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Nakkash R, Ghandour L, Brown G, Panter-Brick C, Bomar H, Tleis M, Al Masri H, Fares M, Al Halabi F, Najjar Y, Louis B, Hodroj M, Chamoun Y, Zarzour M, Afifi RA. Syrian refugee young adults as community mental health workers implementing problem management plus: Protocol for a pilot randomized controlled trial to measure the mechanisms of effect on their own wellbeing, stress and coping. Contemp Clin Trials Commun 2024; 40:101325. [PMID: 39045391 PMCID: PMC11263753 DOI: 10.1016/j.conctc.2024.101325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 06/10/2024] [Accepted: 06/13/2024] [Indexed: 07/25/2024] Open
Abstract
This pilot randomized controlled trial protocol aims to (1) assess the impact on the wellbeing of Syrian refugee young adults (18-24 years) of being a community mental health worker (CMHW) implementing WHO's evidence-based psychosocial intervention - Problem Management Plus (PM+) - with adults in their community, and (2) identify the mechanisms associated with the outcomes of enhanced wellbeing and coping, and reduced stress among these CMHWs. Over 108 million people have been forcibly displaced as of the end of 2022. Mental health consequences of these displacements are significant, yet human resources for health are not sufficient to meet the needs. A large proportion of refugee populations are youth and young adults (YA). Evidence indicates their engagement in supporting their communities leads to their own enhanced wellbeing and that of their community. This trial trains Syrian refugees to serve their communities as CMHW (n=19) or tutors (n=19) and compare wellbeing, stress and coping outcomes between these two groups and a control group (n = 40). We will also assess 7 mechanisms as potential pathways for the interventions to influence outcomes. Surveys will assess outcomes and mechanisms, hair samples will measure stress cortisol. The primary analysis will use a Bayesian Hierarchical Model approach to model the trajectories of the mechanisms and primary study endpoints over time for individuals in each of the arms. Our results will elucidate critical mechanisms in which engagement of young adults to support their community enhances their own wellbeing. Trial registration National Institutes of Mental Health, NCT05265611, Registered prospectively in 2021. Lebanon clinical trials registry # LBCTR2023015206, Registered in 2023.
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Affiliation(s)
- Rima Nakkash
- Global and Community Health Department, College of Public Health, George Mason University, Fairfax, VA, USA
| | - Lilian Ghandour
- Epidemiology and Population Health Department, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Grant Brown
- Biostatistics Department, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Catherine Panter-Brick
- Anthropology Department, Yale University, New Haven, CT, USA
- Jackson School of Global Affairs, Yale University, New Haven, CT, USA
| | - Hailey Bomar
- Community and Behavioral Health Department, College of Public Health, Iowa City, IA, USA
| | - Malak Tleis
- Epidemiology and Population Health Department, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Hanan Al Masri
- Epidemiology and Population Health Department, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | | | | | | | | | - Maha Hodroj
- Lebanese National Mental Health Program, Lebanon Ministry of Public Health, Beirut, Lebanon
| | - Yara Chamoun
- Saint Joseph University of Beirut, Beirut, Lebanon
| | | | - Rima A. Afifi
- Community and Behavioral Health Department, College of Public Health, Iowa City, IA, USA
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Marthoenis M, Fitryasari R, Martina M, Hidayati H, Sari H, Warsini S. The community health worker experience and perception toward mental illness: A multi-settings cross-sectional study in Indonesia. Int J Soc Psychiatry 2024:207640241251752. [PMID: 38679959 DOI: 10.1177/00207640241251752] [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] [Indexed: 05/01/2024]
Abstract
BACKGROUND The experiences and perceptions of Community Health Workers toward mental illness are vital for tailoring interventions, reducing stigma, improving access to services, and fostering community engagement in mental health initiatives. AIMS This study investigates the experiences of community health worker and their perception of mental illness. METHODS A multi-settings cross-sectional study was conducted among 487 Community Health Workers. Their experience and perception toward mental illness were studied with questionnaires, which examined their general perception, religious-related perception, cause, treatment, and expectation for mental treatment. RESULTS Most participants concurred that serving as a community health worker enhances their communication abilities (90.4%), strengthens connections with community health center staff (84.8%), boosts self-confidence (84.6%), and refines their capacity to identify signs of mental disorders (77%). Most notably, they consider their fellow community health workers essential to their extended family. Furthermore, a notable proportion associates' mental illness with religious elements, with 19.5% believing it can result from a lack of religious worship and a minority attributing it to witchcraft or black magic (3.5%). In terms of treatment, 14.2% think Ruqyah can cure mental illness, 6.4% believe in treatment by religious scholars, and a similar percentage (6.4%) think no medication or treatment is necessary for mental problems. CONCLUSION Participants overwhelmingly recognize the positive impact of serving as community health workers, citing improvements in communication, relationships with health center staff, self-confidence, and mental disorder identification. The strong bond among community health workers, likened to an extended family, emphasizes their collective importance. Additionally, the majority advocates for compassionate treatment of individuals with mental illness. These findings underscore the complex interplay of professional, communal, and cultural elements in addressing community mental health.
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Affiliation(s)
- Marthoenis Marthoenis
- Department of Psychiatry and Mental Health Nursing, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | | | - Martina Martina
- Department of Psychiatry and Mental Health Nursing, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Husna Hidayati
- Department of Psychiatry and Mental Health Nursing, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Hasmila Sari
- Department of Psychiatry and Mental Health Nursing, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Sri Warsini
- Department of Mental Health and Community Nursing, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Mbwayo AW, Mathai M, Mutavi T, Waruinge S, Triplett N, Concepcion T, Collins PY, Dorsey S. Training community health volunteers to use mobile platform during the COVID-19 pandemic: The Kenya experience. Glob Ment Health (Camb) 2024; 11:e38. [PMID: 38618483 PMCID: PMC11016365 DOI: 10.1017/gmh.2024.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 03/06/2024] [Accepted: 03/08/2024] [Indexed: 04/16/2024] Open
Abstract
This study describes an alternative to face-to-face training method for community health volunteers (CHVs) as used by a collaborative group from the University of Nairobi, University of Washington and the Nairobi Metropolitan Mental Health Team during the COVID-19 lockdown in Kenya. This qualitative study describes the experiences of 17 CHVs enrolled in a training study, required to utilize different digital platforms (Google Meet or Jitsi) as a training forum for the first time. Verbatim extracts of the participants' daily experiences are extracted from a series of write-ups in the group WhatsApp just before the training. Daily failures and success experiences in joining a Google meet or Jitsi are recorded. Then, 17 participants, 10 women and 7 men, aged between 21 and 51 years (mean = 33), owning a smartphone, were enrolled in the study. None had used Jitsi or Google meet before. Different challenges were reported in login to either and a final decision to use Jitsi, which became the training platform. Training CHVs to deliver a psychosocial intervention using smartphones is possible. However, the trainer must establish appropriate and affordable methods when resources are constrained.
