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Perales J, Reininger BM, Lee M, Linder SH. Participants' perceptions of interactions with community health workers who promote behavior change: a qualitative characterization from participants with normal, depressive and anxious mood states. Int J Equity Health 2018; 17:19. [PMID: 29402278 PMCID: PMC5800056 DOI: 10.1186/s12939-018-0729-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 01/16/2018] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Interventions that promote healthier lifestyles among Latinos often involve community health workers (CHWs). CHWs can effectively advocate for healthier lifestyles and may be pivotal in addressing such mental health conditions as depression and anxiety. The goal of this study was to characterize the relationship dynamics between Latino participants and CHWs, from the participant's perspective. We aimed to determine if CHW-delivered community interventions effected behavior change, especially among participants who reported anxiety and depression. METHODS Semi-structured interviews were conducted with a purposive sample of 28 Latino participants that was based on a mental health scoring strata. Participants completed a lifestyle intervention that included multiple home visits from CHWs to promote physical activity and healthful food choice. Interviews were conducted in the participant's preferred language (English or Spanish). Transcribed interviews were analyzed using a grounded theory approach until concept saturation was achieved. RESULTS The sample was primarily female (82%), lower socioeconomic status (64%), and mean age of 50 years. Participants discussed the rapport building and professionalism of CHWs as a feature that facilitated strong, positive relationships and lifestyle behavior changes. Participants described how CHWs patterned their change approaches, which were similar to commonly used therapeutic techniques in the treatment of anxiety and depression. While anxiety and depression were described as having an impact on behavior change, most, but not all, participants who reported negative mood states said that the CHW relationship helped in changing that state to some extent. CONCLUSIONS Participants' perceptions indicated that positive personal changes were influenced by CHWs. Only participants who reported consistently poor scores for depression, anxiety or both reported negative or neutral experiences with the CHWs. This study lends qualitative support to the use of CHWs as extenders of care, particularly in areas that have a shortage of primary and mental health care providers.
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Affiliation(s)
- Joseph Perales
- La Clínica - Casa del Sol, 1501 Fruitvale Ave, Oakland, California, 94601, USA
| | - Belinda M Reininger
- UT Health School of Public Health in Brownsville, Division of Health Promotion & Behavioral Sciences and Hispanic Health Research Center, One West University Blvd, Brownsville, TX, 78520, USA. .,Michael & Susan Dell Center for Healthy Living, UT School of Public Health, Austin Regional Campus, University of Texas Administration Building (UTA), 1616 Guadalupe Street, Suite 6.300, Austin, Texas, 78701, USA. .,University of Texas Health Science Center at Houston, Center for Clinical and Translational Sciences, 7000 Fannin, Suite 1800, Houston, Texas, 77030, USA.
| | - MinJae Lee
- University of Texas Health Science Center at Houston, Center for Clinical and Translational Sciences, 7000 Fannin, Suite 1800, Houston, Texas, 77030, USA.,University of Texas Health Science Center at Houston, Biostatistics/Epidemiology/Research Design (BERD) Core, Center for Clinical and Translational Sciences, 7000 Fannin, Suite 1800, Houston, Texas, 77030, USA
| | - Stephen H Linder
- UT Health School of Public Health, Institute for Health Policy, Division of Management, Policy and Community Health, 6410 Fannin, Houston, TX, 77030, USA
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Cardarelli R, Horsley M, Ray L, Maggard N, Schilling J, Weatherford S, Feltner F, Gilliam K. Reducing 30-day readmission rates in a high-risk population using a lay-health worker model in Appalachia Kentucky. HEALTH EDUCATION RESEARCH 2018; 33:73-80. [PMID: 29474535 DOI: 10.1093/her/cyx064] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 10/09/2017] [Indexed: 06/08/2023]
Abstract
This exploratory study aimed to address the effectiveness of a lay-health worker (LHW) model in addressing social needs and readmissions of high-risk patients admitted in a rural community hospital. A quasi-experimental study design assessed implementation of a LHW model for assisting high-risk patients with their post-discharge social needs. Outcome measures included 30-day hospital readmissions rates during a 4-month baseline period compared with a 6-month post-implementation period. The LHW intervention involved assessment and development of a personalized social needs plan for enrolled patients (e.g. transportation and community resource identification), with post-discharge follow-up calls. There was a 47.7% relative reduction of 30-day hospital readmissions rates between baseline and intervention phases of the study. Simple regression analyses demonstrated a 56% decrease in odds (90% confidence interval 0.20-0.98) in being readmitted within 30-days among those in the intervention phase compared with those in the baseline phase. Once adjusting for education, transportation cost and anxiety symptoms, there was a 77% decrease in odds among those exposed to the LHW program. LHWs offer an effective hospital-based model to improve transitions in care from the hospital setting, especially those at high-risk with persistent social needs.
