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Silaule O, Casteleijn D, Adams F, Nkosi NG. Strategies to Alleviate the Burden Experienced by Informal Caregivers of Persons With Severe Mental Disorders in Low- and Middle-Income Countries: Scoping Review. Interact J Med Res 2024; 13:e48587. [PMID: 38236636 PMCID: PMC10835589 DOI: 10.2196/48587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 08/20/2023] [Accepted: 10/04/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND There is considerable evidence of the burden of care encountered by informal caregivers of persons with severe and enduring mental health conditions in low- and middle-income countries. Previous studies have highlighted the need to support these informal caregivers as key players in the care of these patients. To date, limited evidence exists on the extent and types of strategies for supporting these informal caregivers in low- and middle-income countries. OBJECTIVE This scoping review aims to identify and describe the extent and type of evidence on the existing strategies for alleviating the burden of care among informal caregivers of persons with severe and enduring mental health conditions in low- and middle-income countries. METHODS A systematic literature search was completed following the Joanna Briggs Institute methodology for scoping reviews. The participants, concept, and context framework was used to guide the search for literature sources across 5 databases: PubMed, MEDLINE, CINAHL, and PsycINFO for published literature and ProQuest for unpublished literature. This review included studies that reported on strategies for alleviating the burden of care among informal caregivers of persons with severe and enduring mental health conditions, with a focus on studies that evaluated or recommended caregiver interventions and support strategies in low- and middle-income countries. The search was limited to studies conducted between 2001 and 2021, and only papers written in English were considered for inclusion. Using the Covidence software (Veritas Health Innovation), 2 reviewers independently screened the papers, applied the inclusion and exclusion criteria, and met biweekly to discuss and resolve conflicts. The relevant studies and reported outcomes were summarized, organized, and analyzed descriptively using numeric summary analysis and deductive content analysis. RESULTS Of the 18,342 studies identified, 44 (0.24%) met the inclusion criteria. The included studies were from 16 low- and middle-income countries in Asia, Africa, Europe, and South and North America. Most studies (21/44, 48%) were randomized controlled trials conducted in Asian countries. The identified strategies were grouped into 2 categories: implemented and recommended intervention strategies. Identified strategies included community-based interventions, psychoeducation interventions, support groups, cognitive behavioral therapy, spirituality-based interventions, and smartphone-based interventions. In addition, mindfulness and empowerment, collaborative interventions, standard care, financial and social support, counseling, occupation-based interventions, policy and legislature, and access to mental health care were identified. Psychoeducation and support group interventions were identified as common strategies for alleviating the burden of care among informal caregivers of persons with severe and enduring mental health conditions. CONCLUSIONS This review provides evidence on the types of implemented and recommended strategies for alleviating the burden of care among informal caregivers in low- and middle-income countries. Although psychoeducational interventions were the most preferred strategy for alleviating burden, their benefits were short-lived when compared with peer-led support groups. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/44268.
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Affiliation(s)
- Olindah Silaule
- Department of Occupational Therapy, University of the Witwatersrand, Johannesburg, South Africa
| | - Daleen Casteleijn
- Department of Occupational Therapy, University of Pretoria, Pretoria, South Africa
| | - Fasloen Adams
- Division of Occupational Therapy, Stellenbosch University, Cape Town, South Africa
| | - Nokuthula Gloria Nkosi
- Department of Nursing Education, University of the Witwatersrand, Johannesburg, South Africa
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Rai S, Gurung D, Kohrt B. The PhotoVoice method for collaborating with people with lived experience of mental health conditions to strengthen mental health services. Glob Ment Health (Camb) 2023; 10:e80. [PMID: 38161746 PMCID: PMC10755382 DOI: 10.1017/gmh.2023.73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/24/2023] [Accepted: 11/06/2023] [Indexed: 01/03/2024] Open
Abstract
There is a growing recognition of the benefits of collaborating with people with lived experience (PWLE) of mental health conditions in mental health research and implementation of services. Such collaboration has been effective in reducing mental health stigma and improving the quality of mental health care. Here, we describe using PhotoVoice as a collaborative method in which PWLE use visual narratives to tell their recovery stories for promoting social contact, debunking myths and reducing stigma. First, we outline the framework of this collaboration, drawing on theories from medical anthropology and social psychology and focusing on reducing mental health stigma among primary healthcare workers. Then, we describe the process using our learnings from implementing PhotoVoice in Nepal, Ethiopia and Uganda. We highlight collaboration in five key steps with associated considerations: (1) identifying PWLE for collaboration; (2) training in photography, distress management and presentation skills; (3) developing a photographic recovery story; (4) training healthcare workers using the PhotoVoice narratives; and (5) ongoing support of mental health systems strengthening in collaboration with PWLE. Then, we critically reflect on the process, highlighting the benefits and challenges to the participants and researchers, thereby paving the way for expanding collaborations with PWLE using the PhotoVoice method.
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Affiliation(s)
- Sauharda Rai
- Center for Global Mental Health Equity, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
| | - Dristy Gurung
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Brandon Kohrt
- Center for Global Mental Health Equity, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
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Gréaux M, Moro MF, Kamenov K, Russell AM, Barrett D, Cieza A. Health equity for persons with disabilities: a global scoping review on barriers and interventions in healthcare services. Int J Equity Health 2023; 22:236. [PMID: 37957602 PMCID: PMC10644565 DOI: 10.1186/s12939-023-02035-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 10/11/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Persons with disabilities experience health inequities in terms of increased mortality, morbidity, and limitations in functioning when compared to the rest of the population. Many of the poor health outcomes experienced by persons with disabilities cannot be explained by the underlying health condition or impairment, but are health inequities driven by unfair societal and health system factors. A synthesis of the global evidence is needed to identify the factors that hinder equitable access to healthcare services for persons with disabilities, and the interventions to remove these barriers and promote disability inclusion. METHODS We conducted a scoping review following the methodological framework proposed by Arksey and O'Malley, Int J Soc Res Methodol 8:19-32. We searched two scholarly databases, namely MEDLINE (Ovid) and Web of Science, the websites of Organizations of Persons with Disabilities and governments, and reviewed evidence shared during WHO-led consultations on the topic of health equity for persons with disabilities. We included articles published after 2011 with no restriction to geographical location, the type of underlying impairments or healthcare services. A charting form was developed and used to extract the relevant information for each included article. RESULTS Of 11,884 articles identified in the search, we included 182 articles in this review. The majority of sources originated from high-income countries. Barriers were identified worldwide across different levels of the health system (such as healthcare costs, untrained healthcare workforces, issues of inclusive and coordinated services delivery), and through wider contributing factors of health inequities that expand beyond the health system (such as societal stigma or health literacy). However, the interventions to promote equitable access to healthcare services for persons with disabilities were not readily mapped onto those needs, their sources of funding and projected sustainability were often unclear, and few offered targeted approaches to address issues faced by marginalized groups of persons with disabilities with intersectional identities. CONCLUSION Persons with disabilities continue to face considerable barriers when accessing healthcare services, which negatively affects their chances of achieving their highest attainable standard of health. It is encouraging to note the increasing evidence on interventions targeting equitable access to healthcare services, but they remain too few and sparce to meet the populations' needs. Profound systemic changes and action-oriented strategies are warranted to promote health equity for persons with disabilities, and advance global health priorities.
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Affiliation(s)
- Mélanie Gréaux
- Faculty of Education, University of Cambridge, Cambridge, UK.
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Hartog K, Peters RMH, Tukahiirwa RK, Jordans MJD. Reducing stigma impacting children and adolescents in low- and middle-income countries: The development of a common multi-component stigma reduction intervention. PLoS One 2023; 18:e0292064. [PMID: 37906579 PMCID: PMC10617710 DOI: 10.1371/journal.pone.0292064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 09/12/2023] [Indexed: 11/02/2023] Open
Abstract
INTRODUCTION Stigmatisation impedes health and quality of life. Evidence regarding stigma reduction interventions is, albeit growing, limited. There is a gap in the availability and evidence of interventions for reducing stigma among children and adolescents, especially in low- and middle-income countries. This paper describes the process that led to a stigma reduction intervention impacting children and adolescents in low- and middle-income countries, following previously conducted formative research. METHODS In this study, we conducted (i) online stakeholder consultations (FGD) (n = 43), including a survey assessing intervention acceptability, appropriateness, feasibility and scalability (n = 16); and (ii) preliminary field-testing of intervention content online and in a refugee settlement in Uganda. FINDINGS Stakeholder consultation showed the initial version of STRETCH (Stigma Reduction to Trigger Change for Children), albeit positively received, required adaptations. We made adjustments to i) take into account implementation duration, intervention flexibility and intersectionality; (ii) strengthen the involvement of individuals, including adolescents/youth, with lived stigma experience; (iii) target people close to individuals with lived stigma experience; and (iv) address feasibility and sustainability concerns. Preliminary field-testing simplified STRETCH while adding a community outreach component and revisiting the intervention setup, to ensure STRETCH can also be applied from a modular perspective. CONCLUSION We conducted a process to develop a child-focused multi-component stigma reduction intervention, with intended applicability across stigmas and settings. This paper provides an overview of the intervention development process, generating intervention-specific learnings with generic value. STRETCH aims to reduce stigmatisation at the implementing organisation, create community-wide reflection and stigma reduction demand, and reduce stigmatisation among various target groups.
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Affiliation(s)
- Kim Hartog
- Amsterdam Institute for Social Science Research (AISSR), University of Amsterdam, Amsterdam, The Netherlands
- Research and Development Department, War Child, Amsterdam, The Netherlands
| | - Ruth M. H. Peters
- Faculty of Science, Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Mark J. D. Jordans
- Amsterdam Institute for Social Science Research (AISSR), University of Amsterdam, Amsterdam, The Netherlands
- Research and Development Department, War Child, Amsterdam, The Netherlands
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Vaishnav M, Javed A, Gupta S, Kumar V, Vaishnav P, Kumar A, Salih H, levounis P, NG B, Alkhoori S, Luguercho C, Soghoyan A, Moore E, Lakra V, Aigner M, Wancata J, Ismayilova J, Islam MA, Da Silva AG, Chaimowitz G, Xiaoping W, Okasha T, Meyer-Lindenberg A, Schulze T, NG R, Chiu SN, (Sherry) CKW, Tanra AJ, Park YC, Panteleeva L, Taveras M, Mazaliauskiene R, Sulaiman AHB, Sanchez T, Sedain CP, Sheikh TL, Lien L, Rasool G, Buenaventura R, Gambheera HC, Ranasinghe K, Sartorius N, Charnsil C, Larnaout A, Nakku J, Ashurov Z. Stigma towards mental illness in Asian nations and low-and-middle-income countries, and comparison with high-income countries: A literature review and practice implications. Indian J Psychiatry 2023; 65:995-1011. [PMID: 38108051 PMCID: PMC10725213 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_667_23] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/23/2023] [Accepted: 09/23/2023] [Indexed: 12/19/2023] Open
Abstract
Background Stigma related to mental illness (and its treatment) is prevalent worldwide. This stigma could be at the structural or organizational level, societal level (interpersonal stigma), and the individual level (internalized stigma). Vulnerable populations, for example, gender minorities, children, adolescents, and geriatric populations, are more prone to stigma. The magnitude of stigma and its negative influence is determined by socio-cultural factors and macro (mental health policies, programs) or micro-level factors (societal views, health sectors, or individuals' attitudes towards mentally ill persons). Mental health stigma is associated with more serious psychological problems among the victims, reduced access to mental health care, poor adherence to treatment, and unfavorable outcomes. Although various nationwide and well-established anti-stigma interventions/campaigns exist in high-income countries (HICs) with favorable outcomes, a comprehensive synthesis of literature from the Low- and Middle-Income Countries (LMICs), more so from the Asian continent is lacking. The lack of such literature impedes growth in stigma-related research, including developing anti-stigma interventions. Aim To synthesize the available mental health stigma literature from Asia and LMICs and compare them on the mental health stigma, anti-stigma interventions, and the effectiveness of such interventions from HICs. Materials and Methods PubMed and Google Scholar databases were screened using the following search terms: stigma, prejudice, discrimination, stereotype, perceived stigma, associate stigma (for Stigma), mental health, mental illness, mental disorder psychiatric* (for mental health), and low-and-middle-income countries, LMICs, High-income countries, and Asia, South Asian Association for Regional Cooperation/SAARC (for countries of interest). Bibliographic and grey literature were also performed to obtain the relevant records. Results The anti-stigma interventions in Asia nations and LMICs are generalized (vs. disorder specific), population-based (vs. specific groups, such as patients, caregivers, and health professionals), mostly educative (vs. contact-based or attitude and behavioral-based programs), and lacking in long-term effectiveness data. Government, international/national bodies, professional organizations, and mental health professionals can play a crucial in addressing mental health stigma. Conclusion There is a need for a multi-modal intervention and multi-sectoral coordination to mitigate the mental health stigma. Greater research (nationwide surveys, cultural determinants of stigma, culture-specific anti-stigma interventions) in this area is required.
