness as substantially impacting treatment decisions. Other notable attributions included physical illness, drug/alcohol use, and heredity. Providers reported their clients routinely sought treatment from traditional and spiritual healers prior to seeking care in the formal health system. This study builds a foundation for the ongoing development of the mental health system in northern Tanzania. Findings also support exploration of integrative models of care and task-shifting to incorporate traditional and spiritual beliefs.
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Murphy J, Corbett KK, Linh DT, Oanh PT, Nguyen VC. Barriers and facilitators to the integration of depression services in primary care in Vietnam: a mixed methods study. BMC Health Serv Res 2018; 18:641. [PMID: 30115050 PMCID: PMC6097413 DOI: 10.1186/s12913-018-3416-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 07/24/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although the prevalence of depression in Vietnam is on par with global rates, services for depression are limited. The government of Vietnam has prioritized enhancing depression care through primary healthcare (PHC) and efforts are currently underway to test and scale-up psychosocial interventions throughout the country. With these initiatives in progress, it is important to understand implementation factors that might influence the successful integration of depression services into PHC. As the implementers of these new interventions, primary care providers (PHPs) are well placed to provide important insight into implementation factors affecting the integration of depression services into PHC. This mixed-methods study examines factors at the individual, organizational and structural levels that may act as barriers and facilitators to the integration of depression services into PHC in Vietnam from the perspective of PHPs. METHODS Data collection took place in Hanoi, Vietnam in 2014. We conducted semi-structured interviews with PHPs (n = 30) at commune health centres and outpatient clinics in one rural and one urban district of Hanoi. Theoretical thematic analysis was used to analyse interview data. We administered an online survey to PHPs at n = 150 randomly selected communes across Hanoi. N = 226 PHPs responded to the survey. We used descriptive statistics to describe the study variables acting as barriers and facilitators and used a chi-square test of independence to indicate statistically significant (p < .05) associations between study variables and the profession, location and gender of PHPs. RESULTS Individual-level barriers include low level of knowledge and familiarity with depression among PHPs. Organizational barriers include low resource availability in PHC and low managerial discretion. Barriers at the structural level include limited mental health training among all PHPs and the existing programmatic structure of PHC in Vietnam, which sets mental health apart from general services. Facilitators at the individual level include positive attitudes among PHPs towards people with depression and interest in undergoing enhanced training in depression service delivery. CONCLUSIONS While facilitating factors at the individual level are encouraging, considerable barriers at the structural level must be addressed to ensure the successful integration of depression services into PHC in Vietnam.
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Affiliation(s)
- Jill Murphy
- Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, Suite 2400, 515 W. Hastings Street, Vancouver, BC, V6B 5K3, Canada.
| | - Kitty K Corbett
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave. West, Waterloo, ON, N2L3G1, Canada
| | - Dang Thuy Linh
- Institute of Population, Health and Development, 18 Lane 132, Hoa Bang, Yen Hoa, Hanoi, 122667, Vietnam
| | - Pham Thi Oanh
- Institute of Population, Health and Development, 18 Lane 132, Hoa Bang, Yen Hoa, Hanoi, 122667, Vietnam
| | - Vu Cong Nguyen
- Institute of Population, Health and Development, 18 Lane 132, Hoa Bang, Yen Hoa, Hanoi, 122667, Vietnam
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30
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Alburquerque-Sendín F, Ferrari AV, Rodrigues-de-Souza DP, Paras-Bravo P, Velarde-García JF, Palacios-Ceña D. The experience of being a psychiatric nurse in South Africa: A qualitative systematic review. Nurs Outlook 2018; 66:293-310. [PMID: 29573827 DOI: 10.1016/j.outlook.2018.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 01/15/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE The purpose of the study was to summarize the experiences of African psychiatric nurses in their workplace by examining the findings of existing qualitative studies. METHODS Eleven studies published in English, Portuguese, and Spanish, between 1998 and 2016, which explored psychiatric nurses' experiences in Africa, were included. FINDINGS After meta-aggregation, five key findings were identified: 1) organization and management, 2) perceptions of professional safety and insecurity, 3) relationship with the patient, 4) emotional experiences and 5) recommendations for improvement. DISCUSSION The findings in this study highlight the stressful nature of the work climate of the psychiatric nurse in South Africa. More focus on improving working conditions and providing support is necessary to increase the quality of care for psychiatric mental health patients and their nurse providers.
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Affiliation(s)
| | | | | | | | - Juan Francisco Velarde-García
- Department of Nursing, Spanish Red Cross, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Autonoma de Madrid, Madrid, Spain
| | - Domingo Palacios-Ceña
- Department of Physiotherapy, Occupational Therapy, Rehabilitation, and Physical Medicine, Universidad Rey Juan Carlos, Comunidad de Madrid, Spain
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da Rocha HA, dos Santos ADF, Reis IA, Santos MADC, Cherchiglia ML. Mental health in primary care: an evaluation using the Item Response Theory. Rev Saude Publica 2018; 52:17. [PMID: 29489992 PMCID: PMC5825122 DOI: 10.11606/s1518-8787.2018052000051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 03/22/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To determine the items of the Brazilian National Program for Improving Access and Quality of Primary Care that better evaluate the capacity to provide mental health care. METHODS This is a cross-sectional study carried out using the Graded Response Model of the Item Response Theory using secondary data from the second cycle of the National Program for Improving Access and Quality of Primary Care, which evaluates 30,523 primary care teams in the period from 2013 to 2014 in Brazil. The internal consistency, correlation between items, and correlation between items and the total score were tested using the Cronbach's alpha, Spearman's correlation, and point biserial coefficients, respectively. The assumptions of unidimensionality and local independence of the items were tested. Word clouds were used as one way to present the results. RESULTS The items with the greatest ability to discriminate were scheduling of the agenda according to risk stratification, keeping of records of the most serious cases of users in psychological distress, and provision of group care. The items that required a higher level of mental health care in the parameter of location were the provision of any type of group care and the provision of educational and mental health promotion activities. Total Cronbach's alpha coefficient was 0.87. The items that obtained the highest correlation with total score were the recording of the most serious cases of users in psychological distress and scheduling of the agenda according to risk stratification. The final scores obtained oscillated between -2.07 (minimum) and 1.95 (maximum). CONCLUSIONS There are important aspects in the discrimination of the capacity to provide mental health care by primary health care teams: risk stratification for care management, follow-up of the most serious cases, group care, and preventive and health promotion actions.