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Affiliation(s)
- Roberto Cardarelli
- Department of Family and Community Medicine, University of Kentucky College of Medicine, Lexington 40504, USA
| | - Mary Horsley
- St. Claire Regional Medical Center, Morehead 40351, USA
| | - Lisa Ray
- St. Claire Regional Medical Center, Morehead 40351, USA
| | - Nancy Maggard
- St. Claire Regional Medical Center, Morehead 40351, USA
| | - Jennifer Schilling
- Department of Family and Community Medicine, University of Kentucky College of Medicine, Lexington 40504, USA
| | - Sarah Weatherford
- Department of Family and Community Medicine, University of Kentucky College of Medicine, Lexington 40504, USA
| | - Fran Feltner
- Department of Family and Community Medicine, University of Kentucky College of Medicine, Lexington 40504, USA
- Center of Excellence in Rural Health, Kentucky Homeplace, University of Kentucky, Hazard 41701, USA
| | - Kayla Gilliam
- Center of Excellence in Rural Health, Kentucky Homeplace, University of Kentucky, Hazard 41701, USA
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Cardarelli R, Bausch G, Murdock J, Chyatte MR. Return-on-Investment (ROI) Analyses of an Inpatient Lay Health Worker Model on 30-Day Readmission Rates in a Rural Community Hospital. J Rural Health 2017; 34:411-422. [PMID: 28685850 DOI: 10.1111/jrh.12250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 05/05/2017] [Accepted: 05/05/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of the study was to assess the return-on-investment (ROI) of an inpatient lay health worker (LHW) model in a rural Appalachian community hospital impacting 30-day readmission rates. METHODS The Bridges to Home (BTH) study completed an evaluation in 2015 of an inpatient LHW model in a rural Kentucky hospital that demonstrated a reduction in 30-day readmission rates by 47.7% compared to a baseline period. Using the hospital's utilization and financial data, a validated ROI calculator specific to care transition programs was used to assess the ROI of the BTH model comparing 3 types of payment models including Diagnosis Related Group (DRG)-only payments, pay-for-performance (P4P) contracts, and accountable care organizations (ACOs). FINDINGS The BTH program had a -$0.67 ROI if the hospital had only a DRG-based payment model. If the hospital had P4P contracts with payers and 0.1% of its annual operating revenue was at risk, the ROI increased to $7.03 for every $1 spent on the BTH program. However, if the hospital was an ACO as was the case for this study's community hospital, the ROI significantly increased to $38.48 for every $1 spent on the BTH program. CONCLUSIONS The BTH model showed a viable ROI to be considered by community hospitals that are part of an ACO or P4P program. A LHW care transition model may be a cost-effective alternative for impacting excess 30-day readmissions and avoiding associated penalties for hospital systems with a value-based payment model.