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Affiliation(s)
- Anne W. Mbwayo
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | - Muthoni Mathai
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | - Teresia Mutavi
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | - Stella Waruinge
- Department of Public Mental Health, University of Cape Town, Cape Town, South Africa
| | - Noah Triplett
- Department of Psychology, Department of Global Health, University of Washington, Seattle, USA
| | - Tessa Concepcion
- Department of Psychology, Department of Global Health, University of Washington, Seattle, USA
| | - Pamela Y. Collins
- Department of Mental Health, Johns Hopkins University, Baltimore, USA
| | - Shannon Dorsey
- Department of Psychology, Department of Global Health, University of Washington, Seattle, USA
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Jain S, Pillai P, Mathias K. Opening up the 'black-box': what strategies do community mental health workers use to address the social dimensions of mental health? Soc Psychiatry Psychiatr Epidemiol 2024; 59:493-502. [PMID: 38261003 PMCID: PMC10944393 DOI: 10.1007/s00127-023-02582-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 10/25/2023] [Indexed: 01/24/2024]
Abstract
PURPOSE Community-based workers promote mental health in communities. Recent literature has called for more attention to the ways they operate and the strategies used. For example, how do they translate biomedical concepts into frameworks that are acceptable and accessible to communities? How do micro-innovations lead to positive mental health outcomes, including social inclusion and recovery? The aim of this study was to examine the types of skills and strategies to address social dimensions of mental health used by community health workers (CHWs) working together with people with psychosocial disability (PPSD) in urban north India. METHODS We interviewed CHWs (n = 46) about their registered PPSD who were randomly selected from 1000 people registered with a local non-profit community mental health provider. Notes taken during interviews were cross-checked with audio recordings and coded and analyzed thematically. RESULTS CHWs displayed social, cultural, and psychological skills in forming trusting relationships and in-depth knowledge of the context of their client's lives and family dynamics. They used this information to analyze political, social, and economic factors influencing mental health for the client and their family members. The diverse range of analysis and intervention skills of community health workers built on contextual knowledge to implement micro-innovations in a be-spoke way, applying these to the local ecology of people with psychosocial disabilities (PPSD). These approaches contributed to addressing the social and structural determinants that shaped the mental health of PPSD. CONCLUSION Community health workers (CHWs) in this study addressed social aspects of mental health, individually, and by engaging with wider structural factors. The micro-innovations of CHWs are dependent on non-linear elements, including local knowledge, time, and relationships. Global mental health requires further attentive qualitative research to consider how these, and other factors shape the work of CHWs in different locales to inform locally appropriate mental health care.
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Affiliation(s)
- Sumeet Jain
- The University of Edinburgh, Edinburgh, Scotland, UK.
| | - Pooja Pillai
- Herbertpur Christian Hospital, Emmanuel Hospital Association, Dehradun, Uttarakhand, India
| | - Kaaren Mathias
- Herbertpur Christian Hospital, Emmanuel Hospital Association, Dehradun, Uttarakhand, India
- The University of Canterbury, Christ Church, New Zealand
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Pallikkuth R, Manoj Kumar T, Dictus CT, Bunders-Aelen JFG. Design and Evaluation of Peer Supervision for Community Mental Health Workers: A Task-Shifting Strategy in Low-Resource Settings. Community Ment Health J 2024; 60:131-147. [PMID: 37679654 PMCID: PMC10799819 DOI: 10.1007/s10597-023-01161-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 06/17/2023] [Indexed: 09/09/2023]
Abstract
The use of Lay Mental Health Workers (LMHWs) to tackle the treatment gap in low-resource settings is well established, and although they often receive training, the potential of proper supervision to improve outcomes remains untapped. Indeed, given the strain on expert resources, peer-supervision models based on supervisors' seniority of work experience have significant potential especially in relation to community knowledge and embedding of LMHWs. This study summarizes the evaluation of a pilot program for peer supervision on the basis of Social Cognitive Theories of Self-Efficacy for LMHWs in Kerala, India. Two experienced LMHWs worked as supervisors for a total of 12 LMHWs over the course of a year. These participants were subsequently interviewed to analyze their experiences in order to evaluate the potential of peer supervision and distil relevant information to improve future training of LMHWs. The findings include improved performance and emotional support for the participants.
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Affiliation(s)
- Rekha Pallikkuth
- Department of Clinical Psychology, Mental Health Action Trust, Calicut, India
- Athena Institute, VU University Amsterdam, Amsterdam, The Netherlands
| | - T Manoj Kumar
- Department of Clinical Psychology, Mental Health Action Trust, Calicut, India
- Athena Institute, VU University Amsterdam, Amsterdam, The Netherlands
| | - Claudia T Dictus
- Athena Institute, VU University Amsterdam, Amsterdam, The Netherlands.
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Guenzel N, Daisy Dai H, Dean L. Context of substance initiation among urban Native Americans: an exploratory retrospective case-control study. PeerJ 2023; 11:e16482. [PMID: 38034870 PMCID: PMC10688302 DOI: 10.7717/peerj.16482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 10/27/2023] [Indexed: 12/02/2023] Open
Abstract
Background Addiction is a significant problem among many Native American groups but has rarely been examined in urban populations. In particular, little is known about the context in which urban Native Americans first use substances. This study compares cases (people with a history of addiction) to controls (people without a history of addiction) on demographics, substance use history, context of first substance use, and polysubstance use. In addition, this appears to be the first study to overcome the lack of Native American professionals by employing and training lay community members to identify criteria of substance use disorders in survey participants. Employing community members helped foster trust that enabled the revelation of sensitive and often illegal activity. As a result, the investigators were able to recruit participants who likely would not have engaged with traditional researchers. Methods The trained Native American lay research assistants recruited community members and administered surveys. They first asked questions regarding the criteria for substance use disorders. Individuals who were determined to have met criteria for a substance use disorder in the past were classified as cases (n = 38) and those who never met such criteria were classified as controls (n = 42). They then asked demographic, substance use, and polysubstance use questions. Lastly, eight cases and eight controls were randomly selected for a second interview by a licensed drug and alcohol counselor (LDAC) who conducted a blinded assessment regarding the presence or absence of a history of a substance use disorder. Results Both groups reported a relatively young age of first substance use (age 16 years for cases and age 15 years for controls). Alcohol was the first substance most commonly used in both groups. Controls reported first benzodiazepine use at a younger age than cases but no other significant differences were found. Both groups reported first obtaining their first drug from family, friends, or at home (rather than a party, bar, or store). Most commonly, the location of their first use of drugs occurred at a friend's home, a party, a bar, or school rather than at their own home. Cases were marginally more likely to report that their first drug use occurred with a friend rather than with a family member when compared with controls. The majority of both groups reported that their first drug use occurred with other Native Americans rather than with non-Native Americans. Polysubstance use was common in both groups (43-45%). There were no significant differences between the groups regarding polysubstance use. The LDAC arrived at the same determination as the trained research assistants on all eight cases and eight controls.
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Affiliation(s)
- Nicholas Guenzel
- College of Nursing, University of Nebraska Medical Center, Lincoln, NE, United States of America
| | - Hongying Daisy Dai
- College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States of America
| | - Lyndsay Dean
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, United States of America
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Baynes C, Kanté AM, Exavery A, Tani K, Sikustahili G, Mushi H, Baraka J, Ramsey K, Sherr K, Weiner BJ, Phillips JF. The implementation and effectiveness of multi-tasked, paid community health workers on maternal and child health: A cluster-randomized pragmatic trial and qualitative process evaluation in Tanzania. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002050. [PMID: 37725612 PMCID: PMC10508634 DOI: 10.1371/journal.pgph.0002050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/22/2023] [Indexed: 09/21/2023]
Abstract
Community health worker programs have proliferated worldwide based on evidence that they help prevent mortality, particularly among children. However, there is limited evidence from randomized studies on the processes and effectiveness of implementing community health worker programs through public health systems. This paper describes the results of a cluster-randomized pragmatic implementation trial (registration number ISRCTN96819844) and qualitative process evaluation of a community health worker program in Tanzania that was implemented from 2011-2015. Program effects on maternal, newborn and child health service utilization, childhood morbidity and sick childcare seeking were evaluated using difference-in-difference regression analysis with outcomes measured through pre- and post-intervention household surveys in intervention and comparison trial arms. A qualitative process evaluation was conducted between 2012 and 2014 and comprised of in-depth interviews and focus group discussions with community health workers, community members, facility-based health workers and staff of district health management teams. The community health worker program reduced incidence of illness and improved access to timely and appropriate curative care for children under five; however, there was no effect on facility-based maternal and newborn health service utilization. The positive outcomes occurred because of high levels of acceptability of community health workers within communities, as well as the durability of community health workers' motivation and confidence. Implementation factors that generated these effects were the engagement of communities in program startup; the training, remuneration and supervision of the community health workers from the local health system and community. The lack of program effects on maternal and newborn health service utilization at facilities were attributed to lapses in the availability of needed care at facilities. Strategies that strengthen and align communities' and health systems core capacities, and their ability to learn, adapt and integrate evidence-based interventions, are needed to maximize the health impact of community health workers.