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Affiliation(s)
- Mrugesh Vaishnav
- Samvedana Group of Hospital and Research Centre, Institute of Psychological and Sexual Research-Samvedana Foundation, Ahmedabad, Gujarat, India
| | - Afzal Javed
- World Psychiatric Association (WPA), Geneva, Switzerland
| | - Snehil Gupta
- Associate Professor, Dept. of Psychiatry, All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India
| | - Vinay Kumar
- President, Indian Psychiatric Society, Ahmedabad, Gujarat, India
| | | | - Akash Kumar
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), Bhopal, India
| | - Hakimullah Salih
- President, Afghanistan National Psychiatrists Association, San Diego, USA
| | | | - Bernardo NG
- Clinical Assistant Professor, Department of Psychiatry, University of California, San Diego, USA
| | - Samia Alkhoori
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
| | - Cora Luguercho
- President, Association of Argentine Psychiatrists (APSA), Australia
| | | | - Elizabeth Moore
- President of the Royal Australian and New Zealand College of Psychiatrists (RANZCP), Australia
| | - Vinay Lakra
- Divisional Director, Mental Health, Northern Health, Australia
| | - Martin Aigner
- President, Austrian Society for Psychiatry, Psychotherapy and Psychosomatics
| | - Johannes Wancata
- Professor and Chair for Social Psychiatry, Medical University of Vienna, University Campus
| | - Jamila Ismayilova
- The National Mental Health Center of the Ministry of Health of Azerbaijan
| | - Md. Azizul Islam
- President, Bangladesh Association of Psychiatrist, Principal, US-Bangla Medical College
| | | | - Gary Chaimowitz
- Head of Service, Forensic Psychiatry Program, St. Joseph's Healthcare, Hamilton
| | | | - Tarek Okasha
- Professor of Psychiatry, Okasha Institute of Psychiatry, Faculty of Medicine Ain Shams University in Cairo, Egypt
| | | | - Thomas Schulze
- Director of the Institute of Psychiatric Phenomics and Genomics (www.ippg.eu) at the University Hospital of LMU, Munich, Germany
| | | | - SN Chiu
- President, Hong Kong College of Psychiatrists
| | - Chan Kit Wa (Sherry)
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
| | | | - Yong Chon Park
- Emeritus Professor, Department of Psychiatry, Han Yang University, Seoul, Korea
| | | | - Marisol Taveras
- Department of Mental Health, Dr. Ney Arias Lora Traumatology Hospital, Santo Domingo Norte
| | - Ramune Mazaliauskiene
- Lithuanian Health Sciences University; Lithuanian Health Sciences University Kaunas Hospital
| | | | | | | | | | - Lars Lien
- Department of Health and Social Science, Innlandet University of Applied Science, Elverum, Norway
| | | | - Robert Buenaventura
- Associate Professor II, La Consolacion University Philippines College of Medicine
| | | | | | - Norman Sartorius
- President, Association for the Improvement of Mental Health Programmes (AMH), Geneva, Switzerland
| | - Chawanun Charnsil
- Professor of Psychiatry: Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Amine Larnaout
- Razi Hospital, Faculty of Medicine of Tunis, Tunis El Manar University, Tunisia
| | - Juliet Nakku
- Butabika Hospital and Makerere University, Kampala, Uganda
| | - Zarif Ashurov
- Head of the Psychiatry and Narcology, Department of the Tashkent Medical Academy
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Merner B, Schonfeld L, Virgona A, Lowe D, Walsh L, Wardrope C, Graham-Wisener L, Xafis V, Colombo C, Refahi N, Bryden P, Chmielewski R, Martin F, Messino NM, Mussared A, Smith L, Biggar S, Gill M, Menzies D, Gaulden CM, Earnshaw L, Arnott L, Poole N, Ryan RE, Hill S. Consumers' and health providers' views and perceptions of partnering to improve health services design, delivery and evaluation: a co-produced qualitative evidence synthesis. Cochrane Database Syst Rev 2023; 3:CD013274. [PMID: 36917094 PMCID: PMC10065807 DOI: 10.1002/14651858.cd013274.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
BACKGROUND Partnering with consumers in the planning, delivery and evaluation of health services is an essential component of person-centred care. There are many ways to partner with consumers to improve health services, including formal group partnerships (such as committees, boards or steering groups). However, consumers' and health providers' views and experiences of formal group partnerships remain unclear. In this qualitative evidence synthesis (QES), we focus specifically on formal group partnerships where health providers and consumers share decision-making about planning, delivering and/or evaluating health services. Formal group partnerships were selected because they are widely used throughout the world to improve person-centred care. For the purposes of this QES, the term 'consumer' refers to a person who is a patient, carer or community member who brings their perspective to health service partnerships. 'Health provider' refers to a person with a health policy, management, administrative or clinical role who participates in formal partnerships in an advisory or representative capacity. This QES was co-produced with a Stakeholder Panel of consumers and health providers. The QES was undertaken concurrently with a Cochrane intervention review entitled Effects of consumers and health providers working in partnership on health services planning, delivery and evaluation. OBJECTIVES 1. To synthesise the views and experiences of consumers and health providers of formal partnership approaches that aimed to improve planning, delivery or evaluation of health services. 2. To identify best practice principles for formal partnership approaches in health services by understanding consumers' and health providers' views and experiences. SEARCH METHODS We searched MEDLINE, Embase, PsycINFO and CINAHL for studies published between January 2000 and October 2018. We also searched grey literature sources including websites of relevant research and policy organisations involved in promoting person-centred care. SELECTION CRITERIA We included qualitative studies that explored consumers' and health providers' perceptions and experiences of partnering in formal group formats to improve the planning, delivery or evaluation of health services. DATA COLLECTION AND ANALYSIS Following completion of abstract and full-text screening, we used purposive sampling to select a sample of eligible studies that covered a range of pre-defined criteria, including rich data, range of countries and country income level, settings, participants, and types of partnership activities. A Framework Synthesis approach was used to synthesise the findings of the sample. We appraised the quality of each study using the CASP (Critical Appraisal Skill Program) tool. We assessed our confidence in the findings using the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach. The Stakeholder Panel was involved in each stage of the review from development of the protocol to development of the best practice principles. MAIN RESULTS We found 182 studies that were eligible for inclusion. From this group, we selected 33 studies to include in the final synthesis. These studies came from a wide range of countries including 28 from high-income countries and five from low- or middle-income countries (LMICs). Each of the studies included the experiences and views of consumers and/or health providers of partnering in formal group formats. The results were divided into the following categories. Contextual factors influencing partnerships: government policy, policy implementation processes and funding, as well as the organisational context of the health service, could facilitate or impede partnering (moderate level of confidence). Consumer recruitment: consumer recruitment occurred in different ways and consumers managed the recruitment process in a minority of studies only (high level of confidence). Recruiting a range of consumers who were reflective of the clinic's demographic population was considered desirable, particularly by health providers (high level of confidence). Some health providers perceived that individual consumers' experiences were not generalisable to the broader population whereas consumers perceived it could be problematic to aim to represent a broad range of community views (high level of confidence). Partnership dynamics and processes: positive interpersonal dynamics between health providers and consumers facilitated partnerships (high level of confidence). However, formal meeting formats and lack of clarity about the consumer role could constrain consumers' involvement (high level of confidence). Health providers' professional status, technical knowledge and use of jargon were intimidating for some consumers (high level of confidence) and consumers could feel their experiential knowledge was not valued (moderate level of confidence). Consumers could also become frustrated when health providers dominated the meeting agenda (moderate level of confidence) and when they experienced token involvement, such as a lack of decision-making power (high level of confidence) Perceived impacts on partnership participants: partnering could affect health provider and consumer participants in both positive and negative ways (high level of confidence). Perceived impacts on health service planning, delivery and evaluation: partnering was perceived to improve the person-centredness of health service culture (high level of confidence), improve the built environment of the health service (high level of confidence), improve health service design and delivery e.g. facilitate 'out of hours' services or treatment closer to home (high level of confidence), enhance community ownership of health services, particularly in LMICs (moderate level of confidence), and improve consumer involvement in strategic decision-making, under certain conditions (moderate level of confidence). There was limited evidence suggesting partnering may improve health service evaluation (very low level of confidence). Best practice principles for formal partnering to promote person-centred care were developed from these findings. The principles were developed collaboratively with the Stakeholder Panel and included leadership and health service culture; diversity; equity; mutual respect; shared vision and regular communication; shared agendas and decision-making; influence and sustainability. AUTHORS' CONCLUSIONS Successful formal group partnerships with consumers require health providers to continually reflect and address power imbalances that may constrain consumers' participation. Such imbalances may be particularly acute in recruitment procedures, meeting structure and content and decision-making processes. Formal group partnerships were perceived to improve the physical environment of health services, the person-centredness of health service culture and health service design and delivery. Implementing the best practice principles may help to address power imbalances, strengthen formal partnering, improve the experiences of consumers and health providers and positively affect partnership outcomes.
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Affiliation(s)
- Bronwen Merner
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Lina Schonfeld
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Ariane Virgona
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Dianne Lowe
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
- Child and Family Evidence, Australian Institute of Family Studies, Melbourne, Australia
| | - Louisa Walsh
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Cheryl Wardrope
- Clinical Governance, Metro South Hospital and Health Service, Eight Mile Plains, Australia
| | | | - Vicki Xafis
- The Sydney Children's Hospitals Network, Sydney, Australia
| | - Cinzia Colombo
- Laboratory for medical research and consumer involvement, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Nora Refahi
- Consumer Representative, Melbourne, Australia
| | - Paul Bryden
- Consumer Representative, Caboolture, Australia
| | - Renee Chmielewski
- Planning and Patient Experience, The Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | | | | | | | - Lorraine Smith
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Susan Biggar
- Consumer Representative, Melbourne, Australia
- Australian Health Practitioner Regulation Agency (AHPRA), Melbourne, Australia
| | - Marie Gill
- Gill and Wilcox Consultancy, Melbourne, Australia
| | - David Menzies
- Chronic Disease Programs, South Eastern Melbourne Primary Health Network, Heatherton, Australia
| | - Carolyn M Gaulden
- Detroit Wayne County Authority Health Residency Program, Michigan State University, Providence Hospital, Southfield, Michigan, USA
| | | | | | - Naomi Poole
- Strategy and Innovation, Australian Commission on Safety and Quality in Health Care, Sydney, Australia
| | - Rebecca E Ryan
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Sophie Hill
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
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Murphy KA, Daumit GL. Establishing a Care Continuum for Cardiometabolic Conditions for Patients with Serious Mental Illness. Curr Cardiol Rep 2023; 25:193-202. [PMID: 36847991 PMCID: PMC10042919 DOI: 10.1007/s11886-023-01848-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/03/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE OF REVIEW Addressing cardiometabolic risk factors in persons with serious mental illness requires early screening and proactive medical management in both medical and mental health settings. RECENT FINDINGS Cardiovascular disease remains the leading cause of death for persons with serious mental illness (SMI), such as schizophrenia or bipolar disorder, much of which is driven by a high prevalence of metabolic syndrome, diabetes, and tobacco use. We summarize barriers and recent approaches to screening and treatment for metabolic cardiovascular risk factors within physical health and specialty mental health settings. Incorporating system-based and provider-level support within physical health and psychiatric clinical settings should contribute to improvement for screening, diagnosis, and treatment for cardiometabolic conditions for patients with SMI. Targeted education for clinicians and leveraging multi-disciplinary teams are important first steps to recognize and treat populations with SMI at risk of CVD.
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Affiliation(s)
- Karly A Murphy
- Division of General Internal Medicine, University of California San Francisco School of Medicine, 1701 Divisidero Street, Suite 500, 94117, San Francisco, CA, USA.
| | - Gail L Daumit
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Henderson C, Ouali U, Bakolis I, Berbeche N, Bhattarai K, Brohan E, Cherian A, Girma E, Gronholm PC, Gurung D, Hanlon C, Kallakuri S, Kaur A, Ketema B, Lempp H, Li J, Loganathan S, Maulik PK, Mendon G, Mulatu T, Ma N, Romeo R, Venkatesh RK, Zgueb Y, Zhang W, Thornicroft G. Training for mental health professionals in responding to experienced and anticipated mental health-related discrimination (READ-MH): protocol for an international multisite feasibility study. Pilot Feasibility Stud 2022; 8:257. [PMID: 36514144 PMCID: PMC9745687 DOI: 10.1186/s40814-022-01208-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 10/13/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Mental health and other health professionals working in mental health care may contribute to the experiences of stigma and discrimination among mental health service users but can also help reduce the impact of stigma on service users. However, few studies of interventions to equip such professionals to be anti-stigma agents took place in high-income countries. This study assesses the feasibility, potential effectiveness and costs of Responding to Experienced and Anticipated Discrimination training for health professionals working in mental health care (READ-MH) across low- and middle-income countries (LMICs). METHODS This is an uncontrolled pre-post mixed methods feasibility study of READ-MH training at seven sites across five LMICs (China, Ethiopia, India, Nepal and Tunisia). OUTCOME MEASURES knowledge based on course content, attitudes to working to address the impact of stigma on service users and skills in responding constructively to service users' reports of discrimination. The training draws upon the evidence bases for stigma reduction, health advocacy and medical education and is tailored to sites through situational analyses. Its content, delivery methods and intensity were agreed upon through a consensus exercise with site research teams. READ-MH will be delivered to health professionals working in mental health care immediately after baseline data collection; outcome measures will be collected post-training and 3 months post-baseline, followed by qualitative data collection analysed using a combined deductive and inductive approach. Fidelity will be rated during the delivery of READ-MH, and data on training costs will be collected. Quantitative data will be assessed using generalised linear mixed models. Qualitative data will be evaluated by thematic analysis to identify feedback about the training methods and content, including the implementability of the knowledge and skills learned. Pooled and site-specific training costs per trainee and per session will be reported. CONCLUSIONS The training development used a participatory and contextualised approach. Evaluation design strengths include the diversity of settings, the use of mixed methods, the use of a skills-based measure and the knowledge and attitude measures aligned to the target population and training. Limitations are the uncertain generalisability of skills performance to routine care and the impact of COVID-19 restrictions at several sites limiting qualitative data collection for situational analyses.
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Affiliation(s)
- Claire Henderson
- Centre for Implementation Science, Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park Box, London, SE5 8AF, UK.