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Affiliation(s)
- Hugo André da Rocha
- Universidade Federal de Minas Gerais. Faculdade de Medicina. Programa de Pós-Graduação em Saúde Pública. Belo Horizonte, MG, Brasil
| | - Alaneir de Fátima dos Santos
- Universidade Federal de Minas Gerais. Faculdade de Medicina. Departamento de Medicina Preventiva e Social. Belo Horizonte, MG, Brasil
| | - Ilka Afonso Reis
- Universidade Federal de Minas Gerais. Instituto de Ciências Exatas. Departamento de Estatística. Belo Horizonte, MG, Brasil
| | - Marcos Antônio da Cunha Santos
- Universidade Federal de Minas Gerais. Instituto de Ciências Exatas. Departamento de Estatística. Belo Horizonte, MG, Brasil
| | - Mariângela Leal Cherchiglia
- Universidade Federal de Minas Gerais. Faculdade de Medicina. Departamento de Medicina Preventiva e Social. Programa de Pós-Graduação em Saúde Pública. Belo Horizonte, MG, Brasil
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Gooshi M, Siratinir M, Ebadi A, Tavallai A, Mohammadi A. Psychometric Properties of the Persian Version of the Staff Observation Aggression Scale-Revised (SOAS-R) in Psychiatric Patients. J Caring Sci 2018; 6:335-343. [PMID: 29302573 PMCID: PMC5747592 DOI: 10.15171/jcs.2017.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 05/17/2017] [Indexed: 11/21/2022] Open
Abstract
Introduction: In psychiatric settings, aggressive events frequently occur during
therapy. The use of a proper standard scale to register aggression can facilitate the
assessment and control of aggression and help reduce its frequency and severity. The
aim of this study is to evaluate the validity and reliability of the Staff Observation
Aggression Scale—Revised (SOAS-R).
Methods: This psychometric study of the scale was conducted to determine the validity
and reliability of the SOAS-R. The validation of the scale was assessed on the basis of
319 aggressive events in the psychiatric wards of the Baqiyatallah and Roozbeh
hospitals. Convenience sampling was used for subject selection. Psychometric
properties of SOAS-R were studied in two stages. First, the standard scale was
translated according to the International Quality of Life Assessment (IQOLA)
translation methodology. The face validity, content, and construct validity of the
translated version were then determined. The construct validity of the scale was
assessed by comparing the known groups.
Results: The internal consistency of the whole scale was 0.99. The intra-class
correlation coefficients (ICC) were 0.85–0.99 while kappa coefficient was 0.43 to 0.65
for different aspects of the SOAS-R. The validity of the scale was concurrently
assessed by using the Visual Analogue Scale (VAS), with a Spearman-Brown
correlation coefficient of 0.90.
Conclusion: These results showed a favourable validity and reliability for the Persian
version of the SOAS-R for the assessment of aggressive behaviour in psychiatric
patients.
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Affiliation(s)
- Muhammad Gooshi
- Department of Nursing, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Masoud Siratinir
- Department of Psychiatric Nursing, Behavioral Sciences Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Abbas Ebadi
- Department of Psychiatric Nursing, Behavioral Sciences Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Abbas Tavallai
- Department of Psychiatry, Behavioral Sciences Research Center, Baqiyatollah University of Medical Sciences, Tehran, Iran
| | - Abolfazl Mohammadi
- Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
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Does mhGAP training of primary health care providers improve the identification of child- and adolescent mental, neurological or substance use disorders? Results from a randomized controlled trial in Uganda. Glob Ment Health (Camb) 2018; 5:e29. [PMID: 30455964 PMCID: PMC6236215 DOI: 10.1017/gmh.2018.18] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 03/22/2018] [Accepted: 05/30/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Integrating child and adolescent mental health (CAMH) into primary health care (PHC) using the WHO mental health gap action program (mhGAP) is recommended for closing a mental health treatment gap in low- and middle-income countries, but PHC providers have limited ability to detect CAMH disorders. We aimed to evaluate the effect of PHC provider mhGAP training on CAMH disorder identification in Eastern Uganda. METHODS Thirty-six PHC clinics participated in a randomized controlled trial which compared the proportion of intervention (n = 18) to control (n = 18) clinics with a non-epilepsy CAMH diagnosis over 3 consecutive months following mhGAP-oriented CAMH training. Fisher's exact test and logistic regression based on intention to treat principles were applied. (clinicaltrials.gov registration NCT02552056). RESULTS Nearly two thirds (63.8%, 23/36) of all clinics identified and recorded at least one non-epilepsy CAMH diagnosis from 40 692 clinic visits of patients aged 1-18 recorded over 4 months. The proportion of clinics with a non-epilepsy CAMH diagnosis prior to training was 27.7% (10/36, similar between study arms). Training did not significantly improve intervention clinics' non-epilepsy CAMH diagnosis (13/18, 72.2%) relative to the control (7/18, 38.9%) arm, p = 0.092. The odds of identifying and recording a non-epilepsy CAMH diagnosis were 2.5 times higher in the intervention than control arms at the end of 3 months of follow-up [adj.OR 2.48; 95% CI (1.31-4.68); p = 0.005]. CONCLUSION In this setting, mhGAP CAMH training of PHC providers increases PHC clinics' identification and reporting of non-epilepsy CAMH cases but this increase did not reach statistical significance.