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Affiliation(s)
- Colin Baynes
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - Almamy Malick Kanté
- Department of International Health, Johns Hopkins University, Baltimore, MD, United States of America
| | | | - Kassimu Tani
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | | | | | | | - Kate Ramsey
- Scope Impact, Brooklyn, NY, United States of America
| | - Kenneth Sherr
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - Bryan J. Weiner
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - James F. Phillips
- Department of Population and Family Health, Columbia University, New York, NY, United States of America
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Alinaitwe R, Musisi S, Mukunya D, Wibabara Y, Mutamba BB, Nakasujja N. Feasibility of screening for cognitive impairment among older persons and referral by community health workers in Wakiso district, Uganda. BMC Psychiatry 2023; 23:533. [PMID: 37488506 PMCID: PMC10367281 DOI: 10.1186/s12888-023-05015-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 07/09/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND In Uganda, cognitive impairment in older persons aged ≥ 60 years is often undiagnosed due to inadequate appreciation of the condition compounded with limitations of trained human resource able to conduct appropriate cognitive evaluations. Use of Community Health Workers (CHWs) especially in hard-to-reach communities can be an important link for older persons to the health facilities where they can receive adequate evaluations and interventions for cognitive challenges. The aim of the study was to assess the feasibility of screening for cognitive impairment among older persons and referral by CHWs in Wakiso district, Uganda. METHODS This was a sequential explanatory mixed methods study. The CHWs received a one-day training on causes, signs and symptoms, and management of cognitive impairment and screened older persons ≥ 60 years for cognitive impairment using the Alzheimer's Disease scale 8 (AD8). Psychiatric clinical officers (PCOs) administered the AD8 and the Mini Mental State Examination to the older persons after assessment by the CHWs who then referred them for appropriate clinical care. We conducted Kappa statistic for agreement between the CHWs and PCOs and compared raw scores of the CHWs to Experts scores using Bland Altman and pair plots and corresponding analyses. We also conducted focus group discussions for the older persons, caregivers and CHWs. RESULTS We collected data from 385 older persons. We involved 12 CHWs and 75% were females, majority were married (58.3%) with at least a secondary education (66.7%). There was 96.4% (CI 94.5-98.2%) agreement between PCOs and CHWs in identifying cognitive impairment with the PCOs identifying 54/385 (14.0: 95%CI 10.7-17.9%) older persons compared to 58/385 (15.1: 95%CI 11.6-19.0%) identified by CHWs. Of the 58 identified to have cognitive impairment by the CHWs, 93.1% were referred for care. The average difference between the score of the expert and that of the CHW was - 0.042 with a 95% CI of -1.335 to 1.252. Corresponding Bland Altman and pair plots showed high agreement between the measurements although CHWs scored higher values with increasing scores. CONCLUSION CHWs can be trained to identify and refer older persons with cognitive impairment in the communities.
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Affiliation(s)
- Racheal Alinaitwe
- Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda.
| | - Seggane Musisi
- Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda
| | - David Mukunya
- Department of Community and Public Health, Busitema University, Mbale, Uganda
| | - Yvette Wibabara
- Clinical Epidemiology Unit, Makerere University, Kampala, Uganda
| | - Byamah B Mutamba
- Clinical Epidemiology Unit, Makerere University, Kampala, Uganda
- Butabika National Referral Mental Hospital, Kampala, Uganda
| | - Noeline Nakasujja
- Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda
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Mutedzi B, Nkhoma K, Langhaug L, Hunt J, Harding R. Improving bereavement outcomes in Zimbabwe: results of a feasibility cluster trial of the 9-cell bereavement tool. Pilot Feasibility Stud 2023; 9:127. [PMID: 37480142 PMCID: PMC10360285 DOI: 10.1186/s40814-023-01313-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 05/02/2023] [Indexed: 07/23/2023] Open
Abstract
CONTEXT Despite high mortality rates from both communicable and non-communicable diseases, bereavement is under-researched in African countries. The 9-cell bereavement tool was designed to assist individuals to reflect on their feelings about bereavement and identify resources in families and communities to manage bereavement. This study aimed to determine the feasibility of implementing the 9-cell bereavement tool and recruitment to experimental evaluation. METHODS A feasibility cluster randomized trial with embedded qualitative interviews was conducted in two comparable neighbourhoods in Chitungwiza, Zimbabwe. Community leaders identified potential community lay bereavement supporters (interventionists). Each community lay bereavement supporter recruited two to three recently bereaved community members (trial participants). Following baseline data collection, the communities were randomly allocated to intervention or wait-list control. Self-administered questionnaires were completed at T0 (month 0), T1 (3 months) and T2 (6 months). Grief, mental health and social support were assessed. Focus group discussions with selected interventionists described training impact and intervention processes. Quantitative and qualitative analyses were performed. RESULTS Implementation of the nine-cell bereavement tool and recruitment to experimental evaluation were successful. Implementation of the tool and the recruitment of study participants were conducted within the intended timeframe of 3 weeks. In line with the suggested sample size, the study was able to recruit and retain at least 75% of the trial participants for the total duration of the study. CONCLUSION The feasibility cluster trial was successfully implemented and assessed. Through the published protocol, the literature review and the results of this study, it has been noted that there is an urgent need to carry out a full trial in this subject matter, not only as a contribution to the currently sparse literature in this regard, but for the enormous potential public health benefit in supporting and saving lives in many more under-resourced and under-supported countries. TRIAL REGISTRATION Protocol registration: http://www.isrctn.com/ISRCTN16484746 . Protocol publication: https://pilotfeasibilitystudies.biomedcentral.com/articles/10.1186/s40814-019-0450-5.
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Affiliation(s)
- Barbara Mutedzi
- Island Hospice and Healthcare, 6 Natal Road, Belgravia, Harare, Zimbabwe.