- South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK.
| | - Uta Ouali
- Department Psychiatry A, Razi University Hospital, Cité des Orangers, 2010, La Manouba, Tunisia
| | - Ioannis Bakolis
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Nada Berbeche
- Department of Psychology, Laboratory of Clinical Psychology: Intersubjectivity and Culture, University of Tunis, Tunis, Tunisia
| | | | - Elaine Brohan
- Centre for Global Mental Health, Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Anish Cherian
- National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Eshetu Girma
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Petra C Gronholm
- Centre for Global Mental Health and Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park Box, London, SE5 8AF, UK
| | - Dristy Gurung
- Transcultural Psychosocial Organization (TPO), Kathmandu, Nepal
| | - Charlotte Hanlon
- Centre for Global Mental Health, Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
- 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
| | - Sudha Kallakuri
- George Institute for Global Health, 308 Elegance Tower, New Delhi, 110025, India
| | - Amanpreet Kaur
- George Institute for Global Health, 308 Elegance Tower, New Delhi, 110025, India
| | - Bezawit Ketema
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Heidi Lempp
- Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences & Medicine, Weston Education Centre, 10, Cutcombe Rd, London, SE5 9RJ, UK
| | - Jie Li
- The Affiliated Brain Hospital of Guangzhou Medical University, No. 36 Mingxin Road, Liwan District, Guangzhou, 510370, China
| | - Santosh Loganathan
- National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Pallab K Maulik
- George Institute for Global Health, 308 Elegance Tower, New Delhi, 110025, India
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Gurucharan Mendon
- National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Tesfahun Mulatu
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ning Ma
- Peking University Sixth Hospital (Institute of Mental Health), National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University, No 51, Huayuanbei Road, Haidian District, Beijing, 100191, China
| | - Renee Romeo
- King's Health Economics, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park Box, London, SE5 8AF, UK
| | | | - Yosra Zgueb
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Wufang Zhang
- Peking University Sixth Hospital (Institute of Mental Health), National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University, No 51, Huayuanbei Road, Haidian District, Beijing, 100191, China
| | - Graham Thornicroft
- Centre for Global Mental Health and Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park Box, London, SE5 8AF, UK
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9
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Kaiser BN, Gurung D, Rai S, Bhardwaj A, Dhakal M, Cafaro CL, Sikkema KJ, Lund C, Patel V, Jordans MJD, Luitel NP, Kohrt BA. Mechanisms of action for stigma reduction among primary care providers following social contact with service users and aspirational figures in Nepal: an explanatory qualitative design. Int J Ment Health Syst 2022; 16:37. [PMID: 35953839 PMCID: PMC9367153 DOI: 10.1186/s13033-022-00546-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 06/28/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND There are increasing initiatives to reduce mental illness stigma among primary care providers (PCPs) being trained in mental health services. However, there is a gap in understanding how stigma reduction initiatives for PCPs produce changes in attitudes and clinical practices. We conducted a pilot randomized controlled trial of a stigma reduction intervention in Nepal: REducing Stigma among HealthcAre Providers (RESHAPE). In a previous analysis of this pilot, we described differences in stigmatizing attitudes and clinical behaviors between PCPs receiving a standard mental health training (mental health Gap Action Program, mhGAP) vs. those receiving an mhGAP plus RESHAPE training. The goal of this analysis is to use qualitative interview data to explain the quantitative differences in stigma outcomes identified between the trial arms. METHODS PCPs were randomized to either standard mental health training using mhGAP led by mental health specialists or the experimental condition (RESHAPE) in which service users living with mental illness shared photographic recovery narratives and participated in facilitated social contact. Qualitative interviews were conducted with PCPs five months post-training (n = 8, standard mhGAP training; n = 20, RESHAPE). Stigmatizing attitudes and clinical practices before and after training were qualitatively explored to identify mechanisms of change. RESULTS PCPs in both training arms described changes in knowledge, skills, and confidence in providing mental healthcare. PCPs in both arms described a positive feedback loop, in which discussing mental health with patients encouraged more patients to seek treatment and open up about their illness, which demonstrated for PCPs that mental illness can be treated and boosted their clinical confidence. Importantly, PCPs in the RESHAPE arm were more likely to describe a willingness to treat mental health patients and attributed this in part to social contact with service users during the training. CONCLUSIONS Our qualitative research identified testable mechanisms of action for stigma reduction and improving clinical behavior: specifically, recovery stories from service users and social engagement led to greater willingness to engage with patients about mental illness, triggering a feedback loop of more positive experiences with patients who benefit from mental healthcare, which further reinforces willingness to deliver mental healthcare. Trial registration ClinicalTrials.gov identifier, NCT02793271.
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Affiliation(s)
- Bonnie N Kaiser
- University of California San Diego, La Jolla, CA, USA.
- Duke Global Health Institute, Durham, NC, USA.
| | - Dristy Gurung
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
- King's College London, London, UK
| | - Sauharda Rai
- Duke Global Health Institute, Durham, NC, USA
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
- University of Washington, Seattle, WA, USA
| | - Anvita Bhardwaj
- Duke Global Health Institute, Durham, NC, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Manoj Dhakal
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
- Patan Academy of Health Sciences, School of Public Health, Kathmandu, Nepal
| | - Cori L Cafaro
- Duke Global Health Institute, Durham, NC, USA
- DePaul University, Chicago, IL, USA
| | - Kathleen J Sikkema
- Duke Global Health Institute, Durham, NC, USA
- Columbia University, New York, NY, USA
| | - Crick Lund
- King's College London, London, UK
- University of Cape Town, Cape Town, South Africa
| | - Vikram Patel
- Harvard Medical School, Cambridge, MA, USA
- Harvard T. H. Chan School of Public Health, Cambridge, MA, USA
| | - Mark J D Jordans
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
- King's College London, London, UK
| | | | - Brandon A Kohrt
- Duke Global Health Institute, Durham, NC, USA
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
- George Washington University, Washington, DC, USA
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10
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Abayneh S, Lempp H, Rai S, Girma E, Getachew M, Alem A, Kohrt BA, Hanlon C. Empowerment training to support service user involvement in mental health system strengthening in rural Ethiopia: a mixed-methods pilot study. BMC Health Serv Res 2022; 22:880. [PMID: 35799252 PMCID: PMC9264546 DOI: 10.1186/s12913-022-08290-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 07/01/2022] [Indexed: 12/03/2022] Open
Abstract
Background Increased service user involvement is recommended to improve weak mental health systems in low-and middle-income countries (LMICs). However, involvement is rarely implemented and interventions to support involvement are sparse. In this study we evaluated the acceptability, feasibility and perceived outcomes of an empowerment and training program for service users and health professionals to facilitate service user involvement in mental health system strengthening in rural Ethiopia. Methods REducing Stigma among HealthcAreProvidErs (RESHAPE) is a training curriculum for service users, their caregivers and aspirational health workers, which uses PhotoVoice methodology, to prepare them in participation of mental health systems strengthening in LMICs. We delivered the RESHAPE training augmented with empowerment content developed in Ethiopia. The interactive face-to-face training was delivered to service users and caregivers (over 10 days), and health professionals (1 day) separately. The study was an uncontrolled, convergent mixed-methods design. The quantitative data consisted of process data, satisfaction questionnaire, and a retrospective pre-test survey. Qualitative data included exit and follow-up in-depth interviews with the service users. Descriptive statistics were performed for quantitative data, and qualitative data were thematically analysed. The findings were integrated through triangulation for convergent themes following analysis. Results Twelve service users, 12 caregivers and 18 health professionals were enrolled, and completed the training. Participants valued the content and delivery process; the standard of the training program met their expectations and participation led to positive gains in understanding about mental illness, stigma, service-user involvement and human rights. The qualitative findings identified positive impacts, including increased self-confidence, sense of empowerment, social - and perceived therapeutic benefits. Conclusions We found that the RESHAPE training with added content for Ethiopia, delivered using the PhotoVoice methodology, is feasible, acceptable and of value to develop and implement training programmes which can empower service users to be involved in mental health system strengthening in this setting. Further study to assess the impact on health systems strengthening is warranted. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08290-x.
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Affiliation(s)
- Sisay Abayneh
- College of Health Sciences, School of Medicine, Department of Psychiatry, WHO Collaborating Centre in Mental Health Research and Capacity Building, Addis Ababa University, Addis Ababa, Ethiopia. .,Madda Walabu University College of Education and Behavoural Studies, Robe, Ethiopia.
| | - Heidi Lempp
- Centre for Rheumatic Diseases, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, Weston Education Centre 10, Cutcombe Rd., London, SE5 9RJ, UK
| | - Sauharda Rai
- Department of Psychiatry, George Washington University, Washington, DC, USA
| | - Eshetu Girma
- Depatment of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Medhanit Getachew
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Atalay Alem
- College of Health Sciences, School of Medicine, Department of Psychiatry, WHO Collaborating Centre in Mental Health Research and Capacity Building, Addis Ababa University, Addis Ababa, Ethiopia
| | - Brandon A Kohrt
- Department of Psychiatry, George Washington University, Washington, DC, USA
| | - Charlotte Hanlon
- College of Health Sciences, School of Medicine, Department of Psychiatry, WHO Collaborating Centre in Mental Health Research and Capacity Building, Addis Ababa University, 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.,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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Kohrt BA, Turner EL, Gurung D, Wang X, Neupane M, Luitel NP, Kartha MR, Poudyal A, Singh R, Rai S, Baral PP, McCutchan S, Gronholm PC, Hanlon C, Lempp H, Lund C, Thornicroft G, Gautam K, Jordans MJD. Implementation strategy in collaboration with people with lived experience of mental illness to reduce stigma among primary care providers in Nepal (RESHAPE): protocol for a type 3 hybrid implementation effectiveness cluster randomized controlled trial. Implement Sci 2022; 17:39. [PMID: 35710491 PMCID: PMC9205129 DOI: 10.1186/s13012-022-01202-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 04/10/2022] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND There are increasing efforts for the integration of mental health services into primary care settings in low- and middle-income countries. However, commonly used approaches to train primary care providers (PCPs) may not achieve the expected outcomes for improved service delivery, as evidenced by low detection rates of mental illnesses after training. One contributor to this shortcoming is the stigma among PCPs. Implementation strategies for training PCPs that reduce stigma have the potential to improve the quality of services. DESIGN In Nepal, a type 3 hybrid implementation-effectiveness cluster randomized controlled trial will evaluate the implementation-as-usual training for PCPs compared to an alternative implementation strategy to train PCPs, entitled Reducing Stigma among Healthcare Providers (RESHAPE). In implementation-as-usual, PCPs are trained on the World Health Organization Mental Health Gap Action Program Intervention Guide (mhGAP-IG) with trainings conducted by mental health specialists. In RESHAPE, mhGAP-IG training includes the added component of facilitation by people with lived experience of mental illness (PWLE) and their caregivers using PhotoVoice, as well as aspirational figures. The duration of PCP training is the same in both arms. Co-primary outcomes of the study are stigma among PCPs, as measured with the Social Distance Scale at 6 months post-training, and reach, a domain from the RE-AIM implementation science framework. Reach is operationalized as the accuracy of detection of mental illness in primary care facilities and will be determined by psychiatrists at 3 months after PCPs diagnose the patients. Stigma will be evaluated as a mediator of reach. Cost-effectiveness and other RE-AIM outcomes will be assessed. Twenty-four municipalities, the unit of clustering, will be randomized to either mhGAP-IG implementation-as-usual or RESHAPE arms, with approximately 76 health facilities and 216 PCPs divided equally between arms. An estimated 1100 patients will be enrolled for the evaluation of accurate diagnosis of depression, generalized anxiety disorder, psychosis, or alcohol use disorder. Masking will include PCPs, patients, and psychiatrists. DISCUSSION This study will advance the knowledge of stigma reduction for training PCPs in partnership with PWLE. This collaborative approach to training has the potential to improve diagnostic competencies. If successful, this implementation strategy could be scaled up throughout low-resource settings to reduce the global treatment gap for mental illness. TRIAL REGISTRATION ClinicalTrials.gov, NCT04282915 . Date of registration: February 25, 2020.
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Affiliation(s)
- Brandon A. Kohrt
- grid.253615.60000 0004 1936 9510Division of Global Mental Health, Department of Psychiatry, George Washington University, Washington D.C., USA
| | - Elizabeth L. Turner
- grid.26009.3d0000 0004 1936 7961Department of Biostatistics and Bioinformatics and Duke Global Health Institute, Duke University, Durham, NC USA
| | - Dristy Gurung
- Transcultural Psychosocial Organization Nepal (TPO Nepal), Pokhara, Nepal
| | - Xueqi Wang
- grid.26009.3d0000 0004 1936 7961Department of Biostatistics and Bioinformatics and Duke Global Health Institute, Duke University, Durham, NC USA
| | - Mani Neupane
- Transcultural Psychosocial Organization Nepal (TPO Nepal), Pokhara, Nepal
| | - Nagendra P. Luitel
- Transcultural Psychosocial Organization Nepal (TPO Nepal), Kathmandu, Nepal
| | - Muralikrishnan R. Kartha
- grid.13097.3c0000 0001 2322 6764King’s Health Economics, IOPPN, King’s College London, London, UK
| | - Anubhuti Poudyal
- grid.21729.3f0000000419368729Department of Sociomedical Sciences, Columbia University, New York, NY USA ,grid.253615.60000 0004 1936 9510Division of Global Mental Health, Department of Psychiatry, George Washington University, Washington, D.C., 20036 USA
| | - Ritika Singh
- grid.253615.60000 0004 1936 9510Division of Global Mental Health, Department of Psychiatry, George Washington University, Washington, D.C., 20036 USA
| | - Sauharda Rai
- grid.34477.330000000122986657Jackson School of International Studies and Department of Global Health, University of Washington, Seattle, USA
| | - Phanindra Prasad Baral
- grid.500537.4Non-communicable Disease and Mental Health Section, Epidemiology and Disease Control Division (EDCD), Department of Health Services (DoHS), Ministry of Health and Population (MoHP), Kathmandu, Nepal
| | - Sabrina McCutchan
- grid.26009.3d0000 0004 1936 7961Duke Global Health Institute, Duke University, Durham, NC USA
| | - Petra C. Gronholm
- grid.13097.3c0000 0001 2322 6764Centre for Global Mental Health and Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Charlotte Hanlon
- grid.13097.3c0000 0001 2322 6764Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK ,grid.7123.70000 0001 1250 5688Department of Psychiatry, School of Medicine and Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Heidi Lempp
- grid.13097.3c0000 0001 2322 6764Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, UK
| | - Crick Lund
- grid.13097.3c0000 0001 2322 6764Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK ,grid.7836.a0000 0004 1937 1151Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Graham Thornicroft
- grid.13097.3c0000 0001 2322 6764Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Kamal Gautam
- Transcultural Psychosocial Organization Nepal (TPO Nepal), Kathmandu, Nepal
| | - Mark J. D. Jordans
- grid.13097.3c0000 0001 2322 6764Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, Center for Global Mental Health, King’s College London, London, UK
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12
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Szlamka Z, Tekola B, Hoekstra R, Hanlon C. The role of advocacy and empowerment in shaping service development for families raising children with developmental disabilities. Health Expect 2022; 25:1882-1891. [PMID: 35644908 PMCID: PMC9327816 DOI: 10.1111/hex.13539] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 03/16/2022] [Accepted: 05/17/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Empowerment of families raising children with developmental disabilities (DDs) is essential to achieving rights‐based service development. Methods In this qualitative study, we investigated stakeholder perceptions on the role of advocacy and empowerment in developing caregiver interventions for families of children with DDs in a global context. Participants had experience with at least one intervention, namely the Caregiver Skills Training developed by the World Health Organization (WHO). Participants were clinicians, caregivers and researchers representing five continents, and representatives of WHO and Autism Speaks. Two focus group discussions and 25 individual interviews were conducted. Data were analysed thematically. Results Three themes were developed: empowerment as independence and as a right; the role and practices of advocacy; and using evidence to drive advocacy. Many professional participants defined empowerment within the realms of their expertise, focusing on caregivers' individual skills and self‐confidence. Caregivers expressed that this expert‐oriented view fails to acknowledge their intuitive knowledge and the need for community‐level empowerment. Participants discussed the challenges of advocacy in light of competing health priorities. The gap between the rights of caregivers and the availability of services, for example, evidence‐based interventions, was highlighted as problematic. Scientific evidence was identified as a key for advocacy. Conclusion Rights‐orientated empowerment of caregivers and advocacy may make vital contributions to service development for children with DDs in contexts worldwide. Patient and Public Contribution Research questions were revised based on views presented during focus group discussions. Participant feedback on preliminary themes informed the development of the interview guides.