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Roncarolo F, Boivin A, Denis JL, Hébert R, Lehoux P. What do we know about the needs and challenges of health systems? A scoping review of the international literature. BMC Health Serv Res 2017; 17:636. [PMID: 28886736 PMCID: PMC5591541 DOI: 10.1186/s12913-017-2585-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 08/30/2017] [Indexed: 11/12/2022] Open
Abstract
Background While there is an extensive literature on Health System (HS) strengthening and on the performance of specific HSs, there are few exhaustive syntheses of the challenges HSs are facing worldwide. This paper reports the findings of a scoping review aiming to classify the challenges of HSs investigated in the scientific literature. Specifically, it determines the kind of research conducted on HS challenges, where it was performed, in which health sectors and on which populations. It also identifies the types of challenge described the most and how they varied across countries. Methods We searched 8 databases to identify scientific papers published in English, French and Italian between January 2000 and April 2016 that addressed HS needs and challenges. The challenges reported in the articles were classified using van Olmen et al.’s dynamic HS framework. Countries were classified using the Human Development Index (HDI). Our analyses relied on descriptive statistics and qualitative content analysis. Results 292 articles were included in our scoping review. 33.6% of these articles were empirical studies and 60.1% were specific to countries falling within the very high HDI category, in particular the United States. The most frequently researched sectors were mental health (41%), infectious diseases (12%) and primary care (11%). The most frequently studied target populations included elderly people (23%), people living in remote or poor areas (21%), visible or ethnic minorities (15%), and children and adolescents (15%). The most frequently reported challenges related to human resources (22%), leadership and governance (21%) and health service delivery (24%). While health service delivery challenges were more often examined in countries within the very high HDI category, human resources challenges attracted more attention within the low HDI category. Conclusions This scoping review provides a quantitative description of the available evidence on HS challenges and a qualitative exploration of the dynamic relationships that HS components entertain. While health services research is increasingly concerned about the way HSs can adopt innovations, little is known about the system-level challenges that innovations should address in the first place. Within this perspective, four key lessons are drawn as well as three knowledge gaps. Electronic supplementary material The online version of this article (10.1186/s12913-017-2585-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Federico Roncarolo
- Institute of Public Health Research of Université de Montréal (IRSPUM), Montreal, Canada
| | - Antoine Boivin
- Institute of Public Health Research of Université de Montréal (IRSPUM), Montreal, Canada.,Department of Family Medicine, Faculty of Medicine, Université de Montréal, Montreal, Canada.,Research Center of the Université de Montréal Health Center (CRCHUM), Montreal, Canada.,Canada Research Chair in Patient and Public Partnership, Montreal, Canada
| | - Jean-Louis Denis
- Department of Health Management, Evaluation and Policy, School of Public Health, Université de Montréal, P.O. Box 6128, Branch Centre-ville, Montreal, QC, H3C 3J7, Canada.,Canada Research Chair in Governance and Transformation of Health Organizations and Systems, Montreal, Canada
| | - Rejean Hébert
- Institute of Public Health Research of Université de Montréal (IRSPUM), Montreal, Canada.,Department of Health Management, Evaluation and Policy, School of Public Health, Université de Montréal, P.O. Box 6128, Branch Centre-ville, Montreal, QC, H3C 3J7, Canada
| | - Pascale Lehoux
- Institute of Public Health Research of Université de Montréal (IRSPUM), Montreal, Canada. .,Research Center of the Université de Montréal Health Center (CRCHUM), Montreal, Canada. .,Department of Health Management, Evaluation and Policy, School of Public Health, Université de Montréal, P.O. Box 6128, Branch Centre-ville, Montreal, QC, H3C 3J7, Canada. .,Université de Montréal Chair on Responsible Innovation in Health, Montreal, Canada.
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Kumar M, Gotz D, Nutley T, Smith JB. Research gaps in routine health information system design barriers to data quality and use in low- and middle-income countries: A literature review. Int J Health Plann Manage 2017; 33:e1-e9. [PMID: 28766742 DOI: 10.1002/hpm.2447] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 07/06/2017] [Indexed: 11/06/2022] Open
Abstract
Despite the potential impact of health information system (HIS) design barriers on health data quality and use and, ultimately, health outcomes in low- and middle-income countries (LMICs), no comprehensive literature review has been conducted to study them in this context. We therefore conducted a formal literature review to understand system design barriers to data quality and use in LMICs and to identify any major research gaps related understanding how system design affects data use. We conducted an electronic search across 4 scientific databases-PubMed, Web of Science, Embase, and Global Health-and consulted a data use expert. Following a systematic inclusion and exclusion process, 316 publications (316 abstracts and 18 full papers) were included in the review. We found a paucity of scientific publications that explicitly describe system design factors that hamper data quality or data use for decision making. Although user involvement, work flow, human-computer interactions, and user experience are critical aspects of system design, our findings suggest that these issues are not discussed or conceptualized in the literature. Findings also showed that individual training efforts focus primarily on imparting data analysis skills. The adverse impact of HIS design barriers on data integrity and health system performance may be even bigger in LMICs than elsewhere, leading to errors in population health management and clinical care. We argue for integrating systems thinking into HIS strengthening efforts to reduce the HIS design-user reality gap.
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Affiliation(s)
- Manish Kumar
- MEASURE Evaluation, Carolina Population Center, University of North Carolina at Chapel Hill, North Carolina, USA.,Carolina Health Informatics Program, University of North Carolina at Chapel Hill, North Carolina, USA
| | - David Gotz
- Carolina Health Informatics Program, University of North Carolina at Chapel Hill, North Carolina, USA.,School of Information and Library Science, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Tara Nutley
- MEASURE Evaluation, Palladium Group, Chapel Hill, North Carolina, USA
| | - Jason B Smith
- MEASURE Evaluation, Carolina Population Center, University of North Carolina at Chapel Hill, North Carolina, USA
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Tsuei SHT, Clair V, Mutiso V, Musau A, Tele A, Frank E, Ndetei D. Factors Influencing Lay and Professional Health Workers’ Self-efficacy in Identification and Intervention for Alcohol, Tobacco, and Other Substance Use Disorders in Kenya. Int J Ment Health Addict 2017. [DOI: 10.1007/s11469-017-9775-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Tsuei SHT, Clair V, Mutiso V, Musau A, Tele A, Frank E, Ndetei D. FACTORS INFLUENCING LAY AND PROFESSIONAL HEALTH WORKERS' SELF-EFFICACY IN IDENTIFICATION AND INTERVENTION FOR ALCOHOL, TOBACCO, AND OTHER SUBSTANCE USE DISORDERS IN KENYA. Int J Ment Health Addict 2017; 15:766-781. [PMID: 31558889 PMCID: PMC6761831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Abstract
The global burden of substance use disorders (SUDs), including alcohol and tobacco, disproportionately affect low- and middle-income countries (LMICs), considering their rising disease burden and low service capacity. Nested within a Kenyan training program, this study explores factors associated with healthcare providers' self-efficacy to treat SUD. Surveys of 206 healthcare workers were used to perform regression and sensitivity analysis assessing various factors association with self-efficacy. Self-efficacy for SUD was lower in those practicing in public facilities and perceiving a need for alcohol use disorder (AUD) training; while higher self-efficacy correlated with a higher proportion of patients with AUD in one's setting, access to mental health worker support, cannabis use at a moderate risk level, and belief that AUD is manageable in outpatient settings. Increasing awareness about SUD prevalence, identification, and treatment skills could improve the self-efficacy of LMICs' health care providers and therefore the willingness to implement more services for patients with SUDs.