| | - Kennedy Nkhoma
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, Bessemer Road, London, SE5 9PJ, UK
| | - Lisa Langhaug
- Zvitambo Maternal and Child Health Research Institute, 16 McLaughlin Road, Harare, Zimbabwe
| | | | - Richard Harding
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, Bessemer Road, London, SE5 9PJ, UK
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Sakeah E, Bawah AA, Kuwolamo I, Anyorikeya M, Asuming PO, Aborigo RA. How different incentives influence reported motivation and perceptions of performance in Ghanaian community-based health planning and services zones. BMC Res Notes 2023; 16:17. [PMID: 36803880 PMCID: PMC9942281 DOI: 10.1186/s13104-023-06286-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 02/07/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Maternal mortality is still a burden worldwide, and Ghana's maternal and child mortalities are still high. Incentive schemes have been effective in improving health workers' performance thereby reducing maternal and child deaths. The efficiency of public health services in most developing countries has been linked to the provision of incentives. Thus, financial packages for Community Health Volunteers (CHVs) serve as enablers for them to be focused and committed to their work. However, the poor performance of CHVs is still a challenge in health service delivery in many developing countries. Although the reasons for these persistent problems are understood, we need to find out how to implement what works in the face of political will and financial constraints. This study assesses how different incentives influence reported motivation and perceptions of performance in Community-based Health Planning and Services Program (CHPS) zones in the Upper East region. METHODS A quasi-experimental study design with post-intervention measurement was used. Performance-based interventions were implemented for 1 year in the Upper East region. The different interventions were rolled out in 55 of 120 CHPS zones. The 55 CHPS zones were randomly assigned to four groups: three groups of 14 CHPS zones with the last group containing 13 CHPS zones. Several alternative types of financial and non-financial incentives as well as their sustainability were explored. The financial incentive was a small monthly performance-based Stipend. The non-financial incentives were: Community recognition; paying for National Health Insurance Scheme (NHIS) premiums and fees for CHV, one spouse, and up to two children below 18 years, and; quarterly performance-based Awards for best-performing CHVs. The four groups represent the four different incentive schemes. We conducted 31 In-depth interviews (IDIs) and 31 Focus Group Discussions (FGDs) with health professionals and community members. RESULTS Community members and the CHVs wanted the stipend as the first incentive but requested that it be increased from the current level. The Community Health Officers (CHOs) prioritized the Awards over the Stipend because they felt it was too small to generate the required motivation in the CHVs. The second incentive was the National Health Insurance Scheme (NHIS) registration. Community recognition was also considered by health professionals as effective in motiving CHVs and work support inputs and CHVs training helped in improving output. The various incentives have helped increase health education and facilitated the work of the volunteers leading to increased outputs: Household visits and Antenatal Care and Postnatal Care coverage improved. The incentives have also influenced the initiative of volunteers. Work support inputs were also regarded as motivators by CHVs, but the challenges with the incentives included the size of the stipend and delays in disbursement. CONCLUSION Incentives are effective in motivating CHVs to improve their performance, thereby improving access to and use of health services by community members. The Stipend, NHIS, Community recognition and Awards, and the work support inputs all appeared to be effective in improving CHVs' performance and outcomes. Therefore, if health professionals implement these financial and non-financial incentives, it could bring a positive impact on health service delivery and use. Also, building the capacities of CHVs and providing them with the necessary inputs could improve output.
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Affiliation(s)
- Evelyn Sakeah
- School of Public Health, C.K. Tedam University of Technology and Applied Sciences, Navrongo, Ghana. .,Population/Public Health Department, Navrongo Health Research Centre, Navrongo, Ghana.
| | - Ayaga A. Bawah
- grid.8652.90000 0004 1937 1485Regional Institute for Population Studies, University of Ghana, Legon, Accra Ghana
| | - Irene Kuwolamo
- grid.415943.ePopulation/Public Health Department, Navrongo Health Research Centre, Navrongo, Ghana
| | - Maria Anyorikeya
- grid.415943.ePopulation/Public Health Department, Navrongo Health Research Centre, Navrongo, Ghana
| | - Patrick O. Asuming
- grid.8652.90000 0004 1937 1485Business School, University of Ghana, Legon, Accra Ghana
| | - Raymond Akawire Aborigo
- grid.415943.ePopulation/Public Health Department, Navrongo Health Research Centre, Navrongo, Ghana
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Bagchi AD, Hargwood P, Saravana A, DiBello AM, D'Alonzo KT, Jadotte Y. Methods of training lay individuals in the use of evidence-based services for the management of mental and behavioral health disorders: a scoping review protocol. JBI Evid Synth 2022; 20:3034-3044. [PMID: 35975306 DOI: 10.11124/jbies-21-00419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The objective of this scoping review is to describe how lay individuals have been trained in evidence-based therapies to manage mental and behavioral health disorders as defined by the International Classification of Diseases, version 11. INTRODUCTION Health service delivery by lay individuals is common in under-resourced areas. Prior systematic reviews have examined the characteristics of lay workers, the types of services they provide, and the efficacy of their services. Our goal is to focus on the methods of training. INCLUSION CRITERIA Participants will include lay individuals who provide services to community residents; we will exclude individuals with formal training in health service delivery. We will consider for inclusion studies that include training programs for evidence-based therapies delivered to individuals with mental and behavioral health disorders, and will exclude those involving pharmacology or focusing on cognitive defects. METHODS We conducted a preliminary search of the literature on PubMed and CINAHL for articles related to the inclusion criteria and published in the past 10 years. Scanning the title, abstract, keywords, and MeSH terms, we generated comprehensive lists of terms and added search terms from 6 recent systematic reviews. Our search strategy will include MEDLINE, CINAHL, PsycINFO, Scopus, Web of Science, and gray literature. We will also consult with experts and review the reference lists of articles selected for final inclusion. Articles published in English or Spanish between 1960 and the present will be considered for inclusion. Data analysis will use a mix of descriptive and qualitative approaches, with data presented graphically or in diagrammatic or tabular format.
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Affiliation(s)
- Ann D Bagchi
- Division of Nursing Science, School of Nursing, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Pamela Hargwood
- Robert Wood Johnson Library of the Health Sciences, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Arunadevi Saravana
- Division of Psychiatric Services Research, School of Medicine, University of Maryland, Baltimore, MD, USA
| | - Angelo M DiBello
- Center of Alcohol and Substance Use Studies and the Graduate School of Applied and Professional Psychology, Rutgers: The State University of New Jersey, Piscataway, NJ, USA
| | - Karen T D'Alonzo
- Division of Nursing Science, School of Nursing, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Yuri Jadotte
- The Northeast Institute for Evidence Synthesis and Translation (NEST): A JBI Centre of Excellence, Rutgers, The State University of New Jersey, Newark, NJ, USA.,Department of Family, Population and Preventive Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
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12
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Mutamba BB, Kumar M. Dedicated and designated approaches to task-shared psychological interventions. Lancet 2022; 400:1283-1285. [PMID: 36244367 DOI: 10.1016/s0140-6736(22)01984-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 10/06/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Byamah B Mutamba
- YouBelong, Kampala, Uganda; Butabika National Referral Mental Hospital, Kampala, Uganda.
| | - Manasi Kumar
- Brain and Mind Institute, Agha Khan University, Nairobi, Kenya
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Chandio N, Micheal S, Tadakmadla SK, Sohn W, Cartwright S, White R, Sanagavarapu P, Parmar JS, Arora A. Barriers and enablers in the implementation and sustainability of toothbrushing programs in early childhood settings and primary schools: a systematic review. BMC Oral Health 2022; 22:242. [PMID: 35717199 PMCID: PMC9206278 DOI: 10.1186/s12903-022-02270-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 06/10/2022] [Indexed: 02/16/2024] Open
Abstract
Background Untreated dental caries negatively impacts a child's quality of life including overall health and wellbeing, growth and development, social interaction ability, and school attendance. School-based toothbrushing programs have been recognised as an effective intervention to reduce the burden of dental caries. However, limited information is available to understand the real-world enablers and challenges in the implementation and sustainability of toothbrushing programs. This review aims to understand the barriers and enablers in the implementation and sustainability of toothbrushing programs in early childhood settings and primary schools.
Methods Five electronic databases [i.e., CINAHL (EBSCO), Medline (EBSCO), EMBASE (Ovid), Web of Science, and PsycINFO] and backward citation chasing were performed. The last updated databases searches were conducted in May 2022. Studies reporting on barriers and enablers in the implementation and sustainability of toothbrushing programs in early childhood settings or primary schools were included in the review. The methodological quality of included studies was assessed by using Joanna Briggs Institute [JBI] and mixed methods appraisal tool [MMAT] critical appraisal tools and results were reported in accordance with PRISMA guidelines. Results A total of six studies met the eligibility criteria and were included in the review. Toothbrushing programs in early childhood settings and primary schools were mostly implemented under the supervision of staff and teachers. A positive attitude of the staff, the flexibility of toothbrushing sessions, involvement of community volunteers and parents were a few of the identified enablers. However, the timing of the communication of the program, inadequate transfer of information among staff, frequent staffing turnover, lack of parental support, and staff feeling overburdened while acting as pseudo parents were frequently reported as barriers. Conclusion The results of this systematic review identify key enablers and barriers for toothbrushing programs in early childhood settings and primary schools which need to be considered for developing oral health promotion initiatives. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-022-02270-7.
