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Ean M, Tripura R, Sothea P, Savoeun U, Peto TJ, Bunthynn S, Callery JJ, Soviet U, Dysoley L, Yeong Cheah P, Adhikari B. A youth advisory group on health and health research in rural Cambodia. Glob Bioeth 2024; 35:2361968. [PMID: 38859929 PMCID: PMC11164040 DOI: 10.1080/11287462.2024.2361968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 05/27/2024] [Indexed: 06/12/2024] Open
Abstract
Engaging young people in health research has been promoted globally. We explored the outcomes of youth advisory group on health and research engagement (YAGHRE) in rural Cambodia. In May 2021, the Mahidol Oxford Tropical Medicine Research Unit (MORU) partnered with a local health centre and a secondary school to establish a youth engagement group. Ten students underwent training and led health engagement activities in schools and communities. Activities were documented as field notes and audio-visual materials which underwent content analysis using theory of change supplemented by iterative discussions with YAGHRE members and stakeholders. Five major outcomes were identified: 1. Increased respect. Engagement activities developed based on input from students and stakeholders may have fostered greater respect. 2. Built trust and relationships. Frequent visits to MORU's laboratory and interactions with researchers appeared to contribute to the building of trust and relationship. 3. Improved health and research literacy. Learning new health and research topics, through participatory activities may have improved literacy; 4. Improved uptake of health and research interventions. Health promotional activities and communication with research participants potentially increased the uptake of interventions; 5. Improved community health. YAGHRE's health promotional interventions may have contributed in enhancing community's health.
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Affiliation(s)
- Mom Ean
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Rupam Tripura
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Phann Sothea
- Techo Siem Pang High School, Provincial Department of Education, Youth and Sport, Siem Pang, Stung Treng, Cambodia
| | - Uch Savoeun
- Siem Pang Health Centre, Provincial Health Department, Siem Pang, Stung Treng, Cambodia
| | - Thomas J. Peto
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Sam Bunthynn
- District Governor Office, Siem Pang District Administration, Siem Pang, Stung Treng, Cambodia
| | - James J. Callery
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Ung Soviet
- Provincial Health Department, Stung Treng, Cambodia
- CNM National Centre for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Lek Dysoley
- Provincial Health Department, Stung Treng, Cambodia
- CNM National Centre for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
- School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia
| | - Phaik Yeong Cheah
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Bipin Adhikari
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
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Hiltensperger R, Ryan G, Ben-Dor IA, Charles A, Epple E, Kalha J, Korde P, Kotera Y, Mpango R, Moran G, Mueller-Stierlin AS, Nixdorf R, Ramesh M, Shamba D, Slade M, Puschner B, Nakku J. Implementation of peer support for people with severe mental health conditions in high-, middle- and low-income-countries: a theory of change approach. BMC Health Serv Res 2024; 24:480. [PMID: 38637776 PMCID: PMC11027518 DOI: 10.1186/s12913-024-10990-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 04/14/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Stakeholder engagement is essential to the design, implementation and evaluation of complex mental health interventions like peer support. Theory of Change (ToC) is commonly used in global health research to help structure and promote stakeholder engagement throughout the project cycle. Stakeholder insights are especially important in the context of a multi-site trial, in which an intervention may need to be adapted for implementation across very different settings while maintaining fidelity to a core model. This paper describes the development of a ToC for a peer support intervention to be delivered to people with severe mental health conditions in five countries as part of the UPSIDES trial. METHODS One hundred thirty-four stakeholders from diverse backgrounds participated in a total of 17 workshops carried out at six UPSIDES implementing sites across high-, middle- and low-income settings (one site each in India, Israel, Uganda and Tanzania; two sites in Germany). The initial ToC maps created by stakeholders at each site were integrated into a cross-site ToC map, which was then revised to incorporate additional insights from the academic literature and updated iteratively through multiple rounds of feedback provided by the implementers. RESULTS The final ToC map divides the implementation of the UPSIDES peer support intervention into three main stages: preparation, implementation, and sustainability. The map also identifies three levels of actors involved in peer support: individuals (service users and peer support workers), organisations (and their staff members), and the public. In the UPSIDES trial, the ToC map proved especially helpful in characterising and distinguishing between (a) common features of peer support, (b) shared approaches to implementation and (c) informing adaptations to peer support or implementation to account for contextual differences. CONCLUSIONS UPSIDES is the first project to develop a multi-national ToC for a mental health peer support intervention. Stakeholder engagement in the ToC process helped to improve the cultural and contextual appropriateness of a complex intervention and ensure equivalence across sites for the purposes of a multi-site trial. It may serve as a blueprint for implementing similar interventions with a focus on recovery and social inclusion among people with mental ill-health across diverse settings. TRIAL REGISTRATION ISRCTN26008944 (Registration Date: 30/10/2019).
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Affiliation(s)
| | - Grace Ryan
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Inbar Adler Ben-Dor
- Department of Social Work, Ben Gurion University of the Negev, Be'er Sheva, Israel
| | - Ashleigh Charles
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Ellen Epple
- Department of Psychiatry II, Ulm University, Ulm, Germany
| | - Jasmine Kalha
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
| | - Palak Korde
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
| | - Yasuhiro Kotera
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Richard Mpango
- Butabika National Referral Hospital, Kampala, Uganda
- Department of Mental Health, School of Health Sciences, Soroti University, Soroti, Uganda
| | - Galia Moran
- Department of Social Work, Ben Gurion University of the Negev, Be'er Sheva, Israel
| | | | - Rebecca Nixdorf
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mary Ramesh
- Department of Health Systems Impact Evaluation and Policy, Ifakara Health Institute, Dar Es Salaam, Tanzania
| | - Donat Shamba
- Department of Health Systems Impact Evaluation and Policy, Ifakara Health Institute, Dar Es Salaam, Tanzania
| | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
- Health and Community Participation Division, Nord University, Namsos, Norway
| | - Bernd Puschner
- Department of Psychiatry II, Ulm University, Ulm, Germany
| | - Juliet Nakku
- Butabika National Referral Hospital, Kampala, Uganda
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Kemp D, Doyle M, Turner M, Hemingway S. Care Plan Templates in Adult Community Mental Health Teams in England and Wales: An Evaluation. NURSING REPORTS 2024; 14:340-352. [PMID: 38391071 PMCID: PMC10885041 DOI: 10.3390/nursrep14010026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/09/2024] [Accepted: 01/21/2024] [Indexed: 02/24/2024] Open
Abstract
Adults accessing community mental health services are required to have a care plan, developed in collaboration with the person accessing the service. The variation in care plan templates in use in England and Wales, and their impact on care planning, is unknown. This study evaluates the community mental health care plan templates in use across England and Wales. Data were obtained from a Freedom of Information request to 50 NHS Mental Health Trusts. An evaluation tool was designed and used to extract data. Data were rated red, amber, or green against clinical and design standards. Forty-seven care plan templates were obtained. The clinical aspect of the care plan template had 60% adherence to the national standards, and the design aspects had 87% adherence. A 'high/low' typology is proposed against the design/clinical standards. The study identifies priority areas for improvement in the care plan templates as space to record the actions that service users and carers will take to contribute to their care plan, space to record the name and contact details for their care coordinator or lead professional, plus others involved in the person's care. This study was not registered.