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Affiliation(s)
- Sian Hsiang-Te Tsuei
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Veronic Clair
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- Africa Mental Health Foundation, Nairobi, Kenya
| | | | | | - Albert Tele
- Africa Mental Health Foundation, Nairobi, Kenya
| | - Erica Frank
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - David Ndetei
- Africa Mental Health Foundation, Nairobi, Kenya
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
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Musyimi CW, Mutiso VN, Nayak SS, Ndetei DM, Henderson DC, Bunders J. Quality of life of depressed and suicidal patients seeking services from traditional and faith healers in rural Kenya. Health Qual Life Outcomes 2017; 15:95. [PMID: 28482849 PMCID: PMC5422872 DOI: 10.1186/s12955-017-0657-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 04/13/2017] [Indexed: 11/27/2022] Open
Abstract
Background In rural Kenya, traditional and faith healers provide an alternative pathway to health care, including mental health care. However, not much is known about the characteristics of the populations they serve. The purpose of this study was to determine the relationship between depression, suicidal ideation, and socio-demographic variables with Quality of Life (QoL) indicators in a sample seeking mental health services from traditional and faith healers in rural Kenya. Understanding QoL in this sample can help develop mental health policy and training to improve the well-being of this population. Method This was a cross-sectional epidemiological survey (n = 443) conducted over a period of 3 months among adult patients seeking care from traditional and faith healers in rural Kenya. Data were collected using the Beck Depression Inventory II (BDI-II), Beck Scale for Suicide Ideation (BSS) and WHO Quality of Life Survey- BREF (WHOQOL-BREF), and analyzed using correlation analyses, parametric tests, and regression analyses. Results Increasing levels of depression were associated with lower QoL among patients seeking care from traditional and faith healers. BSS scores were significantly negatively correlated with overall, physical, psychological, and environmental QoL, p < .05. There was a statistically significant difference between mean scores for overall QoL between depressed (M = 2.35, SD = 0.76) and non-depressed participants (M = 3.03, SD = 0.67), t(441) = 8.899, p < .001. Overall life satisfaction for depressed participants (M = 2.23, SD = 0.69) was significantly lower than non-depressed participants. Regression analyses indicated that depression, suicidal ideation, and being married predicted lower overall QoL controlling for other variables. Post hoc tests and subgroup analysis by gender revealed significant differences for females only. Depression, and older age predicted lower life satisfaction whereas being self-employed predicted higher life satisfaction, when controlling for other variables. Conclusion This study sheds light on correlates of QoL in depressed and non-depressed patients in rural Kenya. Evidence suggests that traditional and faith healers treat patients with a variety of QoL issues. Further research should focus on understanding how these issues tie into QoL, and how these healers can target these to improve care.
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Affiliation(s)
- Christine W Musyimi
- Africa Mental Health Foundation, Nairobi, Kenya.,Vrije Universiteit, Amsterdam, Netherlands
| | | | | | - David M Ndetei
- Africa Mental Health Foundation, Nairobi, Kenya. .,University of Nairobi, Nairobi, Kenya.
| | - David C Henderson
- Boston University School of Medicine, Boston, USA.,Harvard Medical School, Boston, USA
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Reuter PR, McGinnis SM, Reuter KE. Public health professionals' perceptions of mental health services in Equatorial Guinea, Central-West Africa. Pan Afr Med J 2017; 25:236. [PMID: 28293352 PMCID: PMC5337280 DOI: 10.11604/pamj.2016.25.236.10220] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 12/06/2016] [Indexed: 11/11/2022] Open
Abstract
Introduction Mental health disorders constitute 13% of global disease burden, the impacts of which are disproportionality felt in sub-Saharan Africa. Equatorial Guinea, located in Central-West Africa, has the highest per-capita investment in healthcare on the African continent, but only two studies have discussed mental health issues in the country and none of have examined the perspective of professionals working in the field. The purpose of this study was to gain a preliminary understanding of Equatoguinean health care professionals' perspectives on the mental health care system. Methods Nine adult participants (directors or program managers) were interviewed in July 2013 in Malabo, Equatorial Guinea from government agencies, aid organizations, hospitals, and pharmacies. Interviews were designed to collect broad information about the mental healthcare system in Equatorial Guinea including the professionals' perspectives and access to resources. This research was reviewed and approved by an ethical oversight committee. Results All individuals interviewed indicated that the mental health system does not currently meet the needs of the community. Professionals cited infrastructural capacity, stigmatization, and a lack of other resources (training programs, knowledgeable staff, medications, data) as key factors that limit the effectiveness of mental healthcare. Conclusion This study provides a preliminary understanding of the existing mental health care needs in the country, highlighting opportunities for enhanced healthcare services.
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Affiliation(s)
- Peter Robert Reuter
- Florida Gulf Coast University, College of Health Professions and Social Work, Fort Myers, FL, 33965
| | - Shannon Marcail McGinnis
- Public Health Management Corporation, LM 500, Lower Mezzanine, West Tower, 1500 Market Street, Philadelphia, PA 19102
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Goodman ML, Gutarra C, Billingsley KM, Keiser PH, Gitari S. Childhood exposure to emotional abuse and later life stress among Kenyan women: a mediation analysis of cross-sectional data. ANXIETY STRESS AND COPING 2016; 30:469-483. [PMID: 27998176 DOI: 10.1080/10615806.2016.1271876] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND OBJECTIVE We explore whether perceived stress among Kenyan mothers is predicted by childhood exposure to emotional abuse - both witnessed among parents and experienced directly. Further, we explore whether this association is mediated by social support, family functioning and polygynous marriage. DESIGN We used cross-sectional data from a systematic random sample (n = 1974) of mothers in semi-rural Kenya. METHODS Data were collected using validated scales and trained interviewers. Analyses were conducted using bootstrapped structural equation models and fixed-effects linear regression models, controlling for age and household wealth. RESULTS Reported experience of emotional abuse - both directly experienced and observed among household adults - was high in the present population (72.5% and 69%, respectively). Perceived stress among women was significantly higher if they were exposed to more emotional abuse during childhood (p < .001). Lower social support, worse family functioning and higher rates of polygynous marriage mediated pathways between emotional abuse exposure during childhood and adult perceived stress. CONCLUSION Future research should investigate whether social integration, identity formation and self-esteem underlie observed dynamics in sub-Saharan Africa. Efforts to promote social integration and support should target children currently experiencing emotional abuse, and may include child-targeted high quality television programing and adult-targeted media and celebrity campaigns.