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Affiliation(s)
- Zsofia Szlamka
- Department of Psychology Institute of Psychiatry, Psychology and Neuroscience, King's College London London UK
| | - Bethlehem Tekola
- Department of Psychology Institute of Psychiatry, Psychology and Neuroscience, King's College London London UK
| | - Rosa Hoekstra
- Department of Psychology Institute of Psychiatry, Psychology and Neuroscience, King's College London London UK
| | - Charlotte Hanlon
- Department of Health Services and Population Research Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London London UK
- Department of Psychiatry, School of Medicine, WHO Collaborating Centre for Mental Health Research and Capacity‐Building, College of Health Sciences Addis Ababa University Addis Ababa Ethiopia
- Global Health, Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT‐Africa), College of Health Sciences Addis Ababa University Addis Ababa Ethiopia
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13
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A meta-ethnography of participatory health research and co-production in Nepal. Soc Sci Med 2022; 301:114955. [PMID: 35452892 DOI: 10.1016/j.socscimed.2022.114955] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 02/18/2022] [Accepted: 03/29/2022] [Indexed: 11/21/2022]
Abstract
As global health research seeks to decolonialise, democratise, and become more culturally engaging, researchers are increasingly employing participatory and co-productive methods. Working from post-structural perspectives, this meta-ethnographic review explores how such health research in Nepal engages with the epistemological, methodological, and ethical questions it encounters. Five databases including Nepali NepJOL were searched for studies from inception to March 2021. The review included seven studies covering women's group co-production, interviews guided by photo-elicitation, observational methods to explore maternal and child health, mental health, and environmental determinants of health. This meta-ethnography identified that, against the background of a pluralist heritage of health practices, global collaborations involving Nepali researchers and practitioners used participatory research methodology to work with the local populations to improve health and co-production seek primarily to promote Western biomedical and psychosocial interventions. Both advantages and disadvantages were acknowledged. Empirical verification and global acceptance of Western biomedical and psychosocial knowledge were seen as beneficial. Moreover, Western biomedicine was perceived by some as more effective than some local practices in improving health; nevertheless, Nepal faces many challenges that neither can address alone. For participatory and co-productive approaches to become epistemologically enculturated within Nepali health research, researchers need to co-develop more local models and methods which are culturally sensitive and appropriate. Meaningful and effective participatory research can promote active involvement of people who deliver as well as people who use the community-based health care support. These are crucial to optimise sustainable change that global health research partnerships set out to achieve. This meta-ethnography recommends that researchers engage at a deeper level with the epistemological differences between themselves and the communities with whom they seek partnership. Cross-cultural research teams should discuss and address the power differentials which might affect them.
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14
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Henderson C, Ouali U, Bakolis I, Berbeche N, Bhattarai K, Brohan E, Cherian A, Girma E, Gronholm PC, Gurung D, Hanlon C, Kallakuri S, Kaur A, Ketema B, Lempp H, Li J, Loganathan S, Maulik PK, Mendon G, Mulatu T, Ma N, Romeo R, Venkatesh RK, Zgueb Y, Zhang W, Thornicroft G. Training for mental health professionals in responding to experienced and anticipated mental health related discrimination (READ-MH): protocol for an international multisite feasibility study. RESEARCH SQUARE 2022:rs.3.rs-1466318. [PMID: 35378758 PMCID: PMC8978942 DOI: 10.21203/rs.3.rs-1466318/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background: Mental health and other health professionals working in mental health care may contribute to the experiences of stigma and discrimination among mental health service users, but can also help reduce the impact of stigma on service users. However the few studies of interventions to equip such professionals to be anti-stigma agents those took place in High-Income Countries. This study assesses the feasibility, potential effectiveness and costs of Responding to Experienced and Anticipated Discrimination training for health professionals working in mental health care (READ-MH) across Low- and Middle-Income Countries (LMICs). Methods: This is an uncontrolled pre-post mixed methods feasibility study of READ-MH training at seven sites across five LMICs (China, Ethiopia, India, Nepal, and Tunisia). Outcome measures: knowledge based on course content; attitudes to working to address the impact of stigma on service users; and skills in responding constructively to service users' reports of discrimination. The training draws upon the evidence bases for stigma reduction, health advocacy and medical education and is tailored to sites through situational analyses. Its content, delivery methods and intensity were agreed through a consensus exercise with site research teams. READ-MH will be delivered to health professionals working in mental health care immediately after baseline data collection; outcome measures will be collected post-training and three months post-baseline, followed by qualitative data collection. Fidelity will be rated during delivery of READ-MH, and data on training costs will be collected. Quantitative data will be assessed using generalised linear mixed models. Qualitative data will be evaluated by thematic analysis to identify feedback about the training methods and content, including the implementability of the knowledge and skills learned. Pooled and site-specific training costs per trainee and per session will be reported. Conclusions: The training development used a participatory and contextualized approach. Evaluation design strengths include the diversity of settings; the use of mixed methods; the use of a skills-based measure; and knowledge and attitude measures aligned to the target population and training. Limitations are the uncertain generalisability of skills performance to routine care, and the impact of COVID-19 restrictions at several sites limiting qualitative data collection for situational analyses.
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Affiliation(s)
- Claire Henderson
- King’s College London Institute of Psychiatry Psychology and Neuroscience
| | | | - Ioannis Bakolis
- King’s College London Institute of Psychiatry Psychology and Neuroscience
| | | | | | - Elaine Brohan
- King’s College London Institute of Psychiatry Psychology and Neuroscience
| | - Anish Cherian
- NIMHANS: National Institute of Mental Health and Neuro Sciences
| | | | - Petra C Gronholm
- King’s College London Institute of Psychiatry Psychology and Neuroscience
| | - Dristy Gurung
- TPO Nepal: Transcultural Psychosocial Organization Nepal
| | - Charlotte Hanlon
- King’s College London Institute of Psychiatry Psychology and Neuroscience
| | | | | | | | | | - Jie Li
- Affiliated Brain Hospital of Guangzhou Medical University: Guangzhou Huiai Hospital
| | | | | | | | - Tesfahun Mulatu
- Addis Ababa University Department of Community Health: Addis Ababa University School of Public Health
| | - Ning Ma
- Peking University Institute of Mental Health: Peking University Sixth Hospital
| | - Renee Romeo
- King’s College London Institute of Psychiatry Psychology and Neuroscience
| | | | | | - Wufang Zhang
- Peking University Institute of Mental Health: Peking University Sixth Hospital
| | - Graham Thornicroft
- King’s College London Institute of Psychiatry Psychology and Neuroscience
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Treatment Preferences for Pharmacological versus Psychological Interventions among Primary Care Providers in Nepal: Mixed Methods Analysis of a Pilot Cluster Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042149. [PMID: 35206331 PMCID: PMC8871897 DOI: 10.3390/ijerph19042149] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 02/03/2022] [Accepted: 02/10/2022] [Indexed: 02/04/2023]
Abstract
There is increasing evidence supporting the effectiveness of psychological interventions in low- and middle-income countries. However, primary care providers (PCPs) may prefer treating patients with medication. A secondary exploratory analysis of a pilot cluster randomized controlled trial was conducted to evaluate psychological vs. pharmacological treatment preferences among PCPs. Thirty-four health facilities, including 205 PCPs, participated in the study, with PCPs in 17 facilities assigned to a standard version of the mental health Gap Action Programme (mhGAP) training delivered by mental health specialists. PCPs in the other 17 facilities received mhGAP instruction delivered by specialists and people with lived experience of mental illness (PWLE), using a training strategy entitled Reducing Stigma among HealthcAre ProvidErs (RESHAPE). Pre- and post- intervention attitudes were measured through quantitative and qualitative tools. Qualitative interviews with 49 participants revealed that PCPs in both arms endorsed counseling’s benefits and collaboration within the health system to provide counseling. In the RESHAPE arm, PCPs were more likely to increase endorsement of statements such as “depression improves without medication” (F = 9.83, p < 0.001), “not all people with depression must be treated with antidepressants” (χ2 = 17.62, p < 0.001), and “providing counseling to people who have alcohol abuse problems is effective” (χ2 = 26.20, p < 0.001). These mixed-method secondary findings from a pilot trial suggest that in-person participation of PWLE in training PCPs may not only reduce stigma but also increase PCPs’ support of psychological interventions. This requires further investigation in a full-scale trial.
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Gurung D, Poudyal A, Wang YL, Neupane M, Bhattarai K, Wahid SS, Aryal S, Heim E, Gronholm P, Thornicroft G, Kohrt B. Stigma against mental health disorders in Nepal conceptualised with a 'what matters most' framework: a scoping review. Epidemiol Psychiatr Sci 2022; 31:e11. [PMID: 35086602 PMCID: PMC8851063 DOI: 10.1017/s2045796021000809] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 12/15/2021] [Accepted: 12/19/2021] [Indexed: 12/21/2022] Open
Abstract
AIMS Stigma related to mental disorders is a barrier to quality mental healthcare. This scoping review aimed to synthesise literature on stigma related to mental disorders in Nepal to understand stigma processes. The anthropological concept of 'what matters most' to understand culture and stigma was used to frame the literature on explanatory models, manifestations, consequences, structural facilitators and mitigators, and interventions. METHODS We conducted a scoping review with screening guided by the Preferred Reporting Items for Systematic Review and Meta-analysis Extension for Scoping Reviews (PRISMA-ScR). A structured search was done using three international databases (PsycINFO, Medline and Web of Science), one Nepali database (NepJol) and cross-referencing for publications from 1 January 2000 through 24 June 2020. The search was repeated to include structural stigma-related terms. Quality of quantitative studies was assessed using the Systematic Assessment of Quality in Observational Research (SAQOR) tool. The review was registered through the Open Science Framework (OSF) (osf.io/u8jhn). RESULTS The searches yielded 57 studies over a 20-year period: 19 quantitative, 19 qualitative, nine mixed methods, five review articles, two ethnographies and three other types of studies. The review identified nine stigma measures used in Nepal, one stigma intervention, and no studies focused on adolescent and child mental health stigma. The findings suggest that 'what matters most' in Nepali culture for service users, caregivers, community members and health workers include prestige, productivity, privacy, acceptance, marriage and resources. Cultural values related to 'what matters most' are reflected in structural barriers and facilitators including lack of policies, programme planning and resources. Most studies using quantitative tools to assess stigma did not describe cultural adaptation or validation processes, and 15 out of the 18 quantitative studies were 'low-quality' on the SAQOR quality rating. The review revealed clear gaps in implementation and evaluation of stigma interventions in Nepal with only one intervention reported, and most stigma measures not culturally adapted for use. CONCLUSION As stigma processes are complex and interlinked in their influence on 'what matters most' and structural barriers and facilitators, more studies are required to understand this complexity and establish effective interventions targeting multiple domains. We suggest that stigma researchers should clarify conceptual models to inform study design and interpretations. There is a need to develop procedures for the systematic cultural adaptation of stigma assessment tools. Research should be conducted to understand the forms and drivers of structural stigma and to expand intervention research to evaluate strategies for stigma reduction.
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Affiliation(s)
- Dristy Gurung
- Transcultural Psychosocial Organization (TPO) Nepal, Kathmandu, Nepal
- Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Anubhuti Poudyal
- Department of Sociomedical Sciences, Columbia University, New York, New York, USA
- Division of Global Mental Health, Department of Psychiatry, George Washington University, Washington, DC20036, USA
| | - Yixue Lily Wang
- Division of Global Mental Health, Department of Psychiatry, George Washington University, Washington, DC20036, USA
| | - Mani Neupane
- Transcultural Psychosocial Organization (TPO) Nepal, Kathmandu, Nepal
| | - Kalpana Bhattarai
- Transcultural Psychosocial Organization (TPO) Nepal, Kathmandu, Nepal
| | - Syed Shabab Wahid
- Division of Global Mental Health, Department of Psychiatry, George Washington University, Washington, DC20036, USA
- Department of Global Health, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave NW #2, Washington, DC20052, USA
| | | | - Eva Heim
- Institute of Psychology, University of Lausanne, Lausanne, Switzerland
| | - Petra Gronholm
- Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Graham Thornicroft
- Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Brandon Kohrt
- Division of Global Mental Health, Department of Psychiatry, George Washington University, Washington, DC20036, USA
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17
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Poudyal A, Gurung D, Kohrt BA. Evidence-based approaches for promoting gender equity in global mental health research: Study protocol for social network analysis of researchers in Nepal. SSM - MENTAL HEALTH 2021; 1:None. [PMID: 34957425 PMCID: PMC8654682 DOI: 10.1016/j.ssmmh.2021.100032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 10/06/2021] [Accepted: 10/06/2021] [Indexed: 11/23/2022] Open
Abstract
There are increasing efforts for capacity building of researchers in low- and middle-income countries (LMIC) to foster local ability to conduct high quality research. However, female researchers remain underrepresented in scientific communities, particularly in LMIC where they have limited networking and mentorship opportunities. This protocol is for a Social Network Analysis (SNA) to evaluate if gender-sensitive, need-based capacity building can improve researchers' networking and mentorship opportunities in Nepal. The conceptual framework is informed by Social Cognitive Career Theory. Cross-sectional and longitudinal SNA are used to a) assess individual researchers’ network characteristics and their association with academic productivity; and b) examine if the association of network characteristics and academic productivity is mediated by self-efficacy and outcome expectations. Recruitment is designed to include early-career and senior researchers conducting mental health research, as well as students interested in pursuing a career in mental health research. The network characteristics will be mapped for approximately 150 researchers in working in Nepal. SNA characteristics in the network (individual density, homophily, and centrality) will be compared with academic productivity (total peer reviewed publications, h-index), including mediation effects via self-efficacy and outcome expectations. Ultimately, this study will generate information to design more evidence-based strategies for capacity building of a gender-equitable research workforce in global mental health.