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Affiliation(s)
- Donna Kemp
- School of Human and Health Sciences, Queensgate Campus, University of Huddersfield, Huddersfield HD1 3DH, UK
| | - Michael Doyle
- School of Human and Health Sciences, Queensgate Campus, University of Huddersfield, Huddersfield HD1 3DH, UK
| | - Mary Turner
- School of Human and Health Sciences, Queensgate Campus, University of Huddersfield, Huddersfield HD1 3DH, UK
| | - Steve Hemingway
- School of Human and Health Sciences, Queensgate Campus, University of Huddersfield, Huddersfield HD1 3DH, UK
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Mushi D, Hanlon C, Francis JM, Candida M, Demissie M, Teferra S. Adaptation of a model for integration of interventions for alcohol use disorders in primary health care in Tanzania. BMC PRIMARY CARE 2023; 24:106. [PMID: 37085751 PMCID: PMC10120272 DOI: 10.1186/s12875-023-02061-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 04/13/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND Integrating evidence-based interventions for people with alcohol use disorder (AUD) into primary healthcare (PHC) can increase access to care and reduce morbidity, mortality, and population burden. However, for the integration to be feasible, acceptable, and sustainable, there is a need to contextualize the approach and involve stakeholders. Therefore, this study aimed to use participatory methods to adapt a model for integrating AUD interventions in Tanzania's PHC system at the community, facility, and organizational levels. METHODS A mixed-methods study was used. Participants include key mental health stakeholders, experts, and PHC providers. We conducted a situational analysis to investigate opportunities and constraints in the existing systems of care, utilizing data available from the routine collection and/or in the public domain, individual semi-structured interviews (n = 11), and focus group discussions (3 groups; total n = 26 participants) and a series of theory of change (ToC) workshops (n = 32). Data from the three methods were triangulated to develop the adapted model for integrating interventions for AUD in PHC. RESULTS A situational appraisal revealed limited community, facility, and organizational resources and infrastructures for supporting services delivery of integrated AUD interventions. Also, shortage of health workforce, inadequate health management information systems, and limited medical supply and financing. Nevertheless, the theory of change proposed integrated AUD intervention packages and strategies to facilitate integrated care for people with AUD. Additionally, the barriers and facilitators for implementing these integrated AUD interventions and how to overcome them were explored. CONCLUSIONS The adapted model for the integrated AUD intervention in Tanzanian PHC revealed limited resources and system functioning for facilitating integrated AUD services. Nevertheless, it proposes the needed integrated AUD interventions and its barriers, facilitators, and strategies for overcoming them. There is a need to pilot the adapted model to inform plans for more comprehensive implementation or scaling up.
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Affiliation(s)
- Dorothy Mushi
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Science, P.O Box 65001, United Nations Road, Dar Es Salaam, Tanzania.
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Charlotte Hanlon
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Joel M Francis
- Department of Family Medicine and Primary Care, Witwatersrand University, Faculty of Health Sciences, Johannesburg, South Africa
| | - Moshiro Candida
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Mekdes Demissie
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
- Psychiatric Nursing Department, School of Nursing and Midwifery, College of Health and medical Sciences, Haramaya University, Ethiopia, Dire Dawa , Ethiopia
| | - Solomon Teferra
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Girit S, Müller-Stierlin AS, Hiltensperger R, Wenzel L, Lohner M, Mahlke C, Nixdorf R, Puschner B. [Successful Implementation of Peer Support for People with Severe Mental Illness in Germany: a Theory of Change Approach]. Psychother Psychosom Med Psychol 2023; 73:70-77. [PMID: 35793668 DOI: 10.1055/a-1827-4040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Peer support is an established intervention in which people with mental illness receive support by trained peer support workers who have already overcome a mental health crisis. The implementation of peer support is complex due to interacting factors and can be achieved through the participatory Theory of Change method. Aim of this study is to develop a cross-site Theory of Change for the sustainable implementation of UPSIDES peer support in Germany. METHODS Based on site-specific Theories of Change workshops from Ulm and Hamburg in which 47 participants took part, a cross-site Theory of Change was designed and verified in three follow-up workshops with 12 participants. Participants' professional and experiential backgrounds were diverse, including peer support workers, hospital directors and managers, mental health professionals (psychiatrists, psychotherapists, nurses), and researchers. RESULTS The first pathway of the cross-site Theory of Change focuses on the training of peer support workers, whereas the second pathway emphasizes recognition and integration by mental health institutions and professionals. The third pathway specifies the building of a cross-professional care network to integrate various peer support services. Procedures to approach prospective peer clients are depicted in the fourth pathway. The fifth path addresses the clarification of the role description of peer support workers and the implementation in other institutions through cooperation. DISCUSSION Many of the identified implementation steps have been validated in comparable studies. The development of this Theory of Change by bringing together multiple perspectives of key stakeholders is an important basis for the sustainable implementation of UPSIDES peer support. Furthermore, it may serve as a blueprint for the implementation of similar interventions to advance scaling-up of evidence-based user-led and recovery-oriented interventions. CONCLUSION The Theory of Change approach is a well-accepted and feasible method, which can be recommended for the implementation of complex interventions such as UPSIDES peer support.
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Affiliation(s)
- Selina Girit
- Klinik für Psychiatrie und Psychotherapie II, Universität Ulm, Günzburg, Germany
| | | | - Ramona Hiltensperger
- Klinik für Psychiatrie und Psychotherapie II, Universität Ulm, Günzburg, Germany
| | - Lisa Wenzel
- Klinik für Psychiatrie und Psychotherapie II, Universität Ulm, Günzburg, Germany
| | - Manfred Lohner
- Klinik für Psychiatrie und Psychotherapie II, Universität Ulm, Günzburg, Germany
| | - Candelaria Mahlke
- AG sozialpsychiatrische und partizipative Forschung, Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Rebecca Nixdorf
- AG sozialpsychiatrische und partizipative Forschung, Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Bernd Puschner
- Klinik für Psychiatrie und Psychotherapie II, Universität Ulm, Günzburg, Germany
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Tarfa A, Pecanac K, Shiyanbola OO. A qualitative inquiry into the patient-related barriers to linkage and retention in HIV care within the community setting. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2022; 9:100207. [PMID: 36568895 PMCID: PMC9772845 DOI: 10.1016/j.rcsop.2022.100207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 12/07/2022] Open
Abstract
Background People with the Human Immunodeficiency Virus (PWH) experience barriers to care within the community that impedes their progress from when they discover that they are HIV positive to becoming virally suppressed. For individuals with HIV to achieve sustained viral suppression, they must be linked to care to start receiving anti-retroviral therapy and remain retained in care for continuous treatment. However, HIV surveillance data shows that many PWH are not linked to care and become lost to continuous follow-up care. Although pharmacists, PWH, and social workers interact with one another and are aware of their roles in HIV care, their perspectives on barriers to linkage and retention in care have not been investigated collectively. Objectives Explore the perspectives of PWH, pharmacists, and social workers on barriers to linkage and retention of HIV care within the community setting. Methods Convenience sampling was used to recruit 15 stakeholders (five PWH, five community pharmacists, and five social workers) who participated in 1-h, semi-structured interviews based on three domains of the Patient-centered Medical Home Model including (1) experiences (individual and system-level barriers to care experienced by PWH), (2) activities (social workers and pharmacists initiatives that impact adherence to care)and (3) interventions (critical issues pharmacists can address in the community to engage PWH in their HIV care). We conducted a directed content analysis based on deductive coding. To establish rigor, we focused on Lincoln and Guba's criteria of rigorous qualitative methodology: credibility, dependability, confirmability, and transferability. Similarities and divergences of themes were discussed during data analysis and agreement was reached before interpretation. Results Emergent themes uncovered barriers to linkage and retention in HIV care as HIV-related stigma, having mental health illnesses including a history of substance abuse and social determinants of health such as homelessness, food insecurity, and insurance issues. Conclusion The perspectives of pharmacists, social workers, and PWH can provide insight into barriers that should be identified and addressed in people living with HIV to enhance their linkage and retention in care.