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Affiliation(s)
- Michael L Goodman
- a Department of Internal Medicine, University of Texas Medical Branch , Galveston , TX , USA.,b Sodzo International , Houston , TX , USA
| | - Claudia Gutarra
- a Department of Internal Medicine, University of Texas Medical Branch , Galveston , TX , USA
| | - Katherine M Billingsley
- a Department of Internal Medicine, University of Texas Medical Branch , Galveston , TX , USA
| | - Philip H Keiser
- a Department of Internal Medicine, University of Texas Medical Branch , Galveston , TX , USA
| | - Stanley Gitari
- c Community Health Department , Maua Methodist Hospital , Maua , Kenya
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Athié K, Menezes ALDA, da Silva AM, Campos M, Delgado PG, Fortes S, Dowrick C. Perceptions of health managers and professionals about mental health and primary care integration in Rio de Janeiro: a mixed methods study. BMC Health Serv Res 2016; 16:532. [PMID: 27716299 PMCID: PMC5045579 DOI: 10.1186/s12913-016-1740-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 09/06/2016] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Community-based primary mental health care is recommended in low and middle-income countries. The Brazilian Health System has been restructuring primary care by expanding its Family Health Strategy. Due to mental health problems, psychosocial vulnerability and accessibility, Matrix Support teams are being set up to broaden the professional scope of primary care. This paper aims to analyse the perceptions of health professionals and managers about the integration of primary care and mental health. METHOD In this mixed-method study 18 health managers and 24 professionals were interviewed from different primary and mental health care services in Rio de Janeiro. A semi-structured survey was conducted with 185 closed questions ranging from 1 to 5 and one open-ended question, to evaluate: access, gateway, trust, family focus, primary mental health interventions, mental health records, mental health problems, team collaboration, integration with community resources and primary mental health education. Two comparisons were made: health managers and professionals' (Mann-Whitney non-parametric test) and health managers' perceptions (Kruskall-Wallis non parametric-test) in 4 service designs (General Traditional Outpatients, Mental Health Specialised Outpatients, Psychosocial Community Centre and Family Health Strategy)(SPSS version 17.0). Qualitative data were subjected to Framework Analysis. RESULTS Firstly, health managers and professionals' perceptions converged in all components, except the health record system. Secondly, managers' perceptions in traditional services contrasted with managers' perceptions in community-based services in components such as mental health interventions and team collaboration, and converged in gateway, trust, record system and primary mental health education. Qualitative data revealed an acceptance of mental health and primary care integration, but a lack of communication between institutions. The Mixed Method demonstrated that interviewees consider mental health and primary care integration as a requirement of the system, while their perceptions and the model of work produced by the institutional culture are inextricably linked. CONCLUSION There is a gap between health managers' and professionals' understanding of community-based primary mental health care. The integration of different processes of work entails both rethinking workforce actions and institutional support to help make changes.
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Affiliation(s)
- Karen Athié
- Programa de Pós Graduação em Ciências Médicas/ Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Alice Lopes do Amaral Menezes
- Laboratório Interdisciplinar em Atenção Primária à Saúde/LIPAPS/Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Angela Machado da Silva
- Laboratório Interdisciplinar em Atenção Primária à Saúde/LIPAPS/Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Monica Campos
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Pedro Gabriel Delgado
- Núcleo de Pesquisas em Políticas Públicas de Saúde Mental/ Instituto de Psiquiatria da Universidade do Brasil, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Sandra Fortes
- Laboratório Interdisciplinar em Atenção Primária à Saúde/LIPAPS/Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Christopher Dowrick
- Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK
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Mental health system governance in Nigeria: challenges, opportunities and strategies for improvement. Glob Ment Health (Camb) 2016; 3:e9. [PMID: 28596878 PMCID: PMC5314752 DOI: 10.1017/gmh.2016.2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 12/24/2015] [Accepted: 01/20/2016] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION A health systems approach to understanding efforts for improving health care services is gaining traction globally. A component of this approach focuses on health system governance (HSG), which can make or mar the successful implementation of health care interventions. Very few studies have explored HSG in low- and middle-income countries, including Nigeria. Studies focusing on mental health system governance, are even more of a rarity. This study evaluates the mental HSG of Nigeria with a view to understanding the challenges, opportunities and strategies for strengthening it. METHODOLOGY This study was conducted as part of the project, Emerging Mental Health Systems in Low and Middle Income Countries (Emerald). A multi-method study design was utilized to evaluate the mental HSG status of Nigeria. A situational analysis of the health policy and legal environment in the country was performed. Subsequently, 30 key informant interviews were conducted at national, state and district levels to explore the country's mental HSG. RESULTS The existing policy, legislative and institutional framework for HSG in Nigeria reveals a complete exclusion of mental health in key health sector documents. The revised mental health policy is however promising. Using the Siddiqi framework categories, we identified pragmatic strategies for mental health system strengthening that include a consideration of existing challenges and opportunities within the system. CONCLUSION The identified strategies provide a template for the subsequent activities of the Emerald Programme (and other interventions), towards strengthening the mental health system of Nigeria.
