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Mathias K, Pillai P, Gaitonde R, Shelly K, Jain S. Co-production of a pictorial recovery tool for people with psycho-social disability informed by a participatory action research approach-a qualitative study set in India. Health Promot Int 2020; 35:486-499. [PMID: 31098623 DOI: 10.1093/heapro/daz043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Mental health problems are recognized as a leading cause of disability and have seen increased allocations of resources and services globally. There is a growing call for solutions supporting global mental health and recovery to be locally relevant and built on the knowledge and skills of people with mental health problems, particularly in low-income countries. Set in Dehradun district, North India, this study aimed to describe first, the process of co-production of a visual tool to support recovery for people affected by psycho-social disability; second, the key outputs developed and third, critical reflection on the process and outputs. The developmental process consisted of participatory action research and qualitative methods conducted by a team of action researchers and an experts by experience (EBE) group of community members. The team generated eight domains for recovery under three meta-domains of normalcy, belonging and contributing and the ensuing recovery tool developed pictures of activities for each domain. Challenges to using a participatory and emancipatory process were addressed by working with a mentor experienced in participatory methods, and by allocating time to concurrent critical reflection on power relationships. Findings underline the important contribution of an EBE group demonstrating their sophisticated and locally valid constructions of recovery and the need for an honest and critically reflective process in all co-productive initiatives. This study generated local conversations around recovery that helped knowledge flow from bottom-to-top and proposes that the grass-root experiences of participants in a disadvantaged environment are needed for meaningful social and health policy responses.
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Affiliation(s)
- Kaaren Mathias
- Landour Community Hospital, Mussoorie, Uttarakhand 248179, India
| | | | - Rakhal Gaitonde
- Department of Public Health and Clinical Medicine, Umea University, Sweden
| | | | - Sumeet Jain
- School of Social and Political Science, University of Edinburgh, UK
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Ruggeri M, Bonetto C, Lasalvia A, Fioritti A, de Girolamo G, Santonastaso P, Pileggi F, Neri G, Ghigi D, Giubilini F, Miceli M, Scarone S, Cocchi A, Torresani S, Faravelli C, Cremonese C, Scocco P, Leuci E, Mazzi F, Pratelli M, Bellini F, Tosato S, De Santi K, Bissoli S, Poli S, Ira E, Zoppei S, Rucci P, Bislenghi L, Patelli G, Cristofalo D, Meneghelli A. Feasibility and Effectiveness of a Multi-Element Psychosocial Intervention for First-Episode Psychosis: Results From the Cluster-Randomized Controlled GET UP PIANO Trial in a Catchment Area of 10 Million Inhabitants. Schizophr Bull 2015; 41:1192-203. [PMID: 25995057 PMCID: PMC4535643 DOI: 10.1093/schbul/sbv058] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Integrated multi-element psychosocial interventions have been suggested to improve the outcomes of first-episode psychosis (FEP) patients, but they have been studied primarily in experimental settings and in nonepidemiologically representative samples. Thus, we performed a cluster-randomized controlled trial, comparing an integrated multi-element psychosocial intervention, comprising cognitive behavioral therapy, family intervention, and case management, with treatment as usual (TAU) for FEP patients in 117 community mental health centers (CMHCs) in a large area of northern Italy (10 million inhabitants). The randomized units (clusters) were the CMHCs, and the units of observation the patients (and, when available, their family members). The primary hypotheses were that add-on multicomponent intervention: (1) results in greater improvements in symptoms, as assessed with positive and negative syndrome scale and (2) reduces in-hospital stay, based on days of hospitalization over the 9-month follow-up. Four hundred and forty-four FEP patients received the intervention or TAU and were assessed at baseline and 9 months. Based on the retention rates of patients (and families) in the experimental arm, multi-element psychosocial interventions can be implemented in routine mental health services. Regarding primary outcomes, patients in the experimental arm showed greater reductions in overall symptom severity, while no difference could be found for days of hospitalization. Among the secondary outcomes, greater improvements were detected in the experimental arm for global functioning, emotional well-being, and subjective burden of delusions. No difference could be found for service disengagement and subjective burden of auditory hallucinations. These findings support feasibility and effectiveness of early interventions for psychosis in generalist mental health services.
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Affiliation(s)
- Mirella Ruggeri
- Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134 Verona, Italy; Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy;
| | - Chiara Bonetto
- Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134 Verona, Italy
| | - Antonio Lasalvia
- Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134 Verona, Italy; Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Angelo Fioritti
- Department of Mental Health, Azienda ULSS Bologna, Bologna, Italy
| | - Giovanni de Girolamo
- Scientific Direction, St John of God Clinical Research Centre of Brescia, Brescia, Lombardia, Italy
| | - Paolo Santonastaso
- Department of Neurosciences, University of Padova, Padova, Italy and Azienda Ospedaliera Padova, Italy
| | | | - Giovanni Neri
- Department of Mental Health, Azienda ULSS Modena, Modena, Italy; Agenzia Sanitaria e Sociale Regionale, Regione Emilia Romagna, Italy
| | | | | | | | - Silvio Scarone
- Department of Psychiatry, University of Milano, Milano, Italy
| | - Angelo Cocchi
- AO Ospedale Niguarda Ca' Granda Milano, MHD Programma 2000, Milan, Italy
| | | | - Carlo Faravelli
- Department of Psychiatry, University of Firenze, Firenze, Italy
| | - Carla Cremonese
- Department of Mental Health, Azienda Ospedaliera Padova, Padova, Italy
| | - Paolo Scocco
- Department of Mental Health, Azienda ULSS 16, Padova, Italy
| | | | | | | | | | - Sarah Tosato
- Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134 Verona, Italy; Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Katia De Santi
- Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134 Verona, Italy; Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Sarah Bissoli
- Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134 Verona, Italy
| | - Sara Poli
- Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134 Verona, Italy
| | - Elisa Ira
- Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134 Verona, Italy
| | - Silvia Zoppei
- Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134 Verona, Italy
| | - Paola Rucci
- Department of Mental Health, Azienda ULSS Bologna, Bologna, Italy; Agenzia Sanitaria e Sociale Regionale, Regione Emilia Romagna, Italy
| | - Laura Bislenghi
- AO Ospedale Niguarda Ca' Granda Milano, MHD Programma 2000, Milan, Italy
| | - Giovanni Patelli
- AO Ospedale Niguarda Ca' Granda Milano, MHD Programma 2000, Milan, Italy
| | - Doriana Cristofalo
- Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134 Verona, Italy
| | - Anna Meneghelli
- AO Ospedale Niguarda Ca' Granda Milano, MHD Programma 2000, Milan, Italy
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