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Affiliation(s)
- Adati Tarfa
- 2506 Rennebohm Hall, School of Pharmacy, University of Wisconsin, 777 Highland Ave., Madison, WI 53705-222, United States of America,Corresponding author.
| | - Kristen Pecanac
- 4167 Signe Skott Cooper Hall, University of Wisconsin, 701 Highland Avenue, Madison, WI 53705, United States of America
| | - Olayinka O. Shiyanbola
- 2517 Rennebohm Hall, School of Pharmacy, University of Wisconsin, 777 Highland Ave., Madison, WI 53705-222, United States of America
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Salgado MA, Fortes SLCL. [Mental health indicators in primary healthcare: assessment of the quality of access through case detection capacity]. CAD SAUDE PUBLICA 2021; 37:e00178520. [PMID: 34669772 DOI: 10.1590/0102-311x00178520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 01/08/2021] [Indexed: 11/22/2022] Open
Abstract
The objective was to demonstrate the rate of detection of mental disorders in primary healthcare units as a marker of access and indicator of care in mental health. A comparative case study was performed in the electronic patient files of adults seen in two neighboring primary care units in the city of Rio de Janeiro, Brazil, in 2015-2016 and 2016-2017. Diagnoses of mental disorders were extracted, using the International Classification of Diseases, dividing them into three groups: common mental disorders (CMD: F32; F33 F40-45, except F42, and R45), severe mental disorders (SMD: F20-F29; F31-F39), and alcohol and drug use (AD: F10-F19 and Z72). The results were compared to the community prevalence of mental disorders reported in the literature. Statistical analysis was applied with the chi-square test, in addition to a qualitative analysis of each unit´s scenario. Unit A (2015-2016) showed a low detection rate for all disorders [SMD = 45 (0.8%); CMD = 148 (2.64%) and AD = 0]; unit B detected about 50% of the expected cases [SMD = 23 (0.98%); CMD = 140 (5.97%) and AD = 130 (5.54%)]. In 2016-2017 there was an increase in the overall detection of mental disorders at unit A [SMD = 89 (1.6%); CMD = 298 (5.24%) and AD = 7 (0.12%)], in unit B the detection rate remained similar [SMD = 25 (1.0%); CMD = 176 (7.14%) and AD = 121 (4.9%)]. Changes in the units were detected. Distinction in the detection rate was used as an indicator for analysis of mental health care, allowing the study of factors potentially associated with this variation, influencing access to care. Monitoring this indicator helps improve mental health care.
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Tsigebrhan R, Fekadu A, Medhin G, Newton CR, Prince MJ, Hanlon C. Performance of primary health care workers in detection of mental disorders comorbid with epilepsy in rural Ethiopia. BMC FAMILY PRACTICE 2021; 22:204. [PMID: 34649527 PMCID: PMC8518249 DOI: 10.1186/s12875-021-01551-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 09/21/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND Timely detection and management of comorbid mental disorders in people with epilepsy is essential to improve outcomes. The objective of this study was to measure the performance of primary health care (PHC) workers in identifying comorbid mental disorders in people with epilepsy against a standardised reference diagnosis and a screening instrument in rural Ethiopia. METHODS People with active convulsive epilepsy were identified from the community, with confirmatory diagnosis by trained PHC workers. Documented diagnosis of comorbid mental disorders by PHC workers was extracted from clinical records. The standardized reference measure for diagnosing mental disorders was the Operational Criteria for Research (OPCRIT plus) administered by psychiatric nurses. The mental disorder screening scale (Self-Reporting Questionnaire; SRQ-20), was administered by lay data collectors. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of PHC worker diagnosis against the reference standard diagnosis was calculated. Logistic regression was used to examine the factors associated with misdiagnosis of comorbid mental disorder by PHC workers. RESULTS A total of 237 people with epilepsy were evaluated. The prevalence of mental disorders with standardised reference diagnosis was 13.9% (95% confidence interval (CI) 9.6, 18.2%) and by PHC workers was 6.3% (95%CI 3.2, 9.4%). The prevalence of common mental disorder using SRQ-20 at optimum cut-off point (9 or above) was 41.5% (95% CI 35.2, 47.8%). The sensitivity and specificity of PHC workers diagnosis was 21.1 and 96.1%, respectively, compared to the standardised reference diagnosis. In those diagnosed with comorbid mental disorders by PHC workers, only 6 (40%) had SRQ-20 score of 9 or above. When a combination of both diagnostic methods (SRQ-20 score ≥ 9 and PHC diagnosis of depression) was compared with the standardised reference diagnosis of depression, sensitivity increased to 78.9% (95% (CI) 73.4, 84.4%) with specificity of 59.7% (95% CI 53.2, 66.2%). Only older age was significantly associated with misdiagnosis of comorbid mental disorders by PHC (adjusted odds ratio, 95% CI = 1.06, 1.02 to 1.11). CONCLUSION Routine detection of co-morbid mental disorder in people with epilepsy was very low. Combining clinical judgement with use of a screening scale holds promise but needs further evaluation.