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Jenkins R, Othieno C, Ongeri L, Sifuna P, Ongecha M, Kingora J, Kiima D, Omollo R, Ogutu B. Common mental disorder in Nyanza province, Kenya in 2013 and its associated risk factors--an assessment of change since 2004, using a repeat household survey in a demographic surveillance site. BMC Psychiatry 2015; 15:309. [PMID: 26651332 PMCID: PMC4673710 DOI: 10.1186/s12888-015-0693-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 11/28/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Repeat household surveys are useful to assess change in prevalence over time, but there have been no repeat surveys of common mental disorder (CMD) in Kenya, or indeed sub-Saharan Africa. Therefore a repeat household survey of CMD and its associated risk factors was conducted in Maseno area, Kisumu county in Kenya, using a demographic surveillance site as the sample frame, in order to test the hypotheses that (a) the prevalence of CMD would increase between 2004 and 2013 due to the intervening political, social and economic pressures; (b) as in 2004, there would be no gender difference in prevalence of CMD. METHODS One thousand one hundred ninety households were selected, and 1158 adult participants consented to be interviewed with a structured epidemiological assessment while 32 refused to participate in the study interviews, giving a response rate of 97.3%. RESULTS The study found that the overall prevalence of CMD in 2013 was 10.3%. However, there were significantly higher rates of having any CMD in 2013 if one was female (OR 6.2, p < 0.001), divorced/widowed (OR 2.5, p < 0.003), aged over 60 (OR 2.3, p = 0.052), either self-employed (OR 3.3 p < 0.001) or employed (OR 3.3, p < 0.001), or belonged to the lowest asset quintile (OR 2.5, p = .0.004) after adjusting for other variables significant at the bivariate level. The overall prevalence in 2013 was consistent with that found in 2004, despite intervening political and community turbulence. However, this apparent consistency masks the development of a striking difference in prevalence between the genders. Over the decade 2004-13, the prevalence for men dropped from 10.9 to 3.8% (P = 0.001) and the prevalence for women increased from 10.8 to 17.5% (p = 0.001). CONCLUSION Common mental disorders continue to pose a significant public health burden in Kenya, and gender related vulnerability merits further research and is relevant for health worker training.
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Affiliation(s)
- Rachel Jenkins
- Health Services and Population Research Department, Institute of Psychiatry, Kings College London, de Crespigny Park, London, SE 5 8AF, UK.
| | - Caleb Othieno
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya.
| | | | - Peter Sifuna
- Kenya Medical Research Institute, Kisumu, Kenya.
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Jenkins R, Othieno C, Omollo R, Ongeri L, Sifuna P, Mboroki JK, Kiima D, Ogutu B. Probable Post Traumatic Stress Disorder in Kenya and Its Associated Risk Factors: A Cross-Sectional Household Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:13494-509. [PMID: 26516877 PMCID: PMC4627045 DOI: 10.3390/ijerph121013494] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 10/05/2015] [Accepted: 10/14/2015] [Indexed: 12/03/2022]
Abstract
This study aimed to assess the prevalence of probable post-traumatic stress disorder (PTSD), and its associated risk factors in a general household population in Kenya. Data were drawn from a cross-sectional household survey of mental disorders and their associated risk factors. The participants received a structured epidemiological assessment of common mental disorders, and symptoms of PTSD, accompanied by additional sections on socio-demographic data, life events, social networks, social supports, disability/activities of daily living, quality of life, use of health services, and service use. The study found that 48% had experienced a severe trauma, and an overall prevalence rate of 10.6% of probable PTSD, defined as a score of six or more on the trauma screening questionnaire (TSQ). The conditional probability of PTSD was 0.26. Risk factors include being female, single, self-employed, having experienced recent life events, having a common mental disorder (CMD)and living in an institution before age 16. The study indicates that probable PTSD is prevalent in this rural area of Kenya. The findings are relevant for the training of front line health workers, their support and supervision, for health management information systems, and for mental health promotion in state boarding schools.
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Affiliation(s)
- Rachel Jenkins
- Health Services and Population Research Department, Institute of Psychiatry, Kings College London, de Crespigny Park, London SE5 8AF, UK.
| | - Caleb Othieno
- Department of Psychiatry, University of Nairobi, Kenya, Kenyatta National Hospital, Nairobi. P. O. Box 19676-00202.
| | - Raymond Omollo
- Kenya Medical Research Institute, P.O. Box 54-40100 Kisumu, Kenya.
| | - Linnet Ongeri
- Kenya Medical Research Institute, P.O. Box 54-40100 Kisumu, Kenya.
| | - Peter Sifuna
- Kenya Medical Research Institute, P.O. Box 54-40100 Kisumu, Kenya.
| | | | - David Kiima
- Ministry of Health, Nairobi P.O. Box 30016-00100, Kenya.
| | - Bernhards Ogutu
- Kenya Medical Research Institute, P.O. Box 54-40100 Kisumu, Kenya.
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Benzer JK, Cramer IE, Burgess JF, Mohr DC, Sullivan JL, Charns MP. How personal and standardized coordination impact implementation of integrated care. BMC Health Serv Res 2015; 15:448. [PMID: 26432790 PMCID: PMC4592548 DOI: 10.1186/s12913-015-1079-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 09/18/2015] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Integrating health care across specialized work units has the potential to lower costs and increase quality and access to mental health care. However, a key challenge for healthcare managers is how to develop policies, procedures, and practices that coordinate care across specialized units. The purpose of this study was to identify how organizational factors impacted coordination, and how to facilitate implementation of integrated care. METHODS Semi-structured interviews were conducted in August 2009 with 30 clinic leaders and 35 frontline staff who were recruited from a convenience sample of 16 primary care and mental health clinics across eight medical centers. Data were drawn from a management evaluation of primary care-mental health integration in the US Department of Veterans Affairs. To protect informant confidentiality, the institutional review board did not allow quotations. RESULTS Interviews identified antecedents of organizational coordination processes, and highlighted how these antecedents can impact the implementation of integrated care. Overall, implementing new workflow practices were reported to create conflicts with pre-existing standardized coordination processes. Personal coordination (i.e., interpersonal communication processes) between primary care leaders and staff was reported to be effective in overcoming these barriers both by working around standardized coordination barriers and modifying standardized procedures. DISCUSSION This study identifies challenges to integrated care that might be solved with attention to personal and standardized coordination. A key finding was that personal coordination both between primary care and mental health leaders and between frontline staff is important for resolving barriers related to integrated care implementation. CONCLUSION Integrated care interventions can involve both new standardized procedures and adjustments to existing procedures. Aligning and integrating procedures between primary care and specialty care requires personal coordination amongst leaders. Interpersonal relationships should be strengthened between staff when personal connections are important for coordinating patient care across clinical settings.
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Affiliation(s)
- Justin K Benzer
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 S. Huntington Ave (152-M), Boston, MA, 02130, USA.
- Department of Health Policy and Management, Boston University School of Public Health, 715 Albany Street Talbot Building, T2W, Boston, MA, 02118, USA.
- VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX, USA.
| | - Irene E Cramer
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 S. Huntington Ave (152-M), Boston, MA, 02130, USA.
- Department of Health Policy and Management, Boston University School of Public Health, 715 Albany Street Talbot Building, T2W, Boston, MA, 02118, USA.
| | - James F Burgess
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 S. Huntington Ave (152-M), Boston, MA, 02130, USA.
- Department of Health Policy and Management, Boston University School of Public Health, 715 Albany Street Talbot Building, T2W, Boston, MA, 02118, USA.
| | - David C Mohr
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 S. Huntington Ave (152-M), Boston, MA, 02130, USA.
- Department of Health Policy and Management, Boston University School of Public Health, 715 Albany Street Talbot Building, T2W, Boston, MA, 02118, USA.
| | - Jennifer L Sullivan
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 S. Huntington Ave (152-M), Boston, MA, 02130, USA.
- Department of Health Policy and Management, Boston University School of Public Health, 715 Albany Street Talbot Building, T2W, Boston, MA, 02118, USA.
| | - Martin P Charns
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 S. Huntington Ave (152-M), Boston, MA, 02130, USA.
- Department of Health Policy and Management, Boston University School of Public Health, 715 Albany Street Talbot Building, T2W, Boston, MA, 02118, USA.
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Jenkins R, Othieno C, Omollo R, Ongeri L, Sifuna P, Ongecha M, Mboroki JK, Kiima D, Ogutu B. Tedium vitae, death wishes, suicidal ideation and attempts in Kenya-prevalence and risk factors. BMC Public Health 2015; 15:759. [PMID: 26253319 PMCID: PMC4528694 DOI: 10.1186/s12889-015-2089-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Accepted: 07/24/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND There has been no previous household population study of suicidal ideation and attempts in Kenya. Therefore this study aimed to establish the prevalence of suicidal ideation and attempts in a rural population in Kenya, and to assess risk factors. METHODS An epidemiological survey of a household population, using standardised structured interviews. We examined the prevalence of suicidal ideation and suicide attempts and the predictors of suicidal thoughts and attempts, using STATA to calculate unadjusted and adjusted odds ratios. RESULTS A quarter of the sample (24.1 %) had thought that life was not worth living (tedium vitae) at some point in their lives, while a fifth had experienced death wishes at some stage. About 7.9 % reported suicidal thoughts and 1.9 % had made actual suicide attempts at some point in their lives. It can be seen that the prevalence of suicidal thoughts was 0.7 %, 4.2 %, 3.7 % and 7.9 % for last week, last year, at some other time, and lifetime respectively, while the prevalence of suicidal attempts was 0.5 %, 1.2 %, 0.7 and 1.9 % respectively. In the adjusted analysis of factors associated with suicidal thoughts, being female (OR 1.8, p = 0.017), having CMD (OR 2.7, p = 0.001), having a number of recent life events (OR 2.3, p = 0.001 for 2-3 life events and OR 2.6, p = 0.004 for 4 or more life events), and having a large social group size (OR 7.7, p = 0.006 for social group size of 4-8 and OR 9.1, p = 0.003 for social group size of 9 or more) were all associated with increased rates of life time suicidal thoughts, but psychotic symptoms were no longer significant after adjustment for the other variables. In the adjusted analysis of suicide attempts, having any psychotic symptoms (OR 5.1, p = 0.001) was the only factor associated with suicide attempts after adjustment for other factors significant at the bivariate level. CONCLUSION Suicidal ideation and attempts pose a significant public health burden in this poor rural area of Kenya. The findings are relevant for mental health promotion and prevention programmes, public education and professional training programmes in relevant sectors, especially in front line health workers and social workers.
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Affiliation(s)
- Rachel Jenkins
- Institute of Psychiatry, Kings College London, London, UK.
| | | | - Ray Omollo
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya.
| | - Linnet Ongeri
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya.
| | - Peter Sifuna
- Kombewa Health and Demographic Surveillance System, Kombewa, Kenya.
| | - Michael Ongecha
- Centre for Global Health, Kenya Medical Research Institute, Kisumu, Kenya.
| | | | - David Kiima
- Kenya Ministry of Medical Services, Nairobi, Kenya.
| | - Bernhards Ogutu
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya.
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Jack H, Canavan M, Bradley E, Ofori-Atta A. Aggression in mental health settings: a case study in Ghana. Bull World Health Organ 2015; 93:587-8. [PMID: 26478616 PMCID: PMC4581654 DOI: 10.2471/blt.14.145813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Revised: 12/09/2014] [Accepted: 02/23/2015] [Indexed: 11/27/2022] Open
Affiliation(s)
- Helen Jack
- Institute of Psychiatry, King's College London, De Crespigny Park, Denmark Hill, London SE5 8AF, England
| | - Maureen Canavan
- Yale School of Public Health, New Haven, United States of America
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Jenkins R, Othieno C, Ongeri L, Ogutu B, Sifuna P, Mboroki J, Omollo R. Attention deficit hyperactivity disorder symptom self-report in adults in Kenya and its associated risk factors, an analysis from a household survey in a demographic surveillance site. Glob Ment Health (Camb) 2015; 2:e14. [PMID: 28596862 PMCID: PMC5269634 DOI: 10.1017/gmh.2015.14] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Revised: 05/18/2015] [Accepted: 06/06/2015] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND There have been no household surveys of adult attention deficit and hyperactivity disorder (ADHD) in Kenya, and only one in sub-Saharan Africa. METHODS Data on ADHD was used from a household survey of mental disorders and their associated risk factors conducted in Maseno area (population 70 805), near Lake Victoria in Kenya, using a demographic surveillance site as the sample frame, as part of a wider survey of mental health, malaria and immunity A total of 1190 households were selected, and 1158 adult participants consented to the study while 32 refused to participate in the study interviews, giving a response rate of 97.3%. ADHD symptoms were assessed with the WHO Adult ADHD Self-Report Scale (ASRS) Screener. RESULTS This survey found that the overall prevalence of ADHD using the ASRS was 13.1%. This suggests a high level of ADHD in the Kenyan population which needs to be further investigated for its impact on adult mental health. In the adjusted analysis, increased odds ratios (ORs) were found in those with higher assets (OR 1.7, p = 0.023), those with life events (OR 2.4, p = 0.001 for those with 2-3 life events and OR 2.6, p < 0.001 for those with 4 or more life events), and those with common mental disorders (OR 2.3, p = 0.001). CONCLUSION The study demonstrates the magnitude of ADHD symptoms as a public health issue, relevant for health worker training, and the importance of further research into its prevalence in adults and associated risk factors.