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Affiliation(s)
- Roberto Cardarelli
- Department of Family & Community Medicine, University of Kentucky College of Medicine, Lexington, Kentucky
| | | | - Joan Murdock
- College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio
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Carrasquillo O, Lebron C, Alonzo Y, Li H, Chang A, Kenya S. Effect of a Community Health Worker Intervention Among Latinos With Poorly Controlled Type 2 Diabetes: The Miami Healthy Heart Initiative Randomized Clinical Trial. JAMA Intern Med 2017; 177:948-954. [PMID: 28459925 PMCID: PMC5818804 DOI: 10.1001/jamainternmed.2017.0926] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
IMPORTANCE Community health worker (CHW) intervention is a promising approach to address type 2 diabetes among Latinos. However, evidence from randomized clinical studies is limited. OBJECTIVE To compare a CHW intervention with enhanced usual care. DESIGN, SETTING, AND PARTICIPANTS This 52-week, single-blind, randomized clinical trial included 300 Latino adults aged 18 to 65 years who were treated in 2 public hospital outpatient clinics in Miami-Dade County, Florida, from July 1, 2010, through October 31, 2013. Eligible participants had a hemoglobin A1c (HbA1c) level of 8.0 or greater. Follow-up was completed January 31, 2015, and data were analyzed from March 10, 2015, to June 6, 2016. INTERVENTIONS A 1-year CHW intervention consisted of home visits, telephone calls, and group-level activities. MAIN OUTCOMES AND MEASURES Primary outcomes included systolic blood pressure (SBP), low-density lipoprotein cholesterol (LDLC) levels, and HbA1c levels. Secondary outcomes included body mass index, medication regimen intensification, and self-reported measures of diet, physical activity, and medication regimen adherence. RESULTS Of the 300 participants randomized (135 men [45%] and 165 women [55%]; mean [SD] age, 55.2 [7.0] years), we obtained follow-up data on 215 (71.7%). Participants in the CHW group received a median of 4 home visits and 20 telephone calls. After adjusting for baseline values and covariates, participants in the CHW group had an HbA1c level that was 0.51% lower (95% CI, -0.94% to -0.08%) than that of participants in the enhanced usual care group. The reduction in SBP of 4.62 mm Hg (95% CI, -9.01 to -0.24 mm Hg) did not meet the preplanned target of 8 mm Hg and was not statistically significant in unadjusted models. No significant differences in LDLC levels (mean difference, -8.2 mg/dL; 95% CI, -18.8 to 2.3 mg/dL) or any of the preplanned secondary outcomes were observed. Post hoc analyses suggest that the intervention may be more beneficial among those with worse control of their type 2 diabetes at baseline. CONCLUSIONS AND RELEVANCE Among Latinos with poorly controlled type 2 diabetes, a 12-month CHW intervention lowered HbA1c levels by 0.51%. The intervention did not lead to improvements in LDLC levels, and the findings with respect to SBP were variable and half of what was targeted. Future studies should examine whether CHW interventions affect other measures, such as access to health care or social determinants of health. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01152957.
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Affiliation(s)
- Olveen Carrasquillo
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida2Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Cynthia Lebron
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida2Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Yisel Alonzo
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida3Mrs Alonzo is no longer at the University of Miami
| | - Hua Li
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Aileen Chang
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida2Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida4now affiliated with Department of Medicine, George Washington University School of Medicine, Washington, DC
| | - Sonjia Kenya
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida2Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
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Abstract
BACKGROUND Task shifting approaches (rational redistribution of tasks among health workforce teams) to train lay professionals to assist with integrating mental health treatment in primary care has been recommended to close the mental health treatment gap for depression in low- and middle-income countries. This study aims to examine the a new model for depression care in a low-resource environment compared to enhanced treatment at usual (E-TAU). METHODS We trained non-specialist community health workers (local lay employees of the public health system) to provide Interpersonal Counseling (IPC) to treat depressive symptoms in the Brazilian, São Paulo city, family health strategy (FHS). We conducted a randomized controlled trial involving 86 patients with a current major depressive disorder or dysthymia (based on DSM-IV) recruited from an FHS clinic. Participants were randomized to IPC intervention (n = 43) or E-TAU (n = 43). Participants allocated to IPC received 3-4 sessions provided by community health workers; research psychologists followed the E-TAU participants to facilitate their referral to specialized mental health care within the public system. Reduction of depressive symptoms was assessed using the Hamilton Rating Scale (HDRS-17) and the Patient Health Questionnaire (PHQ-9); minor psychiatric symptomatology (including depression, anxiety and somatoform symptoms) were measured using the Self Reporting Questionnaire (SRQ); and functioning was measured by the Clinical Global Impression Scale over a 2-month period. RESULTS Intention-to-treat analysis showed significant improvement on symptoms for both groups over 2 months, without significant differences between them. Per-protocol analysis showed significant better HDRS-17 outcomes for the IPC group. CONCLUSIONS Training non-specialist community health workers in low- and middle-income countries to provide IPC could be a successful strategy in reducing the burden of depression and also potentially a low-cost and effective alternative to specialist-led services that might not be possible in low income settings. TRIAL REGISTRATION Brazilian Clinical Trials, number RBR-5qhmb5 (trial url: http://www.ensaiosclinicos.gov.br/rg/RBR-5qhmb5/) , retrospectively registered after May 1, 2013.