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Affiliation(s)
- Ruth Tsigebrhan
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
- Department of Psychiatry, WHO Collaborating Centre in Mental Health Research and Capacity-Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Abebaw Fekadu
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Psychiatry, WHO Collaborating Centre in Mental Health Research and Capacity-Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Infection & Global Health Department, Brighton and Sussex Medical School, Brighton, UK
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Girmay Medhin
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Aklilu-Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Charles R Newton
- Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, Oxford, UK
| | - Martin J Prince
- Centre for Global Mental Health, Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Charlotte Hanlon
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Psychiatry, WHO Collaborating Centre in Mental Health Research and Capacity-Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Global Mental Health, Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Mushi DP, Hanlon C, Francis JM, Teferra S. Adaptation and piloting of an integrated intervention model for alcohol use disorders in primary healthcare in rural Tanzania: a study protocol. BMJ Open 2020; 10:e038615. [PMID: 33130566 PMCID: PMC7783617 DOI: 10.1136/bmjopen-2020-038615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Integration of evidence-based interventions for alcohol use disorders (AUDs) into primary healthcare has potential to increase coverage and reduce population burden. However, these interventions are rarely implemented in low- and middle-income countries and there is little existing guidance on how this could be achieved. The aim of the proposed study is to adapt and pilot an integrated model for AUDs in Tanzanian primary healthcare. METHODS AND ANALYSIS The study design will include a situational analysis, a qualitative study, a series of participatory Theory of Change (ToC) workshops and pilot intervention study. The evidence-based packages of care for AUD from the WHO mental health Gap Intervention Guide will form the basis of intervention. The situation analysis will use publicly available data to identify existing resources and system functioning. In-depth interviews will be conducted with key stakeholders (people with lived experience of substance use problems, health workers, health planners and community-based organisations) to identify barriers and facilitators to integration and recommended implementation strategies. Thematic analysis will be used. Triangulation of findings will inform the ToC map for the adapted model of integrated services for AUDs. This model will then be piloted. Change in knowledge, skills and attitudes of health workers will be measured pre-implementation and post-implementation. Interrupted time series analysis will be used to identify change in the rate of identification of AUDs beyond that observed due to secular trends or by chance. The integrated model will be finalised for future implementation and larger-scale evaluation. ETHICS AND DISSEMINATION Ethical approval was obtained from Addis Ababa University College of Health Science Institutional Review Board and Muhimbili University of Health and Allied Sciences Institutional Review Board. Findings will be disseminated to inform strategies for scale up of integrated interventions for people with AUDs in Tanzania and similar contexts.
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Affiliation(s)
- Dorothy Peter Mushi
- Department of Psychiatry and Mental Health, School of Medicine,Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Innovative Drug Development and Therapeutics Trial for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Charlotte Hanlon
- Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Innovative Drug Development and Therapeutics Trial for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Joel Msafiri Francis
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg South Africa, Johannesburg, South Africa
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
| | - Solomon Teferra
- Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Epidemiology, Harvard, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Abayneh S, Lempp H, Alem A, Kohrt BA, Fekadu A, Hanlon C. Developing a Theory of Change model of service user and caregiver involvement in mental health system strengthening in primary health care in rural Ethiopia. Int J Ment Health Syst 2020; 14:51. [PMID: 32760440 PMCID: PMC7379363 DOI: 10.1186/s13033-020-00383-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 07/18/2020] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The involvement of service users and caregivers is recommended as a strategy to strengthen health systems and scale up quality mental healthcare equitably, particularly in low-and-middle-income countries. Service user and caregiver involvement is complex, and its meaningful implementation seems to be a worldwide challenge. Theory of Change (ToC) has been recommended to guide the development, implementation and evaluation of such complex interventions. This paper aims to describe a ToC model for service user and caregiver involvement in a primary mental health care in rural Ethiopia. METHODS The ToC was developed in two workshops conducted in (i) Addis Ababa with purposively selected psychiatrists (n = 4) and multidisciplinary researchers (n = 3), and (ii) a rural district in south-central Ethiopia (Sodo), with community stakeholders (n = 24). Information from the workshops (provisional ToC maps, minutes, audio recordings), and inputs from a previous qualitative study were triangulated to develop the detailed ToC map. This ToC map was further refined with written feedback and further consultative meetings with the research team (n = 6) and community stakeholders (n = 35). RESULTS The experiential knowledge and professional expertise of ToC participants combined to produce a ToC map that incorporated key components (community, health organisation, service user and caregiver), necessary interventions, preconditions, assumptions and indicators towards the long-term outcomes. The participatory nature of ToC by itself raised awareness of the possibilities for servicer user and caregiver involvement, promoted co-working and stimulated immediate commitments to mobilise support for a grass roots service user organization. CONCLUSIONS The ToC workshops provided an opportunity to co-produce a ToC for service user and caregiver involvement in mental health system strengthening linked to the planned model for scale-up of mental health care in Ethiopia. The next steps will be to pilot a multi-faceted intervention based on the ToC and link locally generated evidence to published evidence and theories to refine the ToC for broader transferability to other mental health settings.
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Affiliation(s)
- Sisay Abayneh
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, WHO Collaborating Centre in Mental Health Research and Capacity Building, Addis Ababa, Ethiopia
| | - Heidi Lempp
- Faculty of Life Sciences and Medicine, Centre for Rheumatic Diseases, School of Immunology and Microbial Sciences, King’s College London, Weston Education Centre 10, Cutcombe Rd, London, SE5 9RJ UK
| | - Atalay Alem
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, WHO Collaborating Centre in Mental Health Research and Capacity Building, Addis Ababa, Ethiopia
| | - Brandon A. Kohrt
- Department of Psychiatry, George Washington University, Washington, DC USA
| | - Abebaw Fekadu
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, WHO Collaborating Centre in Mental Health Research and Capacity Building, Addis Ababa, Ethiopia
- College of Health Sciences, Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia
- Department of Global Health & Infection, Brighton and Sussex Medical School, Brighton, UK
| | - Charlotte Hanlon
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, WHO Collaborating Centre in Mental Health Research and Capacity Building, Addis Ababa, Ethiopia
- College of Health Sciences, Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 16 De Crespigny Park, London, SE5 8AF UK
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11
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Knowledge, attitude, and practice towards epilepsy among religious cleric and traditional healers of Addis Ababa, Ethiopia. Seizure 2020; 78:57-62. [PMID: 32203881 DOI: 10.1016/j.seizure.2020.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 03/11/2020] [Accepted: 03/12/2020] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Understanding clerics and healers' knowledge, attitude, and practice towards epilepsy are crucial to identify the mechanisms of epilepsy stigma in Ethiopia. The objective of this study is to characterize the social and demographic determinants of knowledge, attitude, and practices of clerics and healers towards people with epilepsy in Addis Ababa, Ethiopia. METHODS A total of 440 clerics and healers were interviewed by trained data collectors using a pretested structured questionnaire. The count sum of outcome variables was grouped into "biological and cultural" knowledge attitude and practice scores. Ordinal regression analysis was performed for each outcome variable against socio-demographic variables of interest. RESULTS The percentage of responses matching cultural causes (58%) surpassed biological causes. The most frequently mentioned cultural cause was an evil spirit (22.5%). While the most frequently mentioned biological cause was a head injury (12%). Consistent with the above findings, cultural treatment responses (77%) exceeded biological treatment responses. The most commonly referred cultural treatment response was Church healing session (12%). The type of faith followed by the study participants positively correlated with higher cultural knowledge, attitude, and practice score. CONCLUSIONS Clerics and traditional healers in Ethiopia have a partiality to the cultural epilepsy explanation model. Cultural metaphors attached to an evil spirit, curse of God, and witchcraft have formed and fostered existing 'epilepsy societal norms' in Ethiopia. The findings of this study contribute to the understanding of epilepsy stigma and treatment gap. Besides, it provided direction to design and implement epilepsy stigma intervention programs in Ethiopia.