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Affiliation(s)
- Anubhuti Poudyal
- Department of Sociomedical Sciences, Columbia University, New York, NY, USA.,Division of Global Mental Health, Department of Psychiatry, George Washington University, Washington, DC, USA
| | - Dristy Gurung
- Institute of Psychology, Psychiatry and Neuroscience, King's College London, UK.,Transcultural Psychosocial Organization, Balutwatar, Kathmandu, Nepal
| | - Brandon A Kohrt
- Division of Global Mental Health, Department of Psychiatry, George Washington University, Washington, DC, USA.,Transcultural Psychosocial Organization, Balutwatar, Kathmandu, Nepal
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18
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Gupta AK, Joshi S, Kafle B, Thapa R, Chapagai M, Nepal S, Niraula A, Paudyal S, Sapkota P, Poudel R, Gurung BS, Pokhrel P, Jha R, Pandit S, Thapaliya S, Shrestha S, Volpe U, Sartorius N. Pathways to mental health care in Nepal: a 14-center nationwide study. Int J Ment Health Syst 2021; 15:85. [PMID: 34930398 PMCID: PMC8685796 DOI: 10.1186/s13033-021-00509-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 12/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pathways to care studies are feasible and tested means of finding the actual routes taken by patients before reaching proper care. In view of the predominance of nonprofessional service providers and the lack of previous large studies on pathways in Nepal, this multicenter study is needed. The aim of the study was to trace the various pathways and carers involved in mental health care; assess clinical variables such as the duration of untreated illness, clinical presentation and treatment; and compare geographically and culturally diverse landscapes. METHODS This was a cross-sectional, convenience sampling study performed at 14 centers where new cases were being taken. The World Health Organization Study of the Pathways-to-Care Schedule was applied. The Nepali version of the encounter form was used. The data were collected between 17 September and 16 October 2020 and were analyzed using the Statistical Package for the Social Sciences (SPSS). Additionally, perspectives from local investigators were collected and discussed. RESULTS Most of the first carers were native/religious faith healers (28.2%), followed by psychiatrists (26%). The median duration for the first psychiatric consultation was 3 weeks. The duration of untreated illness was 30.72 ± 80.34 (median: 4) weeks, and the time taken for this journey was 94.99 ± 274.58 (median: 30) min. The longest delay from the onset of illness to psychiatric care was for epilepsy {90.0 ± 199.0 (median: 25.5)} weeks, followed by neurotic illness {22.89 ± 73.45 (median: 2)} and psychotic illness {10.54 ± 18.28 (median: 2)} weeks. Overall, most patients with severe mental illnesses (SMIs) had their first contact with faithhealers (49%), then met with medical doctors (13%) or psychiatrists (28%). Marked differences in clinical presentation surfaced when hilly centers were compared with the Terai belt. CONCLUSIONS Faith healers, general practitioners and hospital doctors are major carers, and the means of educating them for proper referral can be considered. The investigators see several hindrances and opportunities in the studied pathways. The employment of more mental health professionals and better mental health advocacy, public awareness programs and school education are suggested strategies to improve proper mental health care.
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Affiliation(s)
| | - Sulochana Joshi
- Department of Psychiatry, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Bikram Kafle
- Department of Psychiatry, Devdaha Medical College, Devdaha, Nepal
| | - Ranjan Thapa
- Neuro Cardio and Multi-Specialty Hospital, Biratnagar, Nepal
| | - Manisha Chapagai
- Department of Psychiatry, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Suraj Nepal
- Department of Psychiatry, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Abhash Niraula
- P.T. Birta City Hospital and Research Centre, Birtamode, Nepal
| | - Sreya Paudyal
- Universal College of Medical Sciences, Siddharthanagar, Nepal
| | | | - Reet Poudel
- Department of Psychiatry, Nepalgunj Medical College, Kohalpur, Nepal
| | | | - Prabhakar Pokhrel
- Department of Psychiatry, KIST Medical College and Teaching Hospital, Imadol, Lalitpur, Nepal
| | - Robin Jha
- Department of Psychiatry, Janakpur Provincial Hospital, Janakpur, Nepal
| | - Sanjib Pandit
- Present Address: Department of Psychiatry, Rapti Academy of Health Sciences, Ghorahi, Nepal
- Department of Psychiatry, Karnali Academy of Health Sciences, Jumla, Nepal
| | - Suresh Thapaliya
- Department of Psychiatry, National Medical College, Birgunj, Nepal
- Present Address: Kent and Medway NHS and Social Care Partnership Trust, Kent, UK
| | - Shuva Shrestha
- Department of Psychiatry, National Medical College, Birgunj, Nepal
| | - Umberto Volpe
- Unit of Clinical Psychiatry, Head, Department of Clinical Neurosciences/DIMSC, School of Medicine, Università Politecnica Delle Marche, Via Tronto 10/A, 60126 Ancona, Italy
| | - Norman Sartorius
- Association for the Improvement of Mental Health Programmes (AMH), 20 chemin Colladon, 1209 Geneva, Switzerland
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19
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Kohrt BA, Jordans MJD, Turner EL, Rai S, Gurung D, Dhakal M, Bhardwaj A, Lamichhane J, Singla DR, Lund C, Patel V, Luitel NP, Sikkema KJ. Collaboration With People With Lived Experience of Mental Illness to Reduce Stigma and Improve Primary Care Services: A Pilot Cluster Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2131475. [PMID: 34730821 PMCID: PMC8567115 DOI: 10.1001/jamanetworkopen.2021.31475] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
IMPORTANCE Collaboration with people with lived experience of mental illness (PWLE), also referred to as service users, is a growing priority to reduce stigma and improve mental health care. OBJECTIVE To examine feasibility and acceptability of conducting an antistigma intervention in collaboration with PWLE during mental health training of primary care practitioners (PCPs). DESIGN, SETTING, AND PARTICIPANTS This pilot cluster randomized clinical trial was conducted from February 7, 2016, to August 10, 2018, with assessors, PCPs, and patients blinded to group assignment. The participants were PCPs and primary care patients diagnosed with depression, psychosis, or alcohol use disorder at primary care facilities (the cluster unit of randomization) in Nepal. Statistical analysis was performed from February 2020 to February 2021. INTERVENTIONS In the control group, PCPs were trained on the World Health Organization Mental Health Gap Action Programme-Intervention Guide (mhGAP-IG). In the Reducing Stigma Among Healthcare Providers (RESHAPE) group, the mhGAP-IG trainings for PCPs were cofacilitated by PWLE who presented recovery testimonials through photographic narratives. MAIN OUTCOMES AND MEASURES Prespecified feasibility and acceptability measures were adequacy of randomization, retention rates, intervention fidelity, data missingness, and safety. Outcome measures for PCPs included the Social Distance Scale (SDS), accuracy of diagnoses of mental illness in standardized role-plays using the Enhancing Assessment of Common Therapeutic factors tool (ENACT), and accuracy of diagnosis with actual patients. The primary end point was 16 months posttraining. RESULTS Among the overall sample of 88 PCPs, 75 (85.2%) were men and 67 (76.1%) were upper caste Hindus; the mean (SD) age was 36.2 (8.8) years. Nine of the PCPs (10.2%) were physicians, whereas the remaining 79 PCPs (89.8%) were health assistants or auxiliary health workers. Thirty-four facilities were randomized to RESHAPE or the control group. All eligible PCPs participated: 43 in RESHAPE and 45 in the control group, with 76.7% (n = 33) and 73.3% (n = 33) retention at end line, respectively. Due to PCP dropout, 29 facilities (85.3%) were included in end line analysis. Of 15 PWLE trained as cofacilitators, 11 (73.3%) participated throughout the 3 months of PCP trainings. Among PCPs, mean SDS changes from pretraining to 16 months were -10.6 points (95% CI, -14.5 to -6.74 points) in RESHAPE and -2.79 points (-8.29 to 2.70 points) in the control group. Role-play-based diagnoses with ENACT were 78.1% (25 of 32) accurate in RESHAPE and 66.7% (22 of 33) in the control group. Patient diagnoses were 72.5% (29 of 40) accurate by PCPs in RESHAPE compared with 34.5% (10 of 29) by PCPs in the control group. There were no serious adverse events. CONCLUSIONS AND RELEVANCE This pilot cluster randomized clinical trial found that procedures were feasible and acceptable for PCPs to be trained by PWLE. These pilot results will help inform a full trial to evaluate benefits of collaboration with PWLE during training of PCPs to reduce stigma and improve diagnostic accuracy. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02793271.
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Affiliation(s)
- Brandon A. Kohrt
- Department of Psychiatry and Behavioral Sciences, The George Washington University, Washington, DC
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Mark J. D. Jordans
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
- Center for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- University of Amsterdam, Amsterdam, the Netherlands
| | - Elizabeth L. Turner
- Duke Global Health Institute, Duke University, Durham, North Carolina
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | - Sauharda Rai
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
- Jackson School of International Studies, Department of Global Health, University of Washington, Seattle
| | - Dristy Gurung
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
- Center for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Manoj Dhakal
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
- School of Public Health, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Anvita Bhardwaj
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Daisy R. Singla
- Campbell Family Mental Health Research Institute, Centre of Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Lunenfeld Tanenbaum Research Institute, Toronto, Ontario, Canada
| | - Crick Lund
- Center for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts
- Sangath, Goa, India
| | | | - Kathleen J. Sikkema
- Duke Global Health Institute, Duke University, Durham, North Carolina
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York
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20
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Grandón P, Saldivia S, Cova F, Bustos C, Vaccari P, Ramírez-Vielma R, Vielma-Aguilera A, Zambrano C, Ortiz C, Knaak S. Effectiveness of an intervention to reduce stigma towards people with a severe mental disorder diagnosis in primary health care personnel: Programme Igual-Mente. Psychiatry Res 2021; 305:114259. [PMID: 34752990 DOI: 10.1016/j.psychres.2021.114259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 10/25/2021] [Accepted: 10/30/2021] [Indexed: 11/16/2022]
Abstract
This study assessed the effectiveness of a program (called Igual-Mente, Equal-Mind) designed to reduce stigma in primary health care personnel. A random clinical trial was performed (ISRCTN46464036). There were 316 primary care professionals and technicians who were randomized and assigned to the experimental or control group. The program considered as strategies the education, the contact and the development of skills. There were six sessions with the primary care staff and two sessions with the managers of the health centers. It was executed by two facilitators, a professional psychologist and an expert by experience, i.e., a person diagnosed with a severe mental disorder (SMD). Attitudes, social distance, and humane treatment behaviors toward people with SMD were assessed. The intervention was effective in reducing stigma attitudes y social distance towards people diagnosed with SMD. The magnitude of the changes ranged from moderate to high in all these variables and the effects were maintained for four months after the end of the program. Regarding humane treatment behaviors, the effects were less clear. This study shows good results indicating that well-designed interventions can effectively reduce stigma towards people diagnosed with SMD, which is one of the main challenges of health systems.
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Affiliation(s)
- Pamela Grandón
- Psychology Department, Universidad de Concepcion, Concepcion, Chile.
| | - Sandra Saldivia
- Psychiatric Department, Universidad de Concepcion, Concepcion, Chile
| | - Felix Cova
- Psychology Department, Universidad de Concepcion, Concepcion, Chile
| | - Claudio Bustos
- Psychology Department, Universidad de Concepcion, Concepcion, Chile
| | - Pamela Vaccari
- Psychology Department, Universidad de Concepcion, Concepcion, Chile
| | | | | | | | - Camila Ortiz
- Psychology Department, Universidad de Concepcion, Concepcion, Chile
| | - Stephanie Knaak
- Social Sciences Department, University of Calgary, Calgary, Canada
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21
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Koschorke M, Oexle N, Ouali U, Cherian AV, Deepika V, Mendon GB, Gurung D, Kondratova L, Muller M, Lanfredi M, Lasalvia A, Bodrogi A, Nyulászi A, Tomasini M, El Chammay R, Abi Hana R, Zgueb Y, Nacef F, Heim E, Aeschlimann A, Souraya S, Milenova M, van Ginneken N, Thornicroft G, Kohrt BA. Perspectives of healthcare providers, service users, and family members about mental illness stigma in primary care settings: A multi-site qualitative study of seven countries in Africa, Asia, and Europe. PLoS One 2021; 16:e0258729. [PMID: 34705846 PMCID: PMC8550394 DOI: 10.1371/journal.pone.0258729] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 10/01/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Stigma among healthcare providers is a barrier to the effective delivery of mental health services in primary care. Few studies have been conducted in primary care settings comparing the attitudes of healthcare providers and experiences of people with mental illness who are service users in those facilities. Such research is necessary across diverse global settings to characterize stigma and inform effective stigma reduction. METHODS Qualitative research was conducted on mental illness stigma in primary care settings in one low-income country (Nepal), two lower-middle income countries (India, Tunisia), one upper-middle-income country (Lebanon), and three high-income countries (Czech Republic, Hungary, Italy). Qualitative interviews were conducted with 248 participants: 64 primary care providers, 11 primary care facility managers, 111 people with mental illness, and 60 family members of people with mental illness. Data were analyzed using framework analysis. RESULTS Primary care providers endorsed some willingness to help persons with mental illness but reported not having appropriate training and supervision to deliver mental healthcare. They expressed that people with mental illness are aggressive and unpredictable. Some reported that mental illness is incurable, and mental healthcare is burdensome and leads to burnout. They preferred mental healthcare to be delivered by specialists. Service users did not report high levels of discrimination from primary care providers; however, they had limited expectations of support from primary care providers. Service users reported internalized stigma and discrimination from family and community members. Providers and service users reported unreliable psychiatric medication supply and lack of facilities for confidential consultations. Limitations of the study include conducting qualitative interviews in clinical settings and reliance on clinician-researchers in some sites to conduct interviews, which potentially biases respondents to present attitudes and experiences about primary care services in a positive manner. CONCLUSIONS Primary care providers' willingness to interact with people with mental illness and receive more training presents an opportunity to address stigmatizing beliefs and stereotypes. This study also raises important methodological questions about the most appropriate strategies to accurately understand attitudes and experiences of people with mental illness. Recommendations are provided for future qualitative research about stigma, such as qualitative interviewing by non-clinical personnel, involving non-clinical staff for recruitment of participants, conducting interviews in non-clinical settings, and partnering with people with mental illness to facilitate qualitative data collection and analysis.