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Damari B, Alikhani S, Riazi-Isfahani S, Hajebi A. Transition of Mental Health to a More Responsible Service in Iran. IRANIAN JOURNAL OF PSYCHIATRY 2017; 12:36-41. [PMID: 28496500 PMCID: PMC5425350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objective: This study proposed a model for provision of an effective universal coverage for mental health services based on global and national experiences, available resources and the nature of primary health care system of Iran to reduce the burden of mental health conditions. Method: A framework with prioritized mental and social health services was devised through a review of literature and policy documents. It was then adapted using inputs from the stakeholders and experts. Results: The new model included 2 basic and specialized service strata: a PHC-based infrastructure and essential requirements needed to establish the service. Our proposed socio-mental health approach is based on a WHO recommendation. Conclusion: The key features of the model, which is going to be tested in a pilot study in 2015, are setting up a system for organized referrals to specialized mental facilities and compatibility with the existing primary health care system. Moreover, to achieve this goal, socio-mental health technicians should be employed.
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Affiliation(s)
- Behzad Damari
- National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran.
| | - Siamak Alikhani
- Health Policy Researcher, Ministry of Health and Medical Education, Tehran, Iran.
| | - Sahand Riazi-Isfahani
- National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran.
| | - Ahmad Hajebi
- Research Center for Addiction and Risky Behavior (ReCARB), Psychiatric Department, Iran University of Medical Sciences, Tehran, Iran.,Corresponding Author: Address: Shahid Mansuri St., Niayesh St., Sattarkhan Ave., Tehran, Iran. P.O. Box: 14565-441, Post Code: 1443813444. Tel: 021 66551655, Fax: 021 66506853,
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Tolchard B, Stuhlmiller CM. The New England 4G framework for the treatment of a common health concerns: a gambling case analysis. ACTA ACUST UNITED AC 2016; 6:10. [PMID: 27840789 PMCID: PMC5078154 DOI: 10.1186/s40405-016-0019-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 10/18/2016] [Indexed: 11/10/2022]
Abstract
Approaches using self-help have proved successful at treating a range of mental and physical conditions. Guidance by a trained worker enhances the effects of self-help materials, in particular those based on Cognitive-Behavior Therapy. In the United Kingdom, the Improving Access to Psychological Therapies (IAPT) program was introduced to provide better outcomes for people experiencing mild or moderate anxiety and depression. This stepped care approach included low intensity, guided self-help offered by a newly trained workforce of Psychological Wellbeing Workers. The IAPT program has been extensively evaluated and shown to be cost effective and leads to positive treatment outcomes. This paper describes how the IAPT model has been adapted for use in Australia with gamblers. Two case studies illustrate the application of this guided approach to systematically accessing existing self-help treatments for problem gamblers. Assessment information is gathered, before a plan of action, including a problem statement and achievable goals, is agreed upon by the worker and the person with the gambling problem. The worker then gives the person options based on self-help CBT interventions and, once an option has been chosen, the worker guides the person as they work through various activities. The benefits of this approach are discussed.
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Affiliation(s)
- Barry Tolchard
- School of Nursing, University at Buffalo, Buffalo, NY 14212 USA ; School of Health, University of New England, Armidale, NSW 2351 Australia
| | - Cynthia M Stuhlmiller
- School of Nursing, University at Buffalo, Buffalo, NY 14212 USA ; School of Health, University of New England, Armidale, NSW 2351 Australia
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Schneider H, Okello D, Lehmann U. The global pendulum swing towards community health workers in low- and middle-income countries: a scoping review of trends, geographical distribution and programmatic orientations, 2005 to 2014. HUMAN RESOURCES FOR HEALTH 2016; 14:65. [PMID: 27784298 PMCID: PMC5081930 DOI: 10.1186/s12960-016-0163-2] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 10/10/2016] [Indexed: 05/21/2023]
Abstract
BACKGROUND There has been a substantial increase in publications and interest in community health workers (CHWs) in low- and middle-income countries (LMIC) over the last years. This paper examines the growth, geographical distribution and programmatic orientations of the indexed literature on CHWs in LMIC over a 10-year period. METHODS A scoping review of publications on CHWs from 2005 to 2014 was conducted. Using an inclusive list of terms, we searched seven databases (including MEDLINE, CINAHL, Cochrane) for all English-language publications on CHWs in LMIC. Two authors independently screened titles/abstracts, downloading full-text publications meeting inclusion criteria. These were coded in an Excel spreadsheet by year, type of publication (e.g. review, empirical), country, region, programmatic orientation (e.g. maternal-child health, HIV/AIDS, comprehensive) and CHW roles (e.g. prevention, treatment) and further analysed in Stata14. Drawing principally on the subset of review articles, specific roles within programme areas were identified and grouped. FINDINGS Six hundred seventy-eight publications from 46 countries on CHWs were inventoried over the 10-year period. There was a sevenfold increase in annual number of publications from 23 in 2005 to 156 in 2014. Half the publications were reporting on initiatives in Africa, a third from Asia and 11 % from the Americas (mostly Brazil). The largest single focus and driver of the growth in publications was on CHW roles in meeting the Millennium Development Goals of maternal, child and neonatal survival (35 % of total), followed by HIV/AIDS (16 %), reproductive health (6 %), non-communicable diseases (4 %) and mental health (4 %). Only 17 % of the publications approached CHW roles in an integrated fashion. There were also distinct regional (and sometimes country) profiles, reflecting different histories and programme traditions. CONCLUSIONS The growth in literature on CHWs provides empirical evidence of ever-increasing expectations for addressing health burdens through community-based action. This literature has a strong disease- or programme-specific orientation, raising important questions for the design and sustainable delivery of integrated national programmes.