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Affiliation(s)
- Navira Chandio
- School of Medicine, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia.,Health Equity Laboratory, Campbelltown, NSW, 2560, Australia.,School of Health Sciences, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia.,Translational Health Research Institute, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Sowbhagya Micheal
- School of Medicine, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Santosh Kumar Tadakmadla
- Department of Rural Clinical Sciences, Violet Vines Centre for Rural Health Research, La Trobe Rural Health School, Bendigo, VIC, 3550, Australia
| | - Woosung Sohn
- Sydney Dental School, Faculty of Medicine and Health, The University of Sydney, Surry Hills, 2010, Australia
| | - Susan Cartwright
- Colgate-Palmolive Pty Ltd., 345 George St., Sydney, 2001, Australia
| | - Rhiannon White
- School of Health Sciences, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Prathyusha Sanagavarapu
- Translational Health Research Institute, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia.,School of Education, Western Sydney University, Bankstown Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Jinal Shashin Parmar
- Health Equity Laboratory, Campbelltown, NSW, 2560, Australia.,School of Health Sciences, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Amit Arora
- Health Equity Laboratory, Campbelltown, NSW, 2560, Australia. .,School of Health Sciences, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia. .,Translational Health Research Institute, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia. .,Oral Health Services, Sydney Local Health District and Sydney Dental Hospital, NSW Health, Surry Hills, NSW, 2010, Australia. .,Discipline of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW, 2145, Australia.
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Du Zeying M, Ashcroft T, Kulkarni D, Sawrikar V, Jackson CA. Psychosocial interventions for depression delivered by non-mental health specialists to people living with HIV/AIDS in low- and middle-income countries: A systematic review. J Glob Health 2022; 12:04049. [PMID: 35976003 PMCID: PMC9185189 DOI: 10.7189/jogh.12.04049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Depression commonly co-exists with human immunodeficiency virus (HIV), but in low- and middle-income countries (LMICs), where the HIV burden is greatest, mental health resources are limited. These settings may benefit from psychosocial interventions delivered to people living with HIV/AIDS (PLWH) by non-mental health specialists. We aimed to systematically review randomised controlled trials (RCTs) that investigated the effectiveness of psychosocial interventions delivered by non-mental health specialists to prevent depression in PLWH in LMICs. Methods We used a comprehensive electronic search strategy to identify RCTs of any stage, including pilot studies, which reported on the effectiveness of a psychosocial intervention on depression among adults living with HIV/AIDS in a LMIC setting. Screening, study selection and data extraction was completed independently by two authors. We assessed risk of bias using the Cochrane risk of bias (RoB) tool and performed a narrative synthesis. Results We identified 3431 studies, from which we included 15 studies corresponding to 14 RCTs and a total of 3997 PLWH. Eleven studies were parallel RCTs, one was a stepped-wedged RCT, one was a full factorial RCT, one was a three-arm RCT and four were pilot studies. Studies were generally small, with eight including depression as a primary outcome. All but four trials included men and women and most studies followed participants for less than one year. Twelve trials had at least one domain in which there was a high risk of bias, with the remaining two trials having at least one domain of concern, due to lack of reporting of items. In 12 studies people in the intervention arm had statistically significantly (P < 0.05) lower or more reduced depressive symptom scores, or were less likely to have major depression, at final follow-up than people in the control group. Conclusions Psychosocial interventions delivered by non-specialist mental health workers may be effective in preventing or reducing depression in PLWH in LMICs. However, existing studies are small with a relatively short follow-up period and have methodological limitations. Future trials should address these shortcomings, establish whether intervention effects are clinically meaningful and investigate cost-effectiveness.
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Affiliation(s)
- Mia Du Zeying
- Usher Institute, University of Edinburgh, Teviot Place, Edinburgh, Scotland
| | - Thulani Ashcroft
- Usher Institute, University of Edinburgh, Teviot Place, Edinburgh, Scotland
| | - Durga Kulkarni
- Usher Institute, University of Edinburgh, Teviot Place, Edinburgh, Scotland
| | - Vilas Sawrikar
- Department of Clinical and Health Psychology, School of Health in Social Sciences, University of Edinburgh, Teviot Place, Edinburgh, Scotland
| | - Caroline A Jackson
- Usher Institute, University of Edinburgh, Teviot Place, Edinburgh, Scotland
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Standardising Training of Nurses in an Evidence-Based Psychosocial Intervention for Perinatal Depression: Randomized Trial of Electronic vs. Face-to-Face Training in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074094. [PMID: 35409775 PMCID: PMC8998312 DOI: 10.3390/ijerph19074094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/24/2022] [Accepted: 03/25/2022] [Indexed: 11/16/2022]
Abstract
Background: Rates of perinatal depression in China are high. The Thinking Healthy Programme is a WHO-endorsed, evidence-based psychosocial intervention for perinatal depression, requiring five days of face-to-face training by a specialist trainer. Given the paucity of specialist trainers and logistical challenges, standardized training of large numbers of nurses is a major challenge for scaling up. We developed an electronic training programme (e-training) which eliminates the need for specialist-led, face-to-face training. The aim of this study was to evaluate the effectiveness of the e-training compared to conventional face-to-face training in nursing students. Methods: A single blind, non-inferiority, randomized controlled trial was conducted. One hundred nursing students from two nursing schools were randomly assigned to either e-training or conventional face-to-face training. Results: E-training was not inferior to specialist-led face-to-face training immediately post-training [mean ENhancing Assessment of Common Therapeutic factors (ENACT) score (M) 45.73, standard deviation (SD) 4.03 vs. M 47.08, SD 4.53; mean difference (MD) −1.35, 95% CI; (−3.17, 0.46), p = 0.14]. There was no difference in ENACT scores at three months [M = 42.16, SD 4.85 vs. M = 42.65, SD 4.65; MD = −0.481, 95% CI; (−2.35, 1.39), p = 0.61]. Conclusions: E-training is a promising tool with comparative effectiveness to specialist-led face-to-face training. E-training can be used for training of non-specialists for evidence-based psychosocial interventions at scale and utilized where there is a shortage of specialist trainers, but practice under supervision is necessary to maintain competence. However, continued practice under supervision may be necessary to maintain competence.
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Lay Health Workers in Community-Based Care and Management of Dementia: A Qualitative ‘Pre’ and ‘Post’ Intervention Study in Southwestern Uganda. BIOMED RESEARCH INTERNATIONAL 2022; 2022:9443229. [PMID: 35372572 PMCID: PMC8967551 DOI: 10.1155/2022/9443229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 03/03/2022] [Indexed: 11/17/2022]
Abstract
Background The global need for efficient and cost-effective use of healthcare resources in low-income countries has led to the introduction of lay health workers (LHWs) as a link of the community to healthcare services. As such, the LHWs perform a variety of tasks such as education, support for care delivery, and social support across all disease types. However, little is known about their ability to support dementia care and management in the community. Purpose The goal of the pilot intervention was to evaluate the 5-day training intervention for LHWs in rural southwestern Uganda in community-based care and management of people with dementia, and implementation of the knowledge and skills gained. Methods This was a “pre” and “post” pilot intervention study which involved a qualitative assessment of LHWs' knowledge on community-based management and care for people with dementia. We focused on four core competency domains in the WHO dementia toolkit. The intervention included a five-day training of the LHWs on dementia care, eight weeks of implementation, and an evaluation of the experiences. Analysis focused on the needs assessment, early detection and management, community engagement, support for people with dementia; and evaluation of the eight weeks implementation. Results Before the training, the LHWs did not know much about what dementia-related support to provide in the community. Activities were limited to general support, including nutrition, and health education. After the training, LHWs had a basic understanding of dementia and began sensitizing the communities. They felt more comfortable working with people with dementia and reported a notable change in the attitude of family members. However, they reported challenges in differentiating the signs of early dementia from superstitious beliefs. Conclusion With enhanced capacity, LHWs may be able to support community-based management for people with dementia. A larger study is needed to explore potential roles for LHWs and further assess effectiveness of the LHWs' skills.