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Chibanda D, Abas M, Musesengwa R, Merritt C, Sorsdahl K, Mangezi W, Bandawe C, Cowan F, Araya R, Gomo E, Gibson L, Weiss H, Hanlon C, Lund C. Mental health research capacity building in sub-Saharan Africa: the African Mental Health Research Initiative. Glob Ment Health (Camb) 2020; 7:e8. [PMID: 32346483 PMCID: PMC7176917 DOI: 10.1017/gmh.2019.32] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 11/22/2019] [Accepted: 12/11/2019] [Indexed: 12/12/2022] Open
Abstract
Mental, neurological and substance use (MNS) disorders are a leading, but neglected, cause of morbidity and mortality in sub-Saharan Africa. The treatment gap for MNS is vast with only 10% of people with MNS disorders in low-income countries accessing evidence-based treatments. Reasons for this include low awareness of the burden of MNS disorders and limited evidence to support development, adaptation and implementation of effective and feasible treatments. The overall goal of the African Mental Health Research Initiative (AMARI) is to build an African-led network of MNS researchers in Ethiopia, Malawi, South Africa and Zimbabwe, who are equipped to lead high quality mental health research programs that meet the needs of their countries, and to establish a sustainable career pipeline for these researchers with an emphasis on integrating MNS research into existing programs such as HIV/AIDS. This paper describes the process leading to the development of AMARI's objectives through a theory of change workshop, successes and challenges that have been faced by the consortium in the last 4 years, and the future role that AMARI could play in further building MNS research capacity by brining on board more institutions from low- and middle-income countries with an emphasis on developing an evidence-based training curriculum and a research-driven care service.
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Affiliation(s)
- Dixon Chibanda
- Department of Psychiatry, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Melanie Abas
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Rosemary Musesengwa
- Department of Psychiatry, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Chris Merritt
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Katherine Sorsdahl
- Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Observatory, South Africa
| | - Walter Mangezi
- Department of Psychiatry, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | | | - Frances Cowan
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Ricardo Araya
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Exnevia Gomo
- Department of Immunology, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Lorna Gibson
- Department of Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Helen Weiss
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Charlotte Hanlon
- Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Crick Lund
- Department of Mental Health, Faculty of Health Sciences, University of Cape Town, Observatory, South Africa
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Jacob Arriola KR, Ellis A, Webb-Girard A, Ogutu EA, McClintic E, Caruso B, Freeman MC. Designing integrated interventions to improve nutrition and WASH behaviors in Kenya. Pilot Feasibility Stud 2020; 6:10. [PMID: 32042436 PMCID: PMC6998333 DOI: 10.1186/s40814-020-0555-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 01/23/2020] [Indexed: 01/05/2023] Open
Abstract
Background Child stunting, an indicator of chronic malnutrition, is a global public health problem. Malnutrition during pregnancy and the first 2 years of life undermines the survival, growth, and development of children. Exposure to fecal pathogens vis-à-vis inadequate water, sanitation, and hygiene (WASH) has been implicated in the etiology of child stunting, highlighting the need to integrate WASH with nutrition-sensitive interventions to comprehensively address this complex problem. The aim of this study was to describe a systematic, theoretically informed approach (that drew from the Starr and Fornoff approach to the Theory of Change development and the Behavior Change Wheel approach) to design a multi-component and integrated social and behavior change intervention to improve WASH and nutrition-related behaviors in western Kenya. Methods This intervention was developed to be integrated into an existing project that utilized the care group model and aimed to create a culture of care and support for HIV/AIDS-affected children under two and their caregivers and was executed by local partners. We tested the newly created intervention packages in user-testing trials using an adapted Trials of Improved Practices approach to pilot acceptability and feasibility. Results Using authentic stakeholder engagement and relevant theories, we conducted an 8-step process: (1) conduct mixed methods formative research, (2) prioritize target behaviors, (3) use causal analysis to create problem trees, (4) develop solution trees and articulate assumptions and rationales for change, (5) link solution trees to intervention functions, (6) develop the intervention plan, (7) create the intervention packages, and (8) test and refine the intervention packages. Conclusions This study highlights the need to take a multi-sectorial, integrated approach that integrates contextually relevant behavior change theories with the experiential knowledge gleaned from stakeholders into the design of interventions that seek to reduce child stunting. This process resulted in the creation of intervention packages that grouped behaviors thematically to be most relevant and responsive to the population context. This work has the potential to make important contributions towards achievement of the United Nations’ sustainable development goals.
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Affiliation(s)
- Kimberly R Jacob Arriola
- 1Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Anna Ellis
- 2Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Amy Webb-Girard
- 3Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Emily Awino Ogutu
- 2Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Emilie McClintic
- 2Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Bethany Caruso
- 2Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Matthew C Freeman
- 2Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA USA
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Hanlon C, Medhin G, Selamu M, Birhane R, Dewey M, Tirfessa K, Garman E, Asher L, Thornicroft G, Patel V, Lund C, Prince M, Fekadu A. Impact of integrated district level mental health care on clinical and social outcomes of people with severe mental illness in rural Ethiopia: an intervention cohort study. Epidemiol Psychiatr Sci 2019; 29:e45. [PMID: 31405401 PMCID: PMC8061260 DOI: 10.1017/s2045796019000398] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 06/12/2019] [Accepted: 06/19/2019] [Indexed: 11/26/2022] Open
Abstract
AIM There is limited evidence of the safety and impact of task-shared care for people with severe mental illnesses (SMI; psychotic disorders and bipolar disorder) in low-income countries. The aim of this study was to evaluate the safety and impact of a district-level plan for task-shared mental health care on 6 and 12-month clinical and social outcomes of people with SMI in rural southern Ethiopia. METHODS In the Programme for Improving Mental health carE, we conducted an intervention cohort study. Trained primary healthcare (PHC) workers assessed community referrals, diagnosed SMI and initiated treatment, with independent research diagnostic assessments by psychiatric nurses. Primary outcomes were symptom severity and disability. Secondary outcomes included discrimination and restraint. RESULTS Almost all (94.5%) PHC worker diagnoses of SMI were verified by psychiatric nurses. All prescribing was within recommended dose limits. A total of 245 (81.7%) people with SMI were re-assessed at 12 months. Minimally adequate treatment was received by 29.8%. All clinical and social outcomes improved significantly. The impact on disability (standardised mean difference 0.50; 95% confidence interval (CI) 0.35-0.65) was greater than impact on symptom severity (standardised mean difference 0.28; 95% CI 0.13-0.44). Being restrained in the previous 12 months reduced from 25.3 to 10.6%, and discrimination scores reduced significantly. CONCLUSIONS An integrated district level mental health care plan employing task-sharing safely addressed the large treatment gap for people with SMI in a rural, low-income country setting. Randomised controlled trials of differing models of task-shared care for people with SMI are warranted.