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Affiliation(s)
- R. Jenkins
- Health Services and Population Research Department, Institute of Psychiatry, Kings College London, UK
| | - C. Othieno
- Departmenet Psychiatry, University of Nairobi, Nairobi, Kenya
| | - L. Ongeri
- Kenya Medical Research Institute, Centre for Clinical Research, Nairobi, Kenya
| | - B. Ogutu
- Kenya Medical Research Institute, Centre for Clinical Research, Nairobi, Kenya
| | - P. Sifuna
- Kombewa Health and Demographic Surveillance Site, Kisumu, Kenya
| | - J. Mboroki
- Kenya Medical Training Centre, Mental Health, Nairobi, Kenya
| | - R. Omollo
- Kenya Medical Research Institute, Centre for Clinical Research, Nairobi, Kenya
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Gureje O, Abdulmalik J, Kola L, Musa E, Yasamy MT, Adebayo K. Integrating mental health into primary care in Nigeria: report of a demonstration project using the mental health gap action programme intervention guide. BMC Health Serv Res 2015; 15:242. [PMID: 26094025 PMCID: PMC4475323 DOI: 10.1186/s12913-015-0911-3] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 06/08/2015] [Indexed: 11/16/2022] Open
Abstract
Background The World Mental Health Surveys conducted by the World Health Organization (WHO) have shown that huge treatment gaps for severe mental disorders exist in both developed and developing countries. This gap is greatest in low and middle income countries (LMICs). Efforts to scale up mental health services in LMICs have to contend with the paucity of mental health professionals and health facilities providing specialist services for mental, neurological and substance use (MNS) disorders. A pragmatic solution is to improve access to care through the facilities that exist closest to the community, via a task-shifting strategy. This study describes a pilot implementation program to integrate mental health services into primary health care in Nigeria. Methods The program was implemented over 18 months in 8 selected local government areas (LGAs) in Osun state of Nigeria, using the WHO Mental Health Gap Action Programme Intervention Guide (mhGAP-IG), which had been contextualized for the local setting. A well supervised cascade training model was utilized, with Master Trainers providing training for the Facilitators, who in turn conducted several rounds of training for front-line primary health care workers. The first set of trainings by the Facilitators was supervised and mentored by the Master Trainers and refresher trainings were provided after 9 months. Results A total of 198 primary care workers, from 68 primary care clinics, drawn from 8 LGAs with a combined population of 966,714 were trained in the detection and management of four MNS conditions: moderate to severe major depression, psychosis, epilepsy, and alcohol use disorders, using the mhGAP-IG. Following training, there was a marked improvement in the knowledge and skills of the health workers and there was also a significant increase in the numbers of persons identified and treated for MNS disorders, and in the number of referrals. Even though substantial retention of gained knowledge was observed nine months after the initial training, some level of decay had occurred supporting the need for a refresher training. Conclusion It is feasible to scale up mental health services in primary care settings in Nigeria, using the mhGAP-IG and a well-supervised cascade-training model. This format of training is pragmatic, cost-effective and holds promise, especially in settings where there are few specialists. Electronic supplementary material The online version of this article (doi:10.1186/s12913-015-0911-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Oye Gureje
- WHO Collaborating Centre for Research and Training in Mental Health and Neuroscience, Department of Psychiatry, University of Ibadan, Ibadan, Nigeria.
| | - Jibril Abdulmalik
- Department of Psychiatry, University of Ibadan, Nigeria, Ibadan, Nigeria.
| | - Lola Kola
- World Health Organization, Nigeria Country Office, Osogbo, Nigeria.
| | - Emmanuel Musa
- Nigeria Country Office, World Health Organization, Abuja, Nigeria.
| | - Mohammad Taghi Yasamy
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland.
| | - Kazeem Adebayo
- Department of Psychiatry, Ladoke Akintola University of Technology, Ogbomoso, Nigeria.
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Panda B, Pati S, Nallala S, Chauhan AS, Anasuya A, Som M, Zodpey S. How supportive supervision influences immunization session site practices: a quasi-experimental study in Odisha, India. Glob Health Action 2015; 8:25772. [PMID: 25595596 PMCID: PMC4297277 DOI: 10.3402/gha.v8.25772] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 10/29/2014] [Accepted: 11/27/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Routine immunization (RI) is a key child survival intervention. Ensuring acceptable standards of RI service delivery is critical for optimal outcomes. Accumulated evidences suggest that 'supportive supervision' improves the quality of health care services in general. During 2009-2010, the Government of Odisha and UNICEF jointly piloted this strategy in four districts to improve RI program outcomes. The present study aims to assess the effect of this strategy on improvement of skills and practices at immunization session sites. DESIGN A quasi-experimental 'post-test only' study design was adopted to compare the opinion and practices of frontline health workers and their supervisors in four intervention districts (IDs) with two control districts (CDs). Altogether, we interviewed 111 supervisor-supervisee (health worker) pairs using semi-structured interview schedules and case vignettes. We also directly observed health workers' practices during immunization sessions at 111 sites. Data were analyzed with SPSS version 16.0. RESULTS The mean knowledge score of supervisors in CDs was significantly higher than in intervention groups. Variegated responses were obtained on case vignettes. The control group performed better in solving certain hypothetically asked problems, whereas the intervention group scored better in others. Health workers in IDs gave a lower rating to their respective supervisors' knowledge, skill, and frequency of supervision. Logistics and vaccine availability were better in CDs. CONCLUSION Notwithstanding other limitations, supportive supervision may not have independent effects on improving the quality of immunization services. Addressing systemic issues, such as the availability of essential logistics, supply chain management, timely indenting, and financial resources, could complement the supportive supervision strategy in improving immunization service delivery.
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Affiliation(s)
| | | | | | | | - Anita Anasuya
- DFID, Technical Management and Support Team, Government of Odisha, Odisha, India
| | - Meena Som
- UNICEF State Office for Odisha, Bhubaneswar, Odisha, India
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