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Kiburi SK, Mwangi J, Maina G. Exploring the experiences of clients receiving opioid use disorder treatment at a methadone clinic in Kenya: a qualitative study. Addict Sci Clin Pract 2022; 17:71. [PMID: 36510246 PMCID: PMC9742652 DOI: 10.1186/s13722-022-00352-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Assessing the experiences of individuals on methadone treatment is essential to help evaluate the treatment program's effectiveness. This study aimed to explore the experiences of patients receiving methadone treatment at a clinic in Nairobi, Kenya. METHOD This study employed an exploratory qualitative study design. Through purposive sampling, participants were enrolled from individuals attending a methadone clinic for at least 2 years. Semi-structured individual interviews were used to collect data on substance use and experience before methadone treatment and experiences after starting methadone treatment, including benefits and challenges. Interviews were transcribed, and NVIVO 12 software was used to code the data using the preidentified analytical framework. Thematic analyses were utilized to identify cross-cutting themes between these two data sets. Seventeen participants were enrolled. RESULTS Seventeen participants were enrolled comprising 70% males, with age range from 23 to 49 years and more than half had secondary education. The interview data analysis identified four themes, namely: (a) the impact of opioid use before starting treatment which included adverse effects on health, legal problems and family dysfunction; (b) learning about methadone treatment whereby the majority were referred from community linkage programs, family and friends; (c) experiences with care at the methadone treatment clinic which included benefits such as improved health, family reintegration and stigma reduction; and (d) barriers to optimal methadone treatment such as financial constraints. CONCLUSION The findings of this study show that clients started methadone treatment due to the devastating impact of opioid use disorder on their lives. Methadone treatment allowed them to regain their lives from the adverse effects of opioid use disorder. Additionally, challenges such as financial constraints while accessing treatment were reported. These findings can help inform policies to improve the impact of methadone treatment.
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Affiliation(s)
- Sarah Kanana Kiburi
- grid.411192.e0000 0004 1756 6158Department of Medicine, Aga Khan University Hospital, Nairobi, Kenya ,grid.16463.360000 0001 0723 4123Discipline of Psychiatry, University of KwaZulu Natal, Durban, South Africa
| | - Jackline Mwangi
- grid.9762.a0000 0000 8732 4964Department of Psychology, Kenyatta University, Nairobi, Kenya
| | - Geoffrey Maina
- grid.25152.310000 0001 2154 235XCollege of Nursing, Prince Albert Campus, University of Saskatchewan, Prince Albert, Canada
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Constructing a Nurse-led Cardiovascular Disease Intervention in Rural Ghana: A Qualitative Analysis. Ann Glob Health 2021; 87:121. [PMID: 34900621 PMCID: PMC8641531 DOI: 10.5334/aogh.3379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Cardiovascular disease (CVD) is a growing burden in low- and middle-income countries. Ghana seeks to address this problem by task-shifting CVD diagnosis and management to nurses. The Community-Based Health Planning and Services (CHPS) initiative offers maternal and pediatric health care throughout Ghana but faces barriers to providing CVD care. We employed in-depth interviews to identify solutions to constraints in CVD care to develop a nurse-led CVD intervention in two districts of Ghana's Upper East Region. Objective This study sought to identify non-physician-led interventions for the screening and treatment of cardiovascular disease to incorporate into Ghana's current primary health care structure. Methods Using a qualitative descriptive design, we conducted 31 semistructured interviews of community health officers (CHOs) and supervising subdistrict officers (SDOs) at CHPS community facilities. Summative content analysis revealed the most common intervention ideas and endorsements by the participants. Findings Providers endorsed three interventions: increasing community CVD knowledge and engagement, increasing nonphysician prescribing abilities, and ensuring provider access to medical and transportation equipment. Providers suggested community leaders and volunteers should convey CVD knowledge, marshaling established gathering practices to educate communities and formulate action plans. Providers requested lectures paired with experiential learning to improve their prescribing confidence. Providers recommended revising reimbursement and equipment procurement processes for expediting access to necessary supplies. Conclusions Frontline CHPS primary care providers believe CVD care is feasible. They recommended a three-pronged intervention that combines community outreach, provider training, and logistical support, thereby expanding task-shifting beyond hypertension to include other CVD risk factors. This model could be replicable elsewhere.
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Cohen F. Ecologies of care for serious mental illness in Uganda: A scoping review. GLOBAL SOCIAL WELFARE : RESEARCH, POLICY & PRACTICE 2021; 8:301-315. [PMID: 34926127 PMCID: PMC8673741 DOI: 10.1007/s40609-020-00193-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/11/2020] [Indexed: 06/14/2023]
Affiliation(s)
- Flora Cohen
- Brown School at Washington University in St. Louis
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Widyasari V, Rahman FF, Lin KH, Wang JY. The Effectiveness of Health Services Delivered by Community Health Workers on Outcomes Related to Non-Communicable Diseases among Elderly People in Rural Areas: A Systematic Review. IRANIAN JOURNAL OF PUBLIC HEALTH 2021; 50:1088-1096. [PMID: 34540730 PMCID: PMC8410967 DOI: 10.18502/ijph.v50i6.6408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 01/24/2021] [Indexed: 11/24/2022]
Abstract
Background: The number of elderly and the burden of non-communicable diseases increase with time. Community involvement is expected to be an important prevention agent for their neighbors. This study aimed to determine the effectiveness of health services delivered by community health workers (CHWs) which focus on physiological indices related to non-communicable diseases among elderly people and to explain the health services or interventions carried out by CHWs. Methods: This systematic review was conducted based on the PRISMA guidelines. PubMed, ProQuest Science Database, Scopus, EBSCOhost CINAHL, and Web of Science were taken as the source of databases. Manual search was also conducted for articles published before March 2019 without time restriction. The quality of each study was assessed using Critical Checklist by Joanna Briggs Institute. Results: Of the 3,275 initial studies retrieved, 4 studies were included in qualitative synthesis analysis. Three studies arranged a face-to-face interview, while the other study was conducted over the phone. All the 4 studies were intervention studies. Three of them showed a significant improvement in mean systolic blood pressure for the intervention group compared to the control group. The other study showed a significant improvement in weight loss for the intervention group. Conclusion: Health services delivered by CHWs was beneficial to elderly people in rural areas on some physiological indices. It suggested that health services delivered CHWs could contribute toward secondary prevention programs.