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Affiliation(s)
- C. Hanlon
- Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Centre for Global Mental Health, London, UK
- WHO Collaborating Centre for Mental Health Research and Capacity Building, Department of Psychiatry, Addis Ababa University, College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - G. Medhin
- Addis Ababa University, Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - M. Selamu
- WHO Collaborating Centre for Mental Health Research and Capacity Building, Department of Psychiatry, Addis Ababa University, College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia
| | - R. Birhane
- WHO Collaborating Centre for Mental Health Research and Capacity Building, Department of Psychiatry, Addis Ababa University, College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia
| | - M. Dewey
- Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Centre for Global Mental Health, London, UK
| | - K. Tirfessa
- Kotebe Metropolitan University, College of Education and Behavioral Studies, Addis Ababa, Ethiopia
| | - E. Garman
- Department of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, Republic of South Africa
| | - L. Asher
- Division of Epidemiology and Public Health, University of Nottingham, School of Medicine, Nottingham, UK
| | - G. Thornicroft
- Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Centre for Global Mental Health, London, UK
| | - V. 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, Boston, USA
- Sangath Non-Governmental Organisation, Goa, India
| | - C. Lund
- Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Centre for Global Mental Health, London, UK
- Department of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, Republic of South Africa
| | - M. Prince
- Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Centre for Global Mental Health, London, UK
| | - A. Fekadu
- WHO Collaborating Centre for Mental Health Research and Capacity Building, Department of Psychiatry, Addis Ababa University, College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Global Health & Infection Department, Brighton and Sussex Medical School, Brighton, UK
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15
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De Buck E, Hannes K, Cargo M, Van Remoortel H, Vande Veegaete A, Mosler HJ, Govender T, Vandekerckhove P, Young T. Engagement of stakeholders in the development of a Theory of Change for handwashing and sanitation behaviour change. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2018; 28:8-22. [PMID: 29260884 DOI: 10.1080/09603123.2017.1415306] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A Theory of Change (ToC) is an approach to map programmes aimed at inducing change in a specific context, with the goal of increasing their impact. We applied this approach to the specific case of handwashing and sanitation practices in low- and middle-income countries and developed a ToC as part of a systematic review exercise. Different existing sources of information were used to inform the initial draft of the ToC. In addition, stakeholder involvement occurred and peer review took place. Our stakeholders included methodological (ToC/quantitative and qualitative research) and content experts (WASH (Water, Sanitation, Hygiene)/behaviour change), as well as end-users/practitioners, policy-makers and donors. In conclusion, the development of a ToC, and the involvement of stakeholders in its development, was critical in terms of understanding the context in which the promotional programmes are being implemented. We recommend ToC developers to work with stakeholders to create a ToC relevant for practice.
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Affiliation(s)
- Emmy De Buck
- a Centre for Evidence-Based Practice , Belgian Red Cross-Flanders , Mechelen , Belgium
- b Department of Public Health and Primary Care, Faculty of Medicine , KU Leuven , Leuven , Belgium
| | - Karin Hannes
- c Faculty of Social Sciences , KU Leuven , Leuven , Belgium
| | - Margaret Cargo
- d Centre for Population Health Research , University of South Australia , Adelaide , Australia
| | - Hans Van Remoortel
- a Centre for Evidence-Based Practice , Belgian Red Cross-Flanders , Mechelen , Belgium
| | - Axel Vande Veegaete
- a Centre for Evidence-Based Practice , Belgian Red Cross-Flanders , Mechelen , Belgium
| | | | - Thashlin Govender
- f Division of Community Health, Faculty of Medicine and Health Sciences , Stellenbosch University , Cape Town , South Africa
| | - Philippe Vandekerckhove
- a Centre for Evidence-Based Practice , Belgian Red Cross-Flanders , Mechelen , Belgium
- b Department of Public Health and Primary Care, Faculty of Medicine , KU Leuven , Leuven , Belgium
- g Faculty of Medicine and Health Sciences , University of Ghent , Ghent , Belgium
| | - Taryn Young
- h Centre for Evidence-Based Health Care, Faculty of Medicine and Health Sciences , Stellenbosch University , Cape Town , South Africa
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Paina L, Wilkinson A, Tetui M, Ekirapa-Kiracho E, Barman D, Ahmed T, Mahmood SS, Bloom G, Knezovich J, George A, Bennett S. Using Theories of Change to inform implementation of health systems research and innovation: experiences of Future Health Systems consortium partners in Bangladesh, India and Uganda. Health Res Policy Syst 2017; 15:109. [PMID: 29297374 PMCID: PMC5751673 DOI: 10.1186/s12961-017-0272-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The Theory of Change (ToC) is a management and evaluation tool supporting critical thinking in the design, implementation and evaluation of development programmes. We document the experience of Future Health Systems (FHS) Consortium research teams in Bangladesh, India and Uganda with using ToC. We seek to understand how and why ToCs were applied and to clarify how they facilitate the implementation of iterative intervention designs and stakeholder engagement in health systems research and strengthening. Methods This paper combines literature on ToC, with a summary of reflections by FHS research members on the motivation, development, revision and use of the ToC, as well as on the benefits and challenges of the process. We describe three FHS teams’ experiences along four potential uses of ToCs, namely planning, communication, learning and accountability. Results The three teams developed ToCs for planning and evaluation purposes as required for their initial plans for FHS in 2011 and revised them half-way through the project, based on assumptions informed by and adjusted through the teams’ experiences during the previous 2 years of implementation. All teams found that the revised ToCs and their accompanying narratives recognised greater feedback among intervention components and among key stakeholders. The ToC development and revision fostered channels for both internal and external communication, among research team members and with key stakeholders, respectively. The process of revising the ToCs challenged the teams’ initial assumptions based on new evidence and experience. In contrast, the ToCs were only minimally used for accountability purposes. Conclusions The ToC development and revision process helped FHS research teams, and occasionally key local stakeholders, to reflect on and make their assumptions and mental models about their respective interventions explicit. Other projects using the ToC should allow time for revising and reflecting upon the ToCs, to recognise and document the adaptive nature of health systems, and to foster the time, space and flexibility that health systems strengthening programmes must have to learn from implementation and stakeholder engagement. Electronic supplementary material The online version of this article (doi:10.1186/s12961-017-0272-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ligia Paina
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, United States of America.
| | - Annie Wilkinson
- Institute of Development Studies, Library Road, Brighton, BN1 9RE, United Kingdom
| | - Moses Tetui
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda.,Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden
| | - Elizabeth Ekirapa-Kiracho
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda
| | - Debjani Barman
- IIHMR University, 1 Prabhu Dayal Marg, Sanganer, Jaipur, 302029, India
| | - Tanvir Ahmed
- Institute of Development Studies, Library Road, Brighton, BN1 9RE, United Kingdom.,Health System and Population Studies Division, ICDDR,B, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Shehrin Shaila Mahmood
- Health System and Population Studies Division, ICDDR,B, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Gerry Bloom
- Institute of Development Studies, Library Road, Brighton, BN1 9RE, United Kingdom
| | | | - Asha George
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Sara Bennett
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, United States of America
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Hailemariam M, Fekadu A, Prince M, Hanlon C. Engaging and staying engaged: a phenomenological study of barriers to equitable access to mental healthcare for people with severe mental disorders in a rural African setting. Int J Equity Health 2017; 16:156. [PMID: 28851421 PMCID: PMC5576237 DOI: 10.1186/s12939-017-0657-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 08/22/2017] [Indexed: 11/12/2022] Open
Abstract
Background In low-and middle-income countries, integration of mental health into primary care is recommended to reduce the treatment gap. In this study we explored barriers to initial and ongoing engagement of people with severe mental disorders (SMD) in rural Ethiopia after implementing integrated primary mental healthcare services. Methods A qualitative approach was employed. In-depth interviews were conducted with 50 key informants: service users/caregivers engaged with care (n = 17), non-engagers and their caregivers (n = 10), those who had initiated treatment but disengaged and their caregivers (n = 12) and primary healthcare professionals (n = 11). Two focus group discussions were conducted with community health workers (10 per group). Thematic analysis was used. Results Most respondents reported improved access to care, usually equated with medication, and were motivated to remain engaged due to experienced benefits of care. However, four main barriers to engagement emerged. (1) Poverty: resulting in inability to pay for medication and undermining vital social support affected engagement for all respondents. (2) Unreliable medication supplies and lack of second line options for inadequate response or intolerable side-effects. (3) The long-term nature of the illness: expectations of cure, stigma of chronic illness, low awareness about the illness and treatment and declining social support over time. (4) The nature of SMD: difficulty conveying the person when acutely disturbed and no flexibility for proactive outreach or legal frameworks to provide care when patients lacked capacity. In those who never engaged, geographical inaccessibility was an important barrier. Alternative cultural explanations for illness were only mentioned as a barrier only by two of the respondents. Conclusion Economic interventions may be needed to support ongoing engagement in care for people with SMD. Systems of care for chronic illness need to be strengthened in combination with legal frameworks. Expanded options for affordable and effective medication and psychosocial interventions are required for person-centred care. Electronic supplementary material The online version of this article (10.1186/s12939-017-0657-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maji Hailemariam
- Department of Psychiatry, College of Health Sciences, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Abebaw Fekadu
- Department of Psychiatry, College of Health Sciences, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia.,Center for Innovative Drug Development and Therapeutic Trials for Africa, Addis Ababa University, Addis Ababa, Ethiopia.,Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Centre for Affective Disorders, King's College London, London, UK
| | - Martin Prince
- Institute of Psychiatry, Psychology and Neuroscience, Health Services and Population Research Department, Centre for Global Mental Health, King's College London, London, UK
| | - Charlotte Hanlon
- Department of Psychiatry, College of Health Sciences, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia.,Institute of Psychiatry, Psychology and Neuroscience, Health Services and Population Research Department, Centre for Global Mental Health, King's College London, London, UK
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Reducing the treatment gap for mental, neurological and substance use disorders in Africa: lessons from the Friendship Bench in Zimbabwe. Epidemiol Psychiatr Sci 2017; 26:342-347. [PMID: 28399952 PMCID: PMC6998766 DOI: 10.1017/s2045796016001128] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Mental, neurological and substance use disorders (MNS) are a leading cause of disability in Africa. In response to the large treatment gap for MNS, a growing body of evidence-based treatments (EBTs) is emerging from Africa; however, there is a dearth of knowledge on how to scale up EBT. The Friendship Bench intervention is a brief psychological treatment delivered through the primary health care system in Zimbabwe by trained lay health workers. It has contributed significantly towards narrowing the treatment gap for common mental disorders in Zimbabwe where it has been scaled up to over 70 primary health care facilities. A three-pronged approach consisting of community engagement, use of EBTs and a government endorsed scale-up plan is described as part of the key strategy leading to the scale up of the Friendship Bench.
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Trani JF, Ballard E, Bakhshi P, Hovmand P. Community based system dynamic as an approach for understanding and acting on messy problems: a case study for global mental health intervention in Afghanistan. Confl Health 2016; 10:25. [PMID: 27822297 PMCID: PMC5090881 DOI: 10.1186/s13031-016-0089-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 07/18/2016] [Indexed: 11/22/2022] Open
Abstract
Background Afghanistan lacks suitable specialized mental healthcare services despite high prevalence of severe mental health disorders which are aggravated by the conflict and numerous daily stressors. Recent studies have shown that Afghans with mental illness are not only deprived of care but are vulnerable in many other ways. Innovative participatory approaches to the design of mental healthcare policies and programs are needed in such challenging context. Methods We employed community based system dynamics to examine interactions between multiple factors and actors to examine the problem of persistently low service utilization for people with mental illness. Group model building sessions, designed based on a series of scripts and led by three facilitators, took place with NGO staff members in Mazar-I-Sharif in July 2014 and in Kabul in February 2015. Results We identified major feedback loops that constitute a hypothesis of how system components interact to generate a persistently low rate of service utilization by people with mental illness. In particular, we found that the interaction of the combined burdens of poverty and cost of treatment interact with cultural and social stigmatizing beliefs, in the context of limited clinical or other treatment support, to perpetuate low access to care for people with mental disorders. These findings indicate that the introduction of mental healthcare services alone will not be sufficient to meaningfully improve the condition of individuals with mental illness if community stigma and poverty are not addressed concurrently. Conclusions Our model highlights important factors that prevent persons with mental illness from accessing services. Our study demonstrates that group model building methods using community based system dynamics can provide an effective tool to elicit a common vision on a complex problem and identify shared potential strategies for intervention in a development and global health context. Its strength and originality is the leadership role played by the actors embedded within the system in describing the complex problem and suggesting interventions.
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Affiliation(s)
- Jean-Francois Trani
- Brown School of Social Work, Washington University in St Louis, 1 Brookings Drive, St Louis, MO 63130 USA
| | - Ellis Ballard
- Brown School of Social Work, Washington University in St Louis, 1 Brookings Drive, St Louis, MO 63130 USA
| | - Parul Bakhshi
- Program in Occupational Therapy, School of Medicine, Washington University in St Louis, St Louis, USA
| | - Peter Hovmand
- Brown School of Social Work, Washington University in St Louis, 1 Brookings Drive, St Louis, MO 63130 USA
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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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Hailemariam M, Fekadu A, Selamu M, Medhin G, Prince M, Hanlon C. Equitable access to integrated primary mental healthcare for people with severe mental disorders in Ethiopia: a formative study. Int J Equity Health 2016; 15:121. [PMID: 27460038 PMCID: PMC4962424 DOI: 10.1186/s12939-016-0410-0] [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: 04/26/2016] [Accepted: 07/21/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The provision of mental healthcare through integration into primary care is expected to improve access to care, but not all population groups may benefit equally. The aim of this study was to inform delivery of a new primary care-based mental health service in rural Ethiopia by identifying potential barriers to equitable access to mental healthcare and strategies to overcome them. METHODS A qualitative study was conducted as formative work for the PRogramme for Improving Mental healthcarE (PRIME), a project supporting delivery of mental healthcare integrated into primary care in a rural district in south central Ethiopia. In-depth interviews (n = 21) were carried out with stakeholders selected purposively from mental health service users, caregivers, community leaders and healthcare administrators. A focus group discussion (n = 12) was conducted with community health extension workers. Framework analysis was employed using an adapted version of the access framework developed for use in contexts of livelihood insecurity, which considers (1) availability, (2) accessibility and affordability. and (3) acceptability and adequacy dimensions of access. RESULTS Primary care-based mental healthcare was considered as a positive development, and would increase availability, accessibility and affordability of treatments. Low levels of community awareness, and general preference for traditional and religious healing were raised as potential challenges to the acceptability of integrated mental healthcare. Participants believed integrated mental healthcare would be comprehensive and of satisfactory quality. However, expectations about the effectiveness of treatment for mental disorders were generally low. Threats to equitable access to mental healthcare were identified for perinatal women, persons with physical disability, those living in extreme poverty and people with severe and persistent mental disability. CONCLUSION Establishing an affordable service within reach, raising awareness and financial support to families from low socioeconomic backgrounds were suggested to improve equitable access to mental healthcare by vulnerable groups including perinatal women and people with disabilities. Innovative approaches, such as telephone consultations with psychiatric nurses based in nearby towns and home outreach need to be developed and evaluated.
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Affiliation(s)
- Maji Hailemariam
- College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abebaw Fekadu
- College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia
- Psychology and Neuroscience, Department of Psychological Medicine, Centre for Affective Disorders, King’s College London, Institute of Psychiatry, London, UK
| | - Medhin Selamu
- College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia
| | - Girmay Medhin
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Martin Prince
- Population Research Department, Centre for Global Mental Health, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, Health Services, London, UK
| | - Charlotte Hanlon
- College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia
- Population Research Department, Centre for Global Mental Health, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, Health Services, London, UK
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Asher L, De Silva M, Hanlon C, Weiss HA, Birhane R, Ejigu DA, Medhin G, Patel V, Fekadu A. Community-based Rehabilitation Intervention for people with Schizophrenia in Ethiopia (RISE): study protocol for a cluster randomised controlled trial. Trials 2016; 17:299. [PMID: 27342215 PMCID: PMC4919867 DOI: 10.1186/s13063-016-1427-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 06/03/2016] [Indexed: 11/25/2022] Open
Abstract
Background Care for most people with schizophrenia is best delivered in the community and evidence-based guidelines recommend combining both medication and a psychosocial intervention, such as community-based rehabilitation. There is emerging evidence that community-based rehabilitation for schizophrenia is effective at reducing disability in middle-income country settings, yet there is no published evidence on the effectiveness in settings with fewer mental health resources. This paper describes the protocol of a study that aims to evaluate the effectiveness of community-based rehabilitation as an adjunct to health facility-based care in rural Ethiopia. Methods This is a cluster randomised trial set in a rural district in Ethiopia, with sub-district as the unit of randomisation. Participants will be recruited from an existing cohort of people with schizophrenia receiving treatment in primary care. Fifty-four sub-districts will be randomly allocated in a 1:1 ratio to facility-based care plus community-based rehabilitation (intervention arm) or facility-based care alone (control arm). Facility-based care consists of treatment by a nurse or health officer in primary care (antipsychotic medication, basic psychoeducation and follow-up) with referral to a psychiatric nurse-led outpatient clinic or psychiatric hospital when required. Trained community-based rehabilitation workers will deliver a manualised community-based rehabilitation intervention, with regular individual and group supervision. We aim to recruit 182 people with schizophrenia and their caregivers. Potential participants will be screened for eligibility, including enduring or disabling illness. Participants will be recruited after providing informed consent or, for participants without decision-making capacity, after the primary caregiver gives permission on behalf of the participant. The primary outcome is disability measured with the 36-item WHO Disability Assessment Schedule (WHODAS) version 2.0 at 12 months. The sample size will allow us to detect a 20 % difference in WHODAS 2.0 scores between treatment arms with 85 % power. Secondary outcomes include change in symptom severity, economic activity, physical restraint, discrimination and caregiver burden. Discussion This is the first trial of community-based rehabilitation for schizophrenia and will determine, as a proof of concept, the added value of community-based rehabilitation compared to facility-based care alone in a low-income country with scarce mental health resources. Trial registration Clinical Trials.gov Identifier NCT02160249. Registered on 3 June 2014. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1427-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Laura Asher
- Centre for Global Mental Health, Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK. .,Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Mary De Silva
- Centre for Global Mental Health, Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Charlotte Hanlon
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,Centre for Global Mental Health, Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Helen A Weiss
- MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Rahel Birhane
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Dawit A Ejigu
- Department of Pharmacology, St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Girmay Medhin
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Vikram Patel
- Centre for Global Mental Health, Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK.,Public Health Foundation of India, New Delhi, India.,Sangath, Goa, India
| | - Abebaw Fekadu
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Asher L, Fekadu A, Hanlon C, Mideksa G, Eaton J, Patel V, De Silva MJ. Development of a Community-Based Rehabilitation Intervention for People with Schizophrenia in Ethiopia. PLoS One 2015; 10:e0143572. [PMID: 26618915 PMCID: PMC4664267 DOI: 10.1371/journal.pone.0143572] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 11/08/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Community-based rehabilitation (CBR) is a multi-sectoral strategy to improve the functioning and quality of life of people with disabilities. The RISE (Rehabilitation Intervention for people with Schizophrenia in Ethiopia) trial will evaluate the effectiveness of CBR for people with schizophrenia in Ethiopia. Nevertheless, the components of CBR that are both feasible and likely to prove effective in low and middle-income countries such as Ethiopia are unclear. METHODS In this study intervention development work was undertaken to design a CBR intervention that is acceptable and feasible in the local context. The development work consisted of five phases. 1: Identify potential components of CBR for schizophrenia, 2: Situational analysis, 3: Determine feasibility of CBR (Theory of Change workshops with experts and local stakeholders), 4: Determine acceptability of CBR (16 in-depth interviews and five focus group discussions with people with schizophrenia, caregivers, health workers and community leaders) and 5: Synthesise results to finalise intervention. A Theory of Change map was constructed showing the causal pathway for how we expect CBR to achieve its impact. RESULTS People with schizophrenia in rural Ethiopia experience family conflict, difficulty participating in work and community life, and stigma. Stakeholders perceived CBR to be acceptable and useful to address these problems. The focus of CBR will be on the individual developing the skills and confidence to perform their previous or desired roles and activities. To ensure feasibility, non-health professionals will be trained to deliver CBR and provide supervision, rather than mental health specialists. Novel components of CBR for schizophrenia included family intervention and dealing with distressing symptoms. Microfinance was excluded due to concerns about stress and exploitation. Community mobilisation was viewed as essential to ensure the effectiveness and sustainability of CBR. CONCLUSION Extensive formative research using a variety of methods has enabled the design of a culturally appropriate CBR intervention for people with schizophrenia that is acceptable and feasible.
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Affiliation(s)
- Laura Asher
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abebaw Fekadu
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, King’s College London, London, United Kingdom
| | - Charlotte Hanlon
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Center for Global Mental Health, Institute of Psychiatry, King’s College London, London, United Kingdom
| | - Gemechu Mideksa
- RAPID (Rehabilitation And Prevention Initiative against Disabilities) CBR Project, Adama, Ethiopia
| | - Julian Eaton
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- CBM West Africa Regional Office, Lome, Togo
| | - Vikram Patel
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Sangath, Goa, India
| | - Mary J. De Silva
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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