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Affiliation(s)
- Mirja Koschorke
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Nathalie Oexle
- Department for Psychiatry II, Ulm University and BKH Günzburg, Günzburg, Germany
| | - Uta Ouali
- Department of Psychiatry A, Razi Hospital La Manouba, Manouba, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Anish V. Cherian
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Vayankarappadam Deepika
- Department of Epidemiology, Centre for Public Health, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Gurucharan Bhaskar Mendon
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Dristy Gurung
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
| | - Lucie Kondratova
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czechia
| | - Matyas Muller
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czechia
| | - Mariangela Lanfredi
- Unit of Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Antonio Lasalvia
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | | | | | - Mario Tomasini
- Department of Mental Health, Alto Garda e Ledro Giudicarie, Arco, Italy
| | - Rabih El Chammay
- National Mental Health Programme Ministry of Public Health, Beirut, Lebanon
- Department of Psychiatry, Saint Joseph University, Beirut, Lebanon
| | - Racha Abi Hana
- National Mental Health Programme Ministry of Public Health, Beirut, Lebanon
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, The Netherlands
| | - Yosra Zgueb
- Department of Psychiatry A, Razi Hospital La Manouba, Manouba, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Fethi Nacef
- Department of Psychiatry A, Razi Hospital La Manouba, Manouba, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Eva Heim
- Institute of Psychology, University of Lausanne, Lausanne, Switzerland
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | | | | | - Maria Milenova
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Nadja van Ginneken
- Institute of Population Health Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Graham Thornicroft
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Brandon A. Kohrt
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
- Division of Global Mental Health, Department of Psychiatry, George Washington University, Washington, DC, United States of America
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Lowe D, Ryan R, Schonfeld L, Merner B, Walsh L, Graham-Wisener L, Hill S. Effects of consumers and health providers working in partnership on health services planning, delivery and evaluation. Cochrane Database Syst Rev 2021; 9:CD013373. [PMID: 34523117 PMCID: PMC8440158 DOI: 10.1002/14651858.cd013373.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Health services have traditionally been developed to focus on specific diseases or medical specialties. Involving consumers as partners in planning, delivering and evaluating health services may lead to services that are person-centred and so better able to meet the needs of and provide care for individuals. Globally, governments recommend consumer involvement in healthcare decision-making at the systems level, as a strategy for promoting person-centred health services. However, the effects of this 'working in partnership' approach to healthcare decision-making are unclear. Working in partnership is defined here as collaborative relationships between at least one consumer and health provider, meeting jointly and regularly in formal group formats, to equally contribute to and collaborate on health service-related decision-making in real time. In this review, the terms 'consumer' and 'health provider' refer to partnership participants, and 'health service user' and 'health service provider' refer to trial participants. This review of effects of partnership interventions was undertaken concurrently with a Cochrane Qualitative Evidence Synthesis (QES) entitled Consumers and health providers working in partnership for the promotion of person-centred health services: a co-produced qualitative evidence synthesis. OBJECTIVES To assess the effects of consumers and health providers working in partnership, as an intervention to promote person-centred health services. SEARCH METHODS We searched the CENTRAL, MEDLINE, Embase, PsycINFO and CINAHL databases from 2000 to April 2019; PROQUEST Dissertations and Theses Global from 2016 to April 2019; and grey literature and online trial registries from 2000 until September 2019. SELECTION CRITERIA We included randomised controlled trials (RCTs), quasi-RCTs, and cluster-RCTs of 'working in partnership' interventions meeting these three criteria: both consumer and provider participants meet; they meet jointly and regularly in formal group formats; and they make actual decisions that relate to the person-centredness of health service(s). DATA COLLECTION AND ANALYSIS Two review authors independently screened most titles and abstracts. One review author screened a subset of titles and abstracts (i.e. those identified through clinical trials registries searches, those classified by the Cochrane RCT Classifier as unlikely to be an RCT, and those identified through other sources). Two review authors independently screened all full texts of potentially eligible articles for inclusion. In case of disagreement, they consulted a third review author to reach consensus. One review author extracted data and assessed risk of bias for all included studies and a second review author independently cross-checked all data and assessments. Any discrepancies were resolved by discussion, or by consulting a third review author to reach consensus. Meta-analysis was not possible due to the small number of included trials and their heterogeneity; we synthesised results descriptively by comparison and outcome. We reported the following outcomes in GRADE 'Summary of findings' tables: health service alterations; the degree to which changed service reflects health service user priorities; health service users' ratings of health service performance; health service users' health service utilisation patterns; resources associated with the decision-making process; resources associated with implementing decisions; and adverse events. MAIN RESULTS We included five trials (one RCT and four cluster-RCTs), with 16,257 health service users and more than 469 health service providers as trial participants. For two trials, the aims of the partnerships were to directly improve the person-centredness of health services (via health service planning, and discharge co-ordination). In the remaining trials, the aims were indirect (training first-year medical doctors on patient safety) or broader in focus (which could include person-centredness of health services that targeted the public/community, households or health service delivery to improve maternal and neonatal mortality). Three trials were conducted in high income-countries, one was in a middle-income country and one was in a low-income country. Two studies evaluated working in partnership interventions, compared to usual practice without partnership (Comparison 1); and three studies evaluated working in partnership as part of a multi-component intervention, compared to the same intervention without partnership (Comparison 2). No studies evaluated one form of working in partnership compared to another (Comparison 3). The effects of consumers and health providers working in partnership compared to usual practice without partnership are uncertain: only one of the two studies that assessed this comparison measured health service alteration outcomes, and data were not usable, as only intervention group data were reported. Additionally, none of the included studies evaluating this comparison measured the other primary or secondary outcomes we sought for the 'Summary of findings' table. We are also unsure about the effects of consumers and health providers working in partnership as part of a multi-component intervention compared to the same intervention without partnership. Very low-certainty evidence indicated there may be little or no difference on health service alterations or health service user health service performance ratings (two studies); or on health service user health service utilisation patterns and adverse events (one study each). No studies evaluating this comparison reported the degree to which health service alterations reflect health service user priorities, or resource use. Overall, our confidence in the findings about the effects of working in partnership interventions was very low due to indirectness, imprecision and publication bias, and serious concerns about risk of selection bias; performance bias, detection bias and reporting bias in most studies. AUTHORS' CONCLUSIONS The effects of consumers and providers working in partnership as an intervention, or as part of a multi-component intervention, are uncertain, due to a lack of high-quality evidence and/or due to a lack of studies. Further well-designed RCTs with a clear focus on assessing outcomes directly related to partnerships for patient-centred health services are needed in this area, which may also benefit from mixed-methods and qualitative research to build the evidence base.
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Affiliation(s)
- Dianne Lowe
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Rebecca Ryan
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Lina Schonfeld
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Bronwen Merner
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Louisa Walsh
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | | | - Sophie Hill
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
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Keynejad R, Spagnolo J, Thornicroft G. WHO mental health gap action programme (mhGAP) intervention guide: updated systematic review on evidence and impact. EVIDENCE-BASED MENTAL HEALTH 2021; 24:ebmental-2021-300254. [PMID: 33903119 PMCID: PMC8311089 DOI: 10.1136/ebmental-2021-300254] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/22/2021] [Accepted: 03/29/2021] [Indexed: 01/08/2023]
Abstract
QUESTION There is a large worldwide gap between the service need and provision for mental, neurological and substance use disorders. WHO's Mental Health Gap Action Programme (mhGAP) intervention guide (IG), provides evidence-based guidance and tools for assessment and integrated management of priority disorders. Our 2017 systematic review identified 33 peer-reviewed studies describing mhGAP-IG implementation in low-income and middle-income countries. STUDY SELECTION AND ANALYSIS We searched MEDLINE, Embase, PsycINFO, Web of Knowledge, Scopus, CINAHL, LILACS, ScieELO, Cochrane, PubMed databases, 3ie, Google Scholar and citations of our review, on 24 November 2020. We sought evidence, experience and evaluations of the mhGAP-IG, app or mhGAP Humanitarian IG, from any country, in any language. We extracted data from included papers, but heterogeneity prevented meta-analysis. FINDINGS Of 2621 results, 162 new papers reported applications of the mhGAP-IG. They described mhGAP training courses (59 references), clinical applications (n=49), research uses (n=27), contextual adaptations (n=13), economic studies (n=7) and other educational applications (n=7). Most were conducted in the African region (40%) and South-East Asia (25%). Studies demonstrated improved knowledge, attitudes and confidence post-training and improved symptoms and engagement with care, post-implementation. Research studies compared mhGAP-IG-enhanced usual care with task-shared psychological interventions and adaptation studies optimised mhGAP-IG implementation for different contexts. Economic studies calculated human resource requirements of scaling up mhGAP-IG implementation and other educational studies explored its potential for repurposing. CONCLUSIONS The diverse, expanding global mhGAP-IG literature demonstrates substantial impact on training, patient care, research and practice. Priorities for future research should be less-studied regions, severe mental illness and contextual adaptation of brief psychological interventions.
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Affiliation(s)
- Roxanne Keynejad
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jessica Spagnolo
- Département des Sciences de la Santé Communautaire, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- Centre de recherche Charles-Le Moyne - Saguenay-Lac-Saint-Jean sur les innovations en santé, Campus de Longueuil, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Graham Thornicroft
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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24
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Satinsky EN, Kleinman MB, Tralka HM, Jack HE, Myers B, Magidson JF. Peer-delivered services for substance use in low- and middle-income countries: A systematic review. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 95:103252. [PMID: 33892281 DOI: 10.1016/j.drugpo.2021.103252] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 03/02/2021] [Accepted: 03/29/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND AIMS Addressing the burden of disease associated with substance use is a global priority, yet access to treatment is limited, particularly in low- and middle-income countries (LMICs). Peers, individuals with lived experience of substance use, may play an important role in expanding access to treatment, supporting outcomes, and reducing stigma. While peer-delivered services for substance use have been scaling up in high-income countries (HICs), less is known about their application in LMICs. This systematic review synthesizes the evidence of peer-delivered services for substance use in LMICs. METHODS PsycINFO, Embase, Global Health, PubMed, and six region-specific databases were searched, and articles that described peer-delivered services for substance use and related outcomes in LMICs were included. Risk of bias was evaluated using tools appropriate for each study design. To provide a more stringent evaluation of structured interventions, a subset of articles was analyzed using the Cochrane Effective Practice and Organization of Care (EPOC) framework. RESULTS The search yielded 6540 articles. These were narrowed down to 34 included articles. Articles spanned four continents, included quantitative and qualitative methodologies, and primarily targeted infectious disease risk behaviors. Ten articles were included in the EPOC sub-analysis. In the context of high risk of bias, some of these articles demonstrated positive impacts of the peer-delivered services, including reductions in risk behaviors and increases in infectious disease knowledge scores, while many others showed no significant difference in outcomes between peer intervention and control groups. CONCLUSIONS Peer-delivered services may be feasible for addressing substance use and reducing infectious disease risk behaviors in LMICs, where there are severe human resource shortages. Globally, peers' lived experience is valuable for engaging patients in substance use treatment and harm reduction services. Further research is needed to better characterize and quantify outcomes for peer-delivered services for substance use in LMICs.
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Affiliation(s)
- Emily N Satinsky
- Center for Global Health, Massachusetts General Hospital, Boston, MA, USA; Department of Psychology, University of Maryland, College Park, MD, USA.
| | - Mary B Kleinman
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Hannah M Tralka
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Helen E Jack
- Department of Medicine, University of Washington, Seattle, WA, USA; Centre for Global Mental Health, King's College London, London, UK
| | - Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South Africa Medical Research Council, Cape Town, South Africa; Division of Addiction Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, South Africa
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25
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Tergesen CL, Gurung D, Dhungana S, Risal A, Basel P, Tamrakar D, Amatya A, Park LP, Kohrt BA. Impact of Service User Video Presentations on Explicit and Implicit Stigma toward Mental Illness among Medical Students in Nepal: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18042143. [PMID: 33671743 PMCID: PMC7926497 DOI: 10.3390/ijerph18042143] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/12/2021] [Accepted: 02/14/2021] [Indexed: 12/12/2022]
Abstract
This study evaluated the impact of didactic videos and service user testimonial videos on mental illness stigma among medical students. Two randomized controlled trials were conducted in Nepal. Study 1 examined stigma reduction for depression. Study 2 examined depression and psychosis. Participants were Nepali medical students (Study 1: n = 94, Study 2: n = 213) randomized to three conditions: a didactic video based on the mental health Gap Action Programme (mhGAP), a service user video about living with mental illness, or a control condition with no videos. In Study 1, videos only addressed depression. In Study 2, videos addressed depression and psychosis. In Study 1, both didactic and service user videos reduced stigma compared to the control. In Study 2 (depression and psychosis), there were no differences among the three arms. When comparing Study 1 and 2, there was greater stigma reduction in the service user video arm with only depression versus service user videos describing depression and psychosis. In summary, didactic and service user videos were associated with decreased stigma when content addressed only depression. However, no stigma reduction was seen when including depression and psychosis. This calls for considering different strategies to address stigma based on types of mental illnesses. ClinicalTrials.gov identifier: NCT03231761.
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Affiliation(s)
- Cori L. Tergesen
- Department of Psychology, DePaul University, Chicago, IL 60604, USA;
- Duke Global Health Institute, Duke University, Durham, NC 27708, USA;
| | - Dristy Gurung
- Transcultural Psychosocial Organization Nepal, Baluwatar, Kathmandu, Nepal;
- Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London SE5 8AF, UK
| | - Saraswati Dhungana
- Institute of Medicine, Tribhuvan University, Kathmandu, Nepal; (S.D.); (P.B.)
| | - Ajay Risal
- Department of Psychiatry, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal; (A.R.); (D.T.)
| | - Prem Basel
- Institute of Medicine, Tribhuvan University, Kathmandu, Nepal; (S.D.); (P.B.)
| | - Dipesh Tamrakar
- Department of Psychiatry, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal; (A.R.); (D.T.)
| | | | - Lawrence P. Park
- Duke Global Health Institute, Duke University, Durham, NC 27708, USA;
- Infectious Disease Division, Department of Medicine, Duke University Medical Center, Durham, NC 27708, USA
| | - Brandon A. Kohrt
- Duke Global Health Institute, Duke University, Durham, NC 27708, USA;
- Transcultural Psychosocial Organization Nepal, Baluwatar, Kathmandu, Nepal;
- Division of Global Mental Health, Department of Psychiatry, George Washington University, Washington, DC 20037, USA
- Correspondence: ; Tel.: +1-202-741-2896
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Lasater ME, Murray SM, Keita M, Souko F, Surkan PJ, Warren NE, Winch PJ, Ba A, Doumbia S, Bass JK. Integrating Mental Health into Maternal Health Care in Rural Mali: A Qualitative Study. J Midwifery Womens Health 2020; 66:233-239. [PMID: 33325644 DOI: 10.1111/jmwh.13184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 08/24/2020] [Accepted: 08/31/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Common perinatal mental disorders are prevalent in low- and middle-income countries. The gap between the need for and availability of mental health services, also known as the mental health treatment gap, is particularly acute for women during the perinatal period in rural Mali. This qualitative study aimed to identify a feasible and acceptable integrated care approach for the provision of maternal mental health care in rural Mali to help narrow the treatment gap and increase access to care. METHODS From April to June 2016, qualitative data were collected in the Sélingué health district and Bamako, Mali. In-depth interviews were conducted among women, community health workers, midwives, and mental health specialists. Focus group participants included community health workers, midwives, and an obstetric nurse. All data were inductively coded and analyzed using a thematic analysis approach. RESULTS Women described several coping strategies to manage their distress, including visiting their parents; confiding in a friend, relative, or community health worker; and participating in women's association groups. Mental health-related stigma was described as being widespread in the community and among health providers. In response to the lack of mental health services, midwives and community health workers supported the feasibility and acceptability of the integration of mental health services into maternal health services. Midwives were discussed as being key providers to conduct mental health screenings and provide initial psychosocial care for women. DISCUSSION Integrated maternal and mental health interventions are needed to narrow the gap between the need for and availability of mental health services in rural Mali. Findings from this study underscore the great need for mental health services for women in the perinatal period who reside in rural Mali and that it is both feasible and acceptable to integrate mental health screening and low-level psychosocial care into antenatal care, delivered by midwives.
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Affiliation(s)
- Molly E Lasater
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Sarah M Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Mariam Keita
- Department of Public Health, University of Sciences, Techniques, and Technology of Bamako, Bamako, Mali
| | - Fatoumata Souko
- Department of Public Health, University of Sciences, Techniques, and Technology of Bamako, Bamako, Mali
| | - Pamela J Surkan
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Nicole E Warren
- Department of Community Public Health Nursing, Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Peter J Winch
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Aissata Ba
- Department of Public Health, University of Sciences, Techniques, and Technology of Bamako, Bamako, Mali
| | - Seydou Doumbia
- Faculty of Medicine and Odontostomatology, University of Sciences, Techniques, and Technology of Bamako, Bamako, Mali.,University Clinical Research Center/ICER-Mali, University of Sciences, Techniques, and Technology of Bamako, Bamako, Mali
| | - Judith K Bass
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Rai Y, Gurung D, Gautam K. Insight and challenges: mental health services in Nepal. BJPsych Int 2020; 18:E5. [PMID: 34287402 PMCID: PMC8274424 DOI: 10.1192/bji.2020.58] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/06/2020] [Accepted: 10/15/2020] [Indexed: 11/23/2022] Open
Abstract
This paper describes the current state of mental health services in Nepal and reflects on the significant changes over the past decade. The main challenges to overcome are proper implementation of community-based services, the high suicide rate, stigma of mental illness, financial constraints, lack of mental health legislation and proper utilisation of human resources.
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Affiliation(s)
- Yugesh Rai
- MD, Psychiatry Trainee, Essex Partnership University NHS Foundation Trust, UK.
| | - Deoman Gurung
- MRCPsych, ST4 (General Adult/Old Age Psychiatry), Lancashire Care NHS Foundation Trust, UK
| | - Kamal Gautam
- MD, Executive Manager and Consultant Psychiatrist, Transcultural Psychosocial Organization Nepal (TPO Nepal), Kathmandu, Nepal
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28
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Kohrt BA, Ottman K, Panter-Brick C, Konner M, Patel V. Why we heal: The evolution of psychological healing and implications for global mental health. Clin Psychol Rev 2020; 82:101920. [PMID: 33126037 DOI: 10.1016/j.cpr.2020.101920] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 09/02/2020] [Accepted: 09/13/2020] [Indexed: 01/10/2023]
Abstract
Why do humans heal one another? Evolutionary psychology has advanced our understanding of why humans suffer psychological distress and mental illness. However, to date, the evolutionary origins of what drives humans to alleviate the suffering of others has received limited attention. Therefore, we draw upon evolutionary theory to assess why humans psychologically support one another, focusing on the interpersonal regulation of emotions that shapes how humans heal and console one another when in psychosocial distress. To understand why we engage in psychological healing, we review the evolution of cooperation among social species and the roles of emotional contagion, empathy, and self-regulation. We discuss key aspects of human biocultural evolution that have contributed to healing behaviors: symbolic logic including language, complex social networks, and the long period of childhood that necessitates identifying and responding to others in distress. However, both biological and cultural evolution also have led to social context when empathy and consoling are impeded. Ultimately, by understanding the evolutionary processes shaping why humans psychologically do or do not heal one another, we can improve our current approaches in global mental health and uncover new opportunities to improve the treatment of mental illness across cultures and context around the world.
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Affiliation(s)
- Brandon A Kohrt
- Division of Global Mental Health, Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC, USA.
| | - Katherine Ottman
- Division of Global Mental Health, Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC, USA
| | - Catherine Panter-Brick
- Jackson Institute of Global Affairs, Yale University, New Haven, and Department of Anthropology, Yale University, New Haven, USA
| | - Melvin Konner
- Department of Anthropology, Emory University, Atlanta, USA
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, and Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Harvard University, Boston, USA
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29
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Kaiser BN, Varma S, Carpenter-Song E, Sareff R, Rai S, Kohrt BA. Eliciting recovery narratives in global mental health: Benefits and potential harms in service user participation. Psychiatr Rehabil J 2020; 43:111-120. [PMID: 31355653 PMCID: PMC6986986 DOI: 10.1037/prj0000384] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The engagement of peers and service users is increasingly emphasized in mental health clinical, educational, and research activities. A core means of engagement is via the sharing of recovery narratives, through which service users present their personal history of moving from psychiatric disability to recovery. We critically examine the range of contexts and purposes for which recovery narratives are elicited in global mental health. METHOD We present 4 case studies that represent the variability in recovery narrative elicitation, purpose, and geography: a mental health Gap Action Programme clinician training program in Nepal, an inpatient clinical service in Indian-controlled Kashmir, a recovery-oriented care program in urban Australia, and an undergraduate education program in the rural United States. In each case study, we explore the context, purpose, process of elicitation, content, and implications of incorporating recovery narratives. RESULTS Within each context, organizations engaging service users had a specific intention of what "recovery" should constitute. This was influenced by the anticipated audience for the recovery stories. These expectations influenced the types of service users included, narrative content, and training provided for service users to prepare and share narratives. Our cases illustrate the benefit of these coconstructed narratives and potential negative impacts on service users in some contexts, especially when used as a prerequisite for accessing or being discharged from clinical care. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Recovery narratives have the potential to be used productively across purposes and contexts when there is adequate identification of and responses to potential risks and challenges. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Bonnie N. Kaiser
- Department of Anthropology, Global Health Program, University of California San Diego
| | - Saiba Varma
- Department of Anthropology, University of California San Diego
| | | | | | - Sauharda Rai
- The Henry M. Jackson School of International Studies, University of Washington
| | - Brandon A. Kohrt
- Department of Psychiatry and Behavioral Sciences, George Washington University
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30
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Kudva KG, El Hayek S, Gupta AK, Kurokawa S, Bangshan L, Armas-Villavicencio MVC, Oishi K, Mishra S, Tiensuntisook S, Sartorius N. Stigma in mental illness: Perspective from eight Asian nations. Asia Pac Psychiatry 2020; 12:e12380. [PMID: 31922363 DOI: 10.1111/appy.12380] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 10/30/2019] [Accepted: 12/14/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Stigma against those who suffer from mental illness is a major issue in many nations. Stigma, which is comprised of prejudice, ignorance, and discrimination, serves as a barrier to seeking help and staying in contact with mental health services. It is thus imperative that concerted efforts are taken against stigma. METHODS Eight young psychiatrists from eight Asian nations offer a narrative review of the state of stigma in their respective nations, the sociocultural reasons behind this stigma, recent anti-stigma efforts and the effects, if any, of such efforts. RESULTS Despite these eight nations lying varying significantly in terms of economic developmental levels, there are sociocultural commonalities that undergird stigma across these nations. It is also evident that there have been more recent concerted efforts to combat this stigma, and in some countries, there has been a change in the perceptions of mental illness. CONCLUSION The causes of stigma tend to be similar across various nations, and this perhaps suggests that international collaboration and a concerted global effort to combat this problem might thus be a possibility.
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Affiliation(s)
- Kundadak Ganesh Kudva
- Early Psychosis Intervention Program, Institution of Mental Health, Singapore, Singapore
| | - Samer El Hayek
- Department of Psychiatry, American University of Beirut, Beirut, Lebanon
| | | | - Shunya Kurokawa
- Department of Psychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Liu Bangshan
- Mental Health Institute, The Second Xiangya Hospital of Central South University, Changsha, China
| | | | - Kengo Oishi
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Saumya Mishra
- All India Institute of Medical Sciences, New Delhi, India
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Feasibility of Group Problem Management Plus (PM+) to improve mental health and functioning of adults in earthquake-affected communities in Nepal. Epidemiol Psychiatr Sci 2020; 29:e130. [PMID: 32452336 PMCID: PMC7264859 DOI: 10.1017/s2045796020000414] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
AIMS Psychological interventions that are brief, acceptable, effective and can be delivered by non-specialists are especially necessary in low- and middle-income countries, where mental health systems are unable to address the high level of psychosocial needs. Problem Management Plus (PM+) is a five-session intervention designed for those impaired by psychological distress while living in communities affected by adversity. Individual PM+ has demonstrated effectiveness in reducing distress in Kenya and Pakistan, and a group version of PM+ (Group PM+) was effective for conflict-affected women in Pakistan. This paper describes a feasibility and acceptability trial of locally adapted Group PM+ for women and men in an earthquake-affected region of rural Nepal. METHODS In this feasibility cluster randomised controlled trial, participants in the experimental arm were offered five sessions of Group PM+ and participants in the control arm received enhanced usual care (EUC), which entailed brief psycho-education and providing referral options to primary care services with health workers trained in the mental health Gap Action Programme Intervention Guide (mhGAP-IG). A mixed-methods design was used to assess the feasibility and acceptability of Group PM+. Feasibility was assessed with criteria including fidelity and retention of participants. Acceptability was assessed through in-depth interviews with participants, family members, programme staff and other stakeholders. The primary clinical outcome was depression symptoms assessed using the Patient Health Questionnaire (PHQ-9) administered at baseline and 8-8.5 weeks post-baseline (i.e. after completion of Group PM+ or EUC). RESULTS We recruited 121 participants (83% women and 17% men), with equal allocation to the Group PM+ and EUC arms (1:1). Group PM+ was delivered over five 2.5-3 hour sessions by trained and supervised gender-matched local non-specialists, with an average attendance of four out of five sessions. The quantitative and qualitative results demonstrated feasibility and acceptability for non-specialists to deliver Group PM+. Though the study was not powered to assess for effectiveness, for all five key outcome measures, including the primary clinical outcome, the estimated mean improvement was larger in the Group PM+ arm than the EUC arm. CONCLUSION The intervention and trial procedures were acceptable to participants, family members, and programme staff. The communities and participants found the intervention to be beneficial. Because feasibility and acceptability were established in this trial, a fully powered randomised controlled trial will be conducted for larger scale implementation to determine the effectiveness of the intervention in Nepal.
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Kohrt BA, Turner EL, Rai S, Bhardwaj A, Sikkema KJ, Adelekun A, Dhakal M, Luitel NP, Lund C, Patel V, Jordans MJD. Reducing mental illness stigma in healthcare settings: Proof of concept for a social contact intervention to address what matters most for primary care providers. Soc Sci Med 2020; 250:112852. [PMID: 32135459 PMCID: PMC7429294 DOI: 10.1016/j.socscimed.2020.112852] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 02/08/2020] [Accepted: 02/11/2020] [Indexed: 11/24/2022]
Abstract
Initiatives for integration of mental health services into primary care are underway through the World Health Organization's mental health Gap Action Programme (mhGAP) and related endeavors. However, primary healthcare providers' stigma against persons with mental illness is a barrier to success of these programs. Therefore, interventions are needed to reduce stigma among primary healthcare providers. We developed REducing Stigma among HealthcAre ProvidErs (RESHAPE), a theoretically-grounded intervention that draws upon the medical anthropology conceptual framework of "what matters most." RESHAPE addresses three domains of threats to what matters most: survival, social, and professional. In a proof-of-concept study, mental health service users and aspirational healthcare providers (primary healthcare providers actively incorporating mental health services) were trained to co-facilitate the RESHAPE intervention embedded within mhGAP training in Nepal. Two trainings with the RESHAPE anti-stigma component were held with 41 primary healthcare providers in Nepal. Evaluation of the training included four focus groups and 25 key informant interviews. Stigmatizing attitudes and role play-based clinical competency, assessed with the ENhancing Assessment of Common Therapeutic factors tool (ENACT), were evaluated pre-training and followed-up at four and 16 months. The study was conducted from February 2016 through June 2017. In qualitative interviews, primary healthcare providers described changes in perceptions of violence (survival threats) and the ability to treat mental illness effectively (professional threats). Willingness to interact with a person with mental illness increased from 54% pre-training to 81% at 16 months. Observed clinical competency increased from 49% pre-training to 93% at 16-months. This proof-of-concept study supports reducing stigma by addressing what matters most to healthcare providers, predominantly through mitigating survival and professional threats. Additional efforts are needed to address social threats. These findings support further exploration of service user and aspirational figure involvement in mhGAP trainings based on a "what matters most" conceptual framework.
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Affiliation(s)
- Brandon A Kohrt
- Department of Psychiatry and Behavioral Sciences, The George Washington University, Washington, DC, USA; Duke Global Health Institute, Duke University, Durham, USA.
| | - Elizabeth L Turner
- Duke Global Health Institute, Duke University, Durham, USA; Department of Biostatistics and Bioinformatics, Duke University, Durham, USA.
| | - Sauharda Rai
- Jackson School of International Studies and Department of Global Health, University of Washington, Seattle, USA; Transcultural Psychosocial Organization Nepal TPO - Nepal, Baluwatar, Nepal.
| | - Anvita Bhardwaj
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA.
| | - Kathleen J Sikkema
- Duke Global Health Institute, Duke University, Durham, USA; Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, USA.
| | - Adesewa Adelekun
- Department of Psychiatry, University of California, Los Angeles, USA.
| | - Manoj Dhakal
- Transcultural Psychosocial Organization Nepal TPO - Nepal, Baluwatar, Nepal.
| | - Nagendra P Luitel
- Transcultural Psychosocial Organization Nepal TPO - Nepal, Baluwatar, Nepal.
| | - Crick Lund
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa; Center for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA; Department of Global Health and Population, Harvard TH Chan School of Public Health, Harvard University, Boston, USA; Sangath, Goa, India.
| | - Mark J D Jordans
- Center for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
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Whitley R, Sitter KC, Adamson G, Carmichael V. Can participatory video reduce mental illness stigma? Results from a Canadian action-research study of feasibility and impact. BMC Psychiatry 2020; 20:16. [PMID: 31918689 PMCID: PMC6953159 DOI: 10.1186/s12888-020-2429-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 01/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evidence suggests that stigma against people with mental illness remains high. This demands innovative approaches to reduce stigma. One innovative stigma reduction method is participatory video (PV), whereby marginalized people come together to script, film and produce bottom-up educational videos about shared issues. These videos are then shown to target groups. This paper has two objectives (i) to examine the feasibility of using participatory video with people with severe mental illness (SMI); and (ii) to assess viewer impressions of the resultant videos and subsequent subjective impact. METHODS We conducted a participatory action research study with three workgroups of people with severe mental illness situated in different Canadian cities, who set out to create and disseminate locally-grounded mental-health themed videos. This involved process and outcome evaluation to assess feasibility and impact. Specifically, we (i) observed fidelity to a co-designed action-plan in all three workgroups; (ii) distributed brief purpose-built questionnaires to viewers at organized screenings to assess preliminary impact; and (iii) conducted focus groups with viewers to elicit further impressions of the videos and subsequent subjective impact. RESULTS The three workgroups achieved high-fidelity to the action-plan. They successfully produced a total of 26 videos, over double the targeted number, during an 18-month period. Likewise, the workgroups organized 49 screenings at a range of venues attended by 1542 people, again exceeding the action-plan targets. Results from the viewer questionnaires (N = 1104, response rate 72%) indicated that viewers reported that their understandings had improved after watching the videos. Four themes emerged from six viewer focus groups (N = 30), with participants frequently noting that videos were (i) educational and informative; (ii) real and relatable; (iii) attention-grabbing; and (iv) change-inducing. CONCLUSIONS To our knowledge, this study is the first large-scale multi-site project examining the feasibility and impact of a participatory video program for people with severe mental illness. The results indicate that participatory video is a feasible method in this population and gives preliminary evidence that resultant videos can reduce viewer stigma. Thus, participatory video should be considered a promising practice in the ongoing effort to reduce mental illness stigma.
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Affiliation(s)
- Rob Whitley
- Department of Psychiatry, Douglas Hospital Research Centre, McGill University, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada.
| | - Kathleen C. Sitter
- 0000 0004 1936 7697grid.22072.35University of Calgary, 2500 University Dr. NW, Calgary, AB T2N 1N4 Canada
| | - Gavin Adamson
- 0000 0004 1936 9422grid.68312.3eSchool of Journalism, Ryerson University, 350 Victoria St, Toronto, ON M5B 2K3 Canada
| | - Victoria Carmichael
- 0000 0004 1936 8649grid.14709.3bDepartment of Psychiatry, Douglas Hospital Research Centre, McGill University, 6875 LaSalle Blvd, Montreal, QC H4H 1R3 Canada
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Hartog K, Hubbard CD, Krouwer AF, Thornicroft G, Kohrt BA, Jordans MJD. Stigma reduction interventions for children and adolescents in low- and middle-income countries: Systematic review of intervention strategies. Soc Sci Med 2019; 246:112749. [PMID: 31978636 DOI: 10.1016/j.socscimed.2019.112749] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 12/13/2019] [Accepted: 12/16/2019] [Indexed: 11/18/2022]
Abstract
Stigmatisation and discrimination are common worldwide, and have profound negative impacts on health and quality of life. Research, albeit limited, has focused predominantly on adults. There is a paucity of literature about stigma reduction strategies concerning children and adolescents, with evidence especially sparse for low- and middle-income countries (LMIC). This systematic review synthesised child-focused stigma reduction strategies in LMIC, and compared these to adult-focused interventions. Relevant publications were systematically searched in July and August 2018 in the following databases; Cochrane, Embase, Global Health, HMIC, Medline, PsycINFO, PubMed and WorldWideScience.org, and through Google Custom Search. Included studies and identified reviews were cross-referenced. Three categories of search terms were used: (i) stigma, (ii) intervention, and (iii) LMIC settings. Data on study design, participants and intervention details including strategies and implementation factors were extracted. Within 61 unique publications describing 79 interventions, utilising 14 unique stigma reduction strategies, 14 papers discussed 21 interventions and 10 unique strategies involving children. Most studies targeted HIV/AIDS (50% for children, 38% for adults) or mental illness (14% vs 34%) stigma. Community education (47%), individual empowerment (15%) and social contact (12%) were most employed in child-focused interventions. Most interventions were implemented at one socio-ecological level; child-focused interventions mostly employed community-level strategies (88%). Intervention duration was mostly short; between half a day and a week. Printed or movie-based material was key to deliver child-focused interventions (37%), while professionals most commonly implemented adult-focused interventions (53%). Ten unique, child-focused strategies were all evaluated positively, using a diverse set of scales. Children and adolescents are under-represented in stigma reduction in LMIC. More stigma reduction interventions in LMIC, addressing a wider variety of stigmas, with children as direct and indirect target group, are needed. This systematic review is registered under International Prospective Register of Systematic Reviews PROSPERO, reference number #CRD42018094700.
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Affiliation(s)
- Kim Hartog
- War Child Holland, Research and Development, Helmholzstraat 61-G, 1098, LE, Amsterdam, the Netherlands; Amsterdam Institute for Social Science Research, University of Amsterdam, Postbus 15718, 1001, NE, Amsterdam, the Netherlands.
| | - Carly D Hubbard
- London School of Hygiene and Tropical Medicine, Keppel St., Bloomsbury, London, WC1E, 7HT, United Kingdom.
| | - Angelica F Krouwer
- War Child Holland, Research and Development, Helmholzstraat 61-G, 1098, LE, Amsterdam, the Netherlands.
| | - Graham Thornicroft
- Centre for Global Mental Health, Institute for Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, Camberwell, London, SE5 8AB, United Kingdom.
| | - Brandon A Kohrt
- Division of Global Mental Health, Department of Psychiatry and Behavioral Sciences, George Washington University, 2120 L Street, NW, Suite 600, Washington, DC, 20037, USA.
| | - Mark J D Jordans
- War Child Holland, Research and Development, Helmholzstraat 61-G, 1098, LE, Amsterdam, the Netherlands; Amsterdam Institute for Social Science Research, University of Amsterdam, Postbus 15718, 1001, NE, Amsterdam, the Netherlands.
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Matos B, Haze L. Bottoms up: a whorelistic literature review and commentary on sex workers’ romantic relationships. SEXUAL AND RELATIONSHIP THERAPY 2019. [DOI: 10.1080/14681994.2019.1636958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Bella Matos
- Department of Psychology, The American University of Paris, Paris, France
| | - Lola Haze
- The University of Lived Experience, New York City, USA
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Service user involvement in global mental health: what have we learned from recent research in low and middle-income countries? Curr Opin Psychiatry 2019; 32:355-360. [PMID: 30870258 DOI: 10.1097/yco.0000000000000506] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The Lancet Commission on global mental health and sustainable development claims the field of global mental health is undergoing a 'transformational shift' toward an ethic of 'nothing about us without us'. Yet a systematic review published in 2016 identified few examples of meaningful participation by service users in mental health systems strengthening in low and middle-income countries (LMICs). To investigate whether this is still the case, we conducted a rapid review of primary research published between June 2017 and December 2018. RECENT FINDINGS We identified 10 studies reporting on user involvement in LMICs, including three in mental health policy and planning, three in mental health services or capacity-building and three in treatment decision-making. An additional study was identified as having involved users in data collection, although this was unclear from the original text. Included studies were mostly qualitative and conducted as part of a situation analysis, pilot study, or other formative research. Few reported the results of efforts to improve involvement, suggesting this shift remains at an early stage. SUMMARY Although the number of studies published on user involvement is rapidly increasing, the potentially 'transformational' effects of this shift in global mental health are not yet being felt by most users in LMICs.
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Hinton L, Kohrt BA, Kleinman A. Engaging families to advance global mental health intervention research. Lancet Psychiatry 2019; 6:365-367. [PMID: 30954478 PMCID: PMC6848916 DOI: 10.1016/s2215-0366(19)30134-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 03/04/2019] [Accepted: 03/13/2019] [Indexed: 11/22/2022]
Affiliation(s)
- Ladson Hinton
- Department of Psychiatry and Behavioral Sciences, University of California Davis, 2230 Stockton Blvd, Sacramento, CA, USA.
| | - Brandon A Kohrt
- Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC, USA
| | - Arthur Kleinman
- Department of Global Health & Social Medicine, Harvard Medical School, Boston, MA, USA
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Kohrt BA, Asher L, Bhardwaj A, Fazel M, Jordans MJD, Mutamba BB, Nadkarni A, Pedersen GA, Singla DR, Patel V. The Role of Communities in Mental Health Care in Low- and Middle-Income Countries: A Meta-Review of Components and Competencies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E1279. [PMID: 29914185 PMCID: PMC6025474 DOI: 10.3390/ijerph15061279] [Citation(s) in RCA: 144] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 06/13/2018] [Accepted: 06/14/2018] [Indexed: 12/14/2022]
Abstract
Community-based mental health services are emphasized in the World Health Organization’s Mental Health Action Plan, the World Bank’s Disease Control Priorities, and the Action Plan of the World Psychiatric Association. There is increasing evidence for effectiveness of mental health interventions delivered by non-specialists in community platforms in low- and middle-income countries (LMIC). However, the role of community components has yet to be summarized. Our objective was to map community interventions in LMIC, identify competencies for community-based providers, and highlight research gaps. Using a review-of-reviews strategy, we identified 23 reviews for the narrative synthesis. Motivations to employ community components included greater accessibility and acceptability compared to healthcare facilities, greater clinical effectiveness through ongoing contact and use of trusted local providers, family involvement, and economic benefits. Locations included homes, schools, and refugee camps, as well as technology-aided delivery. Activities included awareness raising, psychoeducation, skills training, rehabilitation, and psychological treatments. There was substantial variation in the degree to which community components were integrated with primary care services. Addressing gaps in current practice will require assuring collaboration with service users, utilizing implementation science methods, creating tools to facilitate community services and evaluate competencies of providers, and developing standardized reporting for community-based programs.
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Affiliation(s)
- Brandon A Kohrt
- Division of Global Mental Health, Department of Psychiatry and Behavioral Sciences, The George Washington University, Washington, DC 20037, USA.
| | - Laura Asher
- Division of Epidemiology and Public Health, University of Nottingham, NG7 2RD, UK.
| | - Anvita Bhardwaj
- Division of Global Mental Health, Department of Psychiatry and Behavioral Sciences, The George Washington University, Washington, DC 20037, USA.
| | - Mina Fazel
- Department of Psychiatry, University of Oxford, Warneford Lane, OX1 2JD, UK.
| | - Mark J D Jordans
- Center for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK.
- War Child, Research and Development, 1098 LE, Amsterdam, The Netherlands.
| | - Byamah B Mutamba
- Butabika National Mental Hospital, 2 Kirombe-Butabika Road, P.O. Box 7017 Kampala, Uganda.
- YouBelong, P.O. Box 36510 Kampala, Uganda.
| | - Abhijit Nadkarni
- Center for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK.
- Sangath, Socorro, Porvorim, Goa 403501, India.
| | - Gloria A Pedersen
- Division of Global Mental Health, Department of Psychiatry and Behavioral Sciences, The George Washington University, Washington, DC 20037, USA.
| | - Daisy R Singla
- Department of Psychiatry, Sinai Health System & University of Toronto, Toronto, ON M5G 1X5, Canada.
| | - Vikram Patel
- Sangath, Socorro, Porvorim, Goa 403501, India.
- Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA 02115, USA.
- Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA.
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