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Affiliation(s)
- Vita Widyasari
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan.,Cluster of Public Health Science, Faculty of Medicine, Universitas Islam Indonesia, Yogyakarta, Indonesia
| | - Ferry Fadzlul Rahman
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan.,Public Health Department, Universitas Muhammadiyah Kalimantan Timur, Samarinda, Indonesia
| | - Kuan-Han Lin
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Jiun-Yi Wang
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan.,Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
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van Ginneken N, Chin WY, Lim YC, Ussif A, Singh R, Shahmalak U, Purgato M, Rojas-García A, Uphoff E, McMullen S, Foss HS, Thapa Pachya A, Rashidian L, Borghesani A, Henschke N, Chong LY, Lewin S. Primary-level worker interventions for the care of people living with mental disorders and distress in low- and middle-income countries. Cochrane Database Syst Rev 2021; 8:CD009149. [PMID: 34352116 PMCID: PMC8406740 DOI: 10.1002/14651858.cd009149.pub3] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Community-based primary-level workers (PWs) are an important strategy for addressing gaps in mental health service delivery in low- and middle-income countries. OBJECTIVES: To evaluate the effectiveness of PW-led treatments for persons with mental health symptoms in LMICs, compared to usual care. SEARCH METHODS: MEDLINE, Embase, CENTRAL, ClinicalTrials.gov, ICTRP, reference lists (to 20 June 2019). SELECTION CRITERIA: Randomised trials of PW-led or collaborative-care interventions treating people with mental health symptoms or their carers in LMICs. PWs included: primary health professionals (PHPs), lay health workers (LHWs), community non-health professionals (CPs). DATA COLLECTION AND ANALYSIS: Seven conditions were identified apriori and analysed by disorder and PW examining recovery, prevalence, symptom change, quality-of-life (QOL), functioning, service use (SU), and adverse events (AEs). Risk ratios (RRs) were used for dichotomous outcomes; mean difference (MDs), standardised mean differences (SMDs), or mean change differences (MCDs) for continuous outcomes. For SMDs, 0.20 to 0.49 represented small, 0.50 to 0.79 moderate, and ≥0.80 large clinical effects. Analysis timepoints: T1 (<1 month), T2 (1-6 months), T3 ( >6 months) post-intervention. MAIN RESULTS: Description of studies 95 trials (72 new since 2013) from 30 LMICs (25 trials from 13 LICs). Risk of bias Most common: detection bias, attrition bias (efficacy), insufficient protection against contamination. Intervention effects *Unless indicated, comparisons were usual care at T2. "Probably", "may", or "uncertain" indicates "moderate", "low," or "very low" certainty evidence. Adults with common mental disorders (CMDs) LHW-led interventions a. may increase recovery (2 trials, 308 participants; RR 1.29, 95%CI 1.06 to 1.56); b. may reduce prevalence (2 trials, 479 participants; RR 0.42, 95%CI 0.18 to 0.96); c. may reduce symptoms (4 trials, 798 participants; SMD -0.59, 95%CI -1.01 to -0.16); d. may improve QOL (1 trial, 521 participants; SMD 0.51, 95%CI 0.34 to 0.69); e. may slightly reduce functional impairment (3 trials, 1399 participants; SMD -0.47, 95%CI -0.8 to -0.15); f. may reduce AEs (risk of suicide ideation/attempts); g. may have uncertain effects on SU. Collaborative-care a. may increase recovery (5 trials, 804 participants; RR 2.26, 95%CI 1.50 to 3.43); b. may reduce prevalence although the actual effect range indicates it may have little-or-no effect (2 trials, 2820 participants; RR 0.57, 95%CI 0.32 to 1.01); c. may slightly reduce symptoms (6 trials, 4419 participants; SMD -0.35, 95%CI -0.63 to -0.08); d. may slightly improve QOL (6 trials, 2199 participants; SMD 0.34, 95%CI 0.16 to 0.53); e. probably has little-to-no effect on functional impairment (5 trials, 4216 participants; SMD -0.13, 95%CI -0.28 to 0.03); f. may reduce SU (referral to MH specialists); g. may have uncertain effects on AEs (death). Women with perinatal depression (PND) LHW-led interventions a. may increase recovery (4 trials, 1243 participants; RR 1.29, 95%CI 1.08 to 1.54); b. probably slightly reduce symptoms (5 trials, 1989 participants; SMD -0.26, 95%CI -0.37 to -0.14); c. may slightly reduce functional impairment (4 trials, 1856 participants; SMD -0.23, 95%CI -0.41 to -0.04); d. may have little-to-no effect on AEs (death); e. may have uncertain effects on SU. Collaborative-care a. has uncertain effects on symptoms/QOL/SU/AEs. Adults with post-traumatic stress (PTS) or CMDs in humanitarian settings LHW-led interventions a. may slightly reduce depression symptoms (5 trials, 1986 participants; SMD -0.36, 95%CI -0.56 to -0.15); b. probably slightly improve QOL (4 trials, 1918 participants; SMD -0.27, 95%CI -0.39 to -0.15); c. may have uncertain effects on symptoms (PTS)/functioning/SU/AEs. PHP-led interventions a. may reduce PTS symptom prevalence (1 trial, 313 participants; RR 5.50, 95%CI 2.50 to 12.10) and depression prevalence (1 trial, 313 participants; RR 4.60, 95%CI 2.10 to 10.08); b. may have uncertain effects on symptoms/functioning/SU/AEs. Adults with harmful/hazardous alcohol or substance use LHW-led interventions a. may increase recovery from harmful/hazardous alcohol use although the actual effect range indicates it may have little-or-no effect (4 trials, 872 participants; RR 1.28, 95%CI 0.94 to 1.74); b. may have little-to-no effect on the prevalence of methamphetamine use (1 trial, 882 participants; RR 1.01, 95%CI 0.91 to 1.13) and functional impairment (2 trials, 498 participants; SMD -0.14, 95%CI -0.32 to 0.03); c. probably slightly reduce risk of harmful/hazardous alcohol use (3 trials, 667 participants; SMD -0.22, 95%CI -0.32 to -0.11); d. may have uncertain effects on SU/AEs. PHP/CP-led interventions a. probably have little-to-no effect on recovery from harmful/hazardous alcohol use (3 trials, 1075 participants; RR 0.93, 95%CI 0.77 to 1.12) or QOL (1 trial, 560 participants; MD 0.00, 95%CI -0.10 to 0.10); b. probably slightly reduce risk of harmful/hazardous alcohol and substance use (2 trials, 705 participants; SMD -0.20, 95%CI -0.35 to -0.05; moderate-certainty evidence); c. may have uncertain effects on prevalence (cannabis use)/SU/AEs. PW-led interventions for alcohol/substance dependence a. may have uncertain effects. Adults with severe mental disorders *Comparisons were specialist-led care at T1. LHW-led interventions a. may have little-to-no effect on caregiver burden (1 trial, 253 participants; MD -0.04, 95%CI -0.18 to 0.11); b. may have uncertain effects on symptoms/functioning/SU/AEs. PHP-led or collaborative-care a. may reduce functional impairment (7 trials, 874 participants; SMD -1.13, 95%CI -1.78 to -0.47); b. may have uncertain effects on recovery/relapse/symptoms/QOL/SU. Adults with dementia and carers PHP/LHW-led carer interventions a. may have little-to-no effect on the severity of behavioural symptoms in dementia patients (2 trials, 134 participants; SMD -0.26, 95%CI -0.60 to 0.08); b. may reduce carers' mental distress (2 trials, 134 participants; SMD -0.47, 95%CI -0.82 to -0.13); c. may have uncertain effects on QOL/functioning/SU/AEs. Children with PTS or CMDs LHW-led interventions a. may have little-to-no effect on PTS symptoms (3 trials, 1090 participants; MCD -1.34, 95%CI -2.83 to 0.14); b. probably have little-to-no effect on depression symptoms (3 trials, 1092 participants; MCD -0.61, 95%CI -1.23 to 0.02) or on functional impairment (3 trials, 1092 participants; MCD -0.81, 95%CI -1.48 to -0.13); c. may have little-or-no effect on AEs. CP-led interventions a. may have little-to-no effect on depression symptoms (2 trials, 602 participants; SMD -0.19, 95%CI -0.57 to 0.19) or on AEs; b. may have uncertain effects on recovery/symptoms(PTS)/functioning. AUTHORS' CONCLUSIONS PW-led interventions show promising benefits in improving outcomes for CMDs, PND, PTS, harmful alcohol/substance use, and dementia carers in LMICs.