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Affiliation(s)
- Helen Schneider
- School of Public Health & SAMRC/UWC Health Services to Systems Unit, University of the Western Cape, Robert Sobukwe Road, Bellville, Cape Town 7535 South Africa
| | - Dickson Okello
- Health Policy and Systems Division, School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925 South Africa
| | - Uta Lehmann
- School of Public Health, University of the Western Cape, Robert Sobukwe Road, Bellville, Cape Town 7535 South Africa
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Preventing infant and child morbidity and mortality due to maternal depression. Best Pract Res Clin Obstet Gynaecol 2016; 36:156-168. [DOI: 10.1016/j.bpobgyn.2016.05.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 05/15/2016] [Indexed: 01/26/2023]
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Marimbe BD, Cowan F, Kajawu L, Muchirahondo F, Lund C. Perceived burden of care and reported coping strategies and needs for family caregivers of people with mental disorders in Zimbabwe. Afr J Disabil 2016; 5:209. [PMID: 28730046 PMCID: PMC5433451 DOI: 10.4102/ajod.v5i1.209] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 03/23/2016] [Indexed: 11/23/2022] Open
Abstract
Background Mental health service resources are inadequate in low-income countries, and families are frequently expected to provide care for their relative with a mental disorder. However, research on the consequences of caregiving has been limited in low-income countries, including Zimbabwe. Objective The study explored the perceived impact of mental illness, reported coping strategies and reported needs of the family members of persons diagnosed with bipolar affective disorder or schizophrenia attending a psychiatric hospital in Harare, Zimbabwe. Methods A purposive sample of 31 family members participated in in-depth interviews and focus group discussions using standardised study guides. Participants were also screened for common mental disorders (CMDs) using the 14-item Shona Symptom Questionnaire. Qualitative data were analysed thematically using NVivo 8 qualitative data analysis software. Statistical Package for Social Sciences (SPSS version 16) was used for descriptive quantitative data analysis. Results Caregivers experienced physical, psychological, emotional, social and financial burdens associated with caregiving. They used both emotion-focused and problem-focused coping strategies, depending on the ill family members’ behaviours. Seeking spiritual assistance emerged as their most common way of coping. Twenty-one (68%) of the caregivers were at risk of CMDs (including three participants who were suicidal) and were referred to a psychiatrist for further management. Caregivers required support from healthcare professionals to help them cope better. Conclusion Caregivers of patients attending psychiatry hospitals in Zimbabwe carry a substantial and frequently unrecognised burden of caring for a family member with a mental disorder. Better support is needed from health professionals and social services to help them cope better. Further research is required to quantitatively measure caregiver burden and evaluate potential interventions in Zimbabwe.
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Affiliation(s)
- Bazondlile D Marimbe
- Department of Psychiatry, College of Health Sciences, University of Zimbabwe, Zimbabwe.,Research Department of Infection and Population Health, University College London, United Kingdom
| | - Frances Cowan
- Research Department of Infection and Population Health, University College London, United Kingdom.,Centre for Sexual Health and HIV/AIDS Research: Zimbabwe, Zimbabwe
| | - Lazarus Kajawu
- Department of Psychiatry, College of Health Sciences, University of Zimbabwe, Zimbabwe
| | - Florence Muchirahondo
- Department of Psychiatry, College of Health Sciences, University of Zimbabwe, Zimbabwe
| | - Crick Lund
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, South Africa
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Murphy JW, Franz BA, Callaghan KA. Group Maturity in a Community-Based Project. SOCIAL WORK IN PUBLIC HEALTH 2016; 31:341-347. [PMID: 27050809 DOI: 10.1080/19371918.2015.1125320] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Community-based projects have become popular as a method to address various community problems. Specifically important is that community members take an active role in these interventions resulting in sustainable social change. Although considerable literature exists on the dynamics of small group interaction, this article addresses how group processes differ in community-based projects. Instead of constructing a static model for group interaction, this discussion focuses on experiences from a recent community-based health project on the island of Grenada. Because community-based projects are directed by a diverse group of community members, maturity is described as a process of negotiation rather than consensus.
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Affiliation(s)
- John W Murphy
- a Department of Sociology, University of Miami , Coral Gables , Florida , USA
| | - Berkeley A Franz
- b Heritage College of Osteopathic Medicine, Department of Social Medicine, Ohio University , Athens , Ohio , USA
| | - Karen A Callaghan
- c Department of Sociology, Barry University , Miami Shores , Florida , USA
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Murphy JW, Schlaerth CA. Emergence, Construction, and Authorial Intent in Community-based Projects. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/0160597616628909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The focus of community-based projects is participation. This idea has both an epistemological and a logistical dimension. Local knowledge is supposed to guide these investigations, while community members should participate in every phase of a project. In fact, some critics argue that they should control these undertakings. In this way, the “authorial intent” of these persons can be given serious attention, thereby improving social services. These requirements, in many ways, take the usual debate between quantitative and qualitative methodologies in a new direction.
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Franz B, Skinner D. Evangelical Protestants and the ACA: An Opening for Community-Based Primary Care? SOCIAL WORK IN PUBLIC HEALTH 2016; 31:231-245. [PMID: 27050877 DOI: 10.1080/19371918.2015.1099497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Evangelical Protestants make up the largest religious subgroup in the United States, and previous research has shown that Evangelical churches are disproportionately active in community engagement and efforts toward social change. Although Evangelical Protestant perspectives have been considered with regard to persistent socioeconomic stratification and racial discrimination, less focus has been given to how churches interpret poor health outcomes within the United States. In particular, this research addresses how enduring health disparities are understood within the larger discussion of healthcare reform. Due to the similarity of approaches favored by participants in this study and community-based philosophy, a suggestion is made for future health policy dialogue. Although Evangelical Protestants have been most likely to reject all aspects of the Affordable Care Act, in many ways the findings of this study suggest the potential for successful future health policy collaboration. In particular, community-based primary care might appeal to Evangelicals and health professionals in the ongoing effort to improve population health and the quality of healthcare in the United States.
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Affiliation(s)
- Berkeley Franz
- a Heritage College of Osteopathic Medicine, Department of Social Medicine , Ohio University , Athens , Ohio , USA
| | - Daniel Skinner
- b Heritage College of Osteopathic Medicine, Department of Social Medicine , Ohio University , Dublin , Ohio , USA
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Abstract
PURPOSE OF REVIEW The study discusses key issues and concepts of how to provide basic mental health services for people with mental disorders in low and middle-income countries (LAMICs). RECENT FINDINGS In the last years a considerable gap between mental healthcare needs and available services in LAMICs has been documented. The transformation of hospital-based to community-based mental health and the building of accessible services in low-resource settings require mental health training of primary care providers, task-sharing/task-shifting models, involvement of families and peers and basic models of community rehabilitation. Several international initiatives have been set up to increase the evidence base and test the feasibility, acceptability, and effectiveness of these approaches which are not new but which have been implemented in only a small amount of LAMICs. A combination of interventions on different levels (governance, legislation, providers, and community) is necessary. SUMMARY It remains to be shown how the recent global mental health movement, beyond increasing international financial resources, will be helpful in finding locally and culturally sensitive solutions to reduce the mental health gap in LAMICs. Although concepts of a well designed mix of services are available, solutions to reduce implementation barriers must be local, and implementation strategies may vary considerably and still lack a sufficient evidence base.
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Niemi M, Kiel S, Allebeck P, Hoan LT. Community-based intervention for depression management at the primary care level in Ha Nam Province, Vietnam: a cluster-randomised controlled trial. Trop Med Int Health 2016; 21:654-61. [PMID: 26821247 DOI: 10.1111/tmi.12674] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of an intervention including psychoeducation and yoga for depression management at the primary healthcare level in one district in the Hà Nam province, Vietnam. METHOD The Patient Health Questionnaire-9 (PHQ-9) was used for depression screening and follow-up. Screened patients were further diagnosed with the Mini-International Neuropsychiatric Diagnostic Interview, by a trained general doctor. A linear regression model, adjusted for age, gender and baseline PHQ-9 score was used to assess whether the intervention leads to decreased depression severity compared to standard care in the control communes. RESULTS Both groups had similar PHQ-9 scores at baseline. The intervention group had on average significantly lower PHQ-9 scores after the intervention than the control group. Almost half of the patients in the intervention group recovered from depression, whereas nobody did in the control group. CONCLUSION The results indicate that the intervention can be more effective than standard care in treating depression. The mean change of the PHQ-9 score after the intervention is deemed to be of clinical relevance.
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Affiliation(s)
- Maria Niemi
- Department of Public Health Science, Karolinska Institutet, Stockholm, Sweden
| | - Simone Kiel
- Department of Public Health Science, Karolinska Institutet, Stockholm, Sweden
| | - Peter Allebeck
- Department of Public Health Science, Karolinska Institutet, Stockholm, Sweden
| | - Le Thi Hoan
- Department of Environmental Health, Hanoi Medical University, Hanoi, Vietnam
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Xu D(R, Gong W, Caine ED, Xiao S, Hughes JP, Ng M, Simoni J, He H, Smith KL, Brown HS, Gloyd S. Lay health supporters aided by a mobile phone messaging system to improve care of villagers with schizophrenia in Liuyang, China: protocol for a randomised control trial. BMJ Open 2016; 6:e010120. [PMID: 26792221 PMCID: PMC4735204 DOI: 10.1136/bmjopen-2015-010120] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Schizophrenia is a severe, chronic and disabling mental illness. Non-adherence to medication and relapse may lead to poorer patient function. This randomised controlled study, under the acronym LEAN (Lay health supporter, e-platform, award, and iNtegration), is designed to improve medication adherence and high relapse among people with schizophrenia in resource poor settings. METHODS/ANALYSIS The community-based LEAN has four parts: (1) Lay health supporters (LHSs), mostly family members who will help supervise patient medication, monitor relapse and side effects, and facilitate access to care, (2) an E-platform to support two-way mobile text and voice messaging to remind patients to take medication; and alert LHSs when patients are non-adherent, (3) an Award system to motivate patients and strengthen LHS support, and (4) iNtegration of the efforts of patients and LHSs with those of village doctors, township mental health administrators and psychiatrists via the e-platform. A random sample of 258 villagers with schizophrenia will be drawn from the schizophrenic '686' Program registry for the 9 Xiang dialect towns of the Liuyang municipality in China. The sample will be further randomised into a control group and a treatment group of equal sizes, and each group will be followed for 6 months after launch of the intervention. The primary outcome will be medication adherence as measured by pill counts and supplemented by pharmacy records. Other outcomes include symptoms and level of function. Outcomes will be assessed primarily when patients present for medication refill visits scheduled every 2 months over the 6-month follow-up period. Data from the study will be analysed using analysis of covariance for the programme effect and an intent-to-treat approach. ETHICS AND DISSEMINATION University of Washington: 49464 G; Central South University: CTXY-150002-6. Results will be published in peer-reviewed journals with deidentified data made available on FigShare. TRIAL REGISTRATION NUMBER ChiCTR-ICR-15006053; Pre-results.
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Affiliation(s)
- Dong (Roman) Xu
- Sun Yat-sen Global Health Institute (SGHI), School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Wenjie Gong
- Xiangya School of Public Health, Central South University, Changsha, Hunan, China
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Eric D Caine
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Shuiyuan Xiao
- Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - James P Hughes
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Marie Ng
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Jane Simoni
- Department of Phycology, University of Washington, Seattle, Washington, USA
| | - Hua He
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Kirk L Smith
- Division of Health Promotion and Behavioral Sciences, University of Texas Health Science Center School of Public Health at Houston, Houston, Texas, USA
| | - Henry Shelton Brown
- Austin Regional Campus Michael & Susan Dell Center for Healthy Living, UTHealth School of Public Health, Austin, Texas, USA
| | - Stephen Gloyd
- Department of Global Health, University of Washington, Seattle, Washington, USA
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Increase of perceived frequency of neighborhood domestic violence is associated with increase of women's depression symptoms in a nationally representative longitudinal study in South Africa. Soc Sci Med 2015; 131:89-97. [PMID: 25769107 DOI: 10.1016/j.socscimed.2015.03.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Studies that examine the effects of neighborhood characteristics on mental health show that perceptions of general neighborhood violence are associated with depression across diverse populations (Clark et al., 2008; Velez-Gomez et al., 2013; Wilson-Genderson & Pruchno, 2013). However, to our knowledge, none have examined the specific effect of perceived frequency of neighborhood domestic violence (PFNDV) on residents' mental health, despite knowledge that domestic violence is a potent predictor of depression at the level of the individual. This study investigates the impact of PFNDV on mental health using the South African National Income Dynamics Study (SA-NIDS). NIDS Waves 2 and 3 measure the perceived frequency of six neighborhood violence subtypes through the NIDS household respondent questionnaire and depression through a questionnaire administered to all NIDS participants. Linear regression was used to model the relationship between change in depression symptoms and change in violence subtypes between Waves 2 and 3. We found that two-year increase in PFNDV was significantly correlated with increase of depression symptoms over the same time period for women, independently of individual, household and neighborhood level characteristics, including five other types of neighborhood violence. No other type of violence was associated with increased depression in women in the fully adjusted model. Research and policy implications are discussed.
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Menon J, Joseph J, Thachil A, Attacheril TV, Banerjee A. Surveillance of Noncommunicable Diseases by Community Health Workers in
Kerala: The Epidemiology of Noncommunicable Diseases in Rural Areas (ENDIRA)
Study. Glob Heart 2014; 9:409-17. [DOI: 10.1016/j.gheart.2014.07.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 06/29/2014] [Accepted: 07/17/2014] [Indexed: 12/15/2022] Open
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Abstract
PURPOSE OF REVIEW In the field of global mental health, an enormous gap between what we know and what we do exists in the delivery of clinical care. Creative and effective strategies that surmount the barriers to provision of mental healthcare are essential to improve the lives of millions affected by mental illness. This article provides a review of three classes of innovative strategies currently being developed and implemented to diminish the mental health treatment gap globally. RECENT FINDINGS This review provides recent evidence related to the feasibility of implementation and efficacy for the following three classes of innovation that show promise for building clinical capacity and expanding mental health coverage: integration of mental health services into primary care; expansion of human capacity through task sharing and training of nonspecialists; and innovative use of technological platforms to enhance access, cut costs, and reduce stigma. SUMMARY The strategies outlined in this review hold great potential for enhancing mental health treatment services, and address some of the major barriers globally to accessing mental healthcare, such as scarcity of resources (infrastructure, capacity, and funding) and stigma. Despite much evidence supporting the efficacy of these models, thorough studies that test their feasibility, acceptability, utility, and effectiveness in various contexts, including low-income and middle-income countries, are required. Moreover, these innovations require social support and political will in order to be successfully implemented and scaled-up such that they have a meaningful impact on the burden of disease associated with mental illness worldwide.
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Ngo VK, Weiss B, Lam T, Dang T, Nguyen T, Nguyen MH. The Vietnam Multicomponent Collaborative Care for Depression Program: Development of Depression Care for Low- and Middle-Income Nations. J Cogn Psychother 2014; 28:156-167. [PMID: 25568593 PMCID: PMC4283138 DOI: 10.1891/0889-8391.28.3.156] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In this article, we discuss the Vietnam Multicomponent Collaborative Care for Depression Program, which was designed to provide evidence-based depression care services in low-resource, non-Western settings such as Vietnam. The article provides the program development background; the social, economic, and political context in which the program was developed; and the structure and content of the program and their underlying rationale in the context of rural Vietnam. Although the program was found to be acceptable, feasible, and effective in reducing depression outcomes, we did face challenges in implementation, which are outlined in this article. Key challenges included cultural factors (e.g., a lack of recognition of depression as a health-related entity amenable to professional treatment, relatively low levels of psychological mindedness useful for understanding of psychological interventions) and health system (e.g., lack of mental health specialists, overburdened health providers unfamiliar with behavioral interventions) factors. We discuss the strategies we employed to resolve these challenges and our successes and failures therein. We conclude with recommendations for others interested in implementing similar programs in low- and middle-income countries settings.
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Affiliation(s)
| | - Bahr Weiss
- Vanderbilt University, Nashville, Tennessee
| | - Trung Lam
- Da Nang Psychiatric Hospital, Da Nang, Vietnam
| | - Thanh Dang
- Khanh Hoa Psychiatric Hospital, Nha Trang, Vietnam
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