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Affiliation(s)
- Nadja van Ginneken
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Weng Yee Chin
- Department of Family Medicine and Primary Care, The University of Hong Kong, Pokfulam, Hong Kong
| | | | - Amin Ussif
- Norwegian Institute of Public Health, Oslo, Norway
| | - Rakesh Singh
- Department of Community Health Sciences, School of Medicine and School of Public Health, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Ujala Shahmalak
- Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, UK
| | - Marianna Purgato
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Antonio Rojas-García
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Eleonora Uphoff
- Cochrane Common Mental Disorders, Centre for Reviews and Dissemination, University of York, York, UK
| | - Sarah McMullen
- Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, UK
| | | | - Ambika Thapa Pachya
- Department of Community Health Sciences, School of Medicine and School of Public Health, Patan Academy of Health Sciences, Lalitpur, Nepal
| | | | - Anna Borghesani
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | | | - Lee-Yee Chong
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Simon Lewin
- Norwegian Institute of Public Health, Oslo, Norway
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
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22
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Mistry SK, Harris-Roxas B, Yadav UN, Shabnam S, Rawal LB, Harris MF. Community Health Workers Can Provide Psychosocial Support to the People During COVID-19 and Beyond in Low- and Middle- Income Countries. Front Public Health 2021; 9:666753. [PMID: 34239854 PMCID: PMC8258154 DOI: 10.3389/fpubh.2021.666753] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 05/24/2021] [Indexed: 11/13/2022] Open
Abstract
The COVID-19 pandemic has been the most challenging public health issue which not only affected the physical health of the global population but also aggravated the mental health conditions such as stress, anxiety, fear, depression and anger. While mental health services are seriously hampered amid this COVID-19 pandemic, health services, particularly those of Low- and Middle- Income Countries (LMICs) are looking for alternatives to provide psychosocial support to the people amid this COVID-19 and beyond. Community Health Workers (CHWs) are an integral part of the health systems in many LMICs and played significant roles such as health education, contact tracing, isolation and mobilization during past emergencies and amid COVID-19 in many LMICs. However, despite their potentials in providing psychosocial support to the people amid this COVID-19 pandemic, they have been underutilized in most health systems in LMICs. The CHWs can be effectively engaged to provide psychosocial support at the community level. Engaging them can also be cost-saving as they are already in place and may cost less compared to other health professionals. However, they need training and supervision and their safety and security needs to be protected during this COVID-19. While many LMICs have mental health policies but their enactment is limited due to the fragility of health systems and limited health care resources. CHWs can contribute in this regard and help to address the psychosocial vulnerabilities of affected population in LMICs during COVID-19 and beyond.
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Affiliation(s)
- Sabuj Kanti Mistry
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW, Australia
| | - Ben Harris-Roxas
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW, Australia
| | - Uday Narayan Yadav
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW, Australia
| | - Sadia Shabnam
- Health Nutrition and Population Program, BRAC, Dhaka, Bangladesh
| | - Lal Bahadur Rawal
- School of Health Medical and Applied Sciences, Central Queensland University, Sydney Campus, Rockhampton, QLD, Australia
| | - Mark F. Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW, Australia
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23
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Chau LW, Murphy J, Nguyen VC, Lou H, Khanh H, Thu T, Minas H, O'Neil J. Lay social workers implementing a task-sharing approach to managing depression in Vietnam. Int J Ment Health Syst 2021; 15:52. [PMID: 34051848 PMCID: PMC8164490 DOI: 10.1186/s13033-021-00478-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 05/22/2021] [Indexed: 11/05/2022] Open
Abstract
Background While depression is a leading contributor to burden of disease in Vietnam, there is a critical gap in depression care due to the shortage of mental health specialists and extremely limited mental health services in general health care settings. We have previously reported the effectiveness of a supported self-management (SSM) task-sharing intervention for depression, delivered by social collaborators (lay social workers). The purpose of this study was to identify factors influencing the effectiveness of delivery of SSM by social collaborators and delineate areas for further attention that are relevant for scale-up. Methods A hundred and ten (110) key informant interviews were conducted with three stakeholder groups (patients, social collaborators, experts) from eight provinces in Vietnam. Participants were identified through records from a recently completed randomized trial that showed the effectiveness of SSM in community-based settings in Vietnam. Qualitative descriptive methods and thematic analysis were used to examine the interviews. A coding framework and corresponding themes were developed deductively, based on the findings from the randomized trial and the literature, and through inductive analysis, to describe the contextual factors that impacted the social collaborators’ role in successfully implementing the SSM intervention. Results Our analysis identified the following benefits of working with social collaborators: (1) increased awareness of mental health in the family and community; (2) reduced stigma; (3) a better understanding that depression is treatable; (4) increased help-seeking; and (5) improved access to care. There were also significant challenges, including social collaborator characteristics (age, education, pre-existing training and skills) and contextual factors influencing their work (roles and responsibilities, training, compensation, support from government). Conclusions Engaging social collaborators in the delivery of SSM in the community can help fill a critical gap in depression care in Vietnam. However, several contextual challenges that are an impediment to increased engagement and sustainable integration into health and social systems need to be resolved through policy change to regulate their practice, define their scope of work, and provide adequate remuneration.
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Affiliation(s)
- Leena W Chau
- Faculty of Health Sciences, Centre for Applied Research in Mental Health and Addiction, Simon Fraser University, 515 West Hastings Street, Vancouver, BC, V6B 5K3, Canada
| | - Jill Murphy
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Mood Disorders Centre, 2255 Wesbrook Mall, Vancouver, BC, V6T 2A1, Canada
| | - Vu Cong Nguyen
- Institute of Population, Health and Development, 14th level, ICON4 Tower, 3 Cau Giay Street, Hanoi, Vietnam
| | - Hayami Lou
- Faculty of Health Sciences, Centre for Applied Research in Mental Health and Addiction, Simon Fraser University, 515 West Hastings Street, Vancouver, BC, V6B 5K3, Canada
| | - Huyen Khanh
- Institute of Population, Health and Development, 14th level, ICON4 Tower, 3 Cau Giay Street, Hanoi, Vietnam
| | - Trang Thu
- Institute of Population, Health and Development, 14th level, ICON4 Tower, 3 Cau Giay Street, Hanoi, Vietnam
| | - Harry Minas
- Global and Cultural Mental Health Unit, Centre for Mental Health, Melbourne School of Population and Global Health, 207 Bouverie Street, Carlton, VIC, 3053, Australia
| | - John O'Neil
- Faculty of Health Sciences, Centre for Applied Research in Mental Health and Addiction, Simon Fraser University, 515 West Hastings Street, Vancouver, BC, V6B 5K3, Canada.
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24
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Raghavan V, Kulandesu A, Karthick S, Senthilkumar S, Gunaselvi T, Rao K, John S, Thara R. Challenges faced by community-level workers in delivering mental health services for a rural community in South India. Indian J Psychiatry 2021; 63:307-308. [PMID: 34211232 PMCID: PMC8221220 DOI: 10.4103/psychiatry.indianjpsychiatry_907_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 08/06/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
- Vijaya Raghavan
- Schizophrenia Research Foundation, Chennai, Tamil Nadu, India. E-mail:
| | - A Kulandesu
- Schizophrenia Research Foundation, Chennai, Tamil Nadu, India. E-mail:
| | - S Karthick
- Schizophrenia Research Foundation, Chennai, Tamil Nadu, India. E-mail:
| | - S Senthilkumar
- Schizophrenia Research Foundation, Chennai, Tamil Nadu, India. E-mail:
| | - T Gunaselvi
- Schizophrenia Research Foundation, Chennai, Tamil Nadu, India. E-mail:
| | - Kotteswara Rao
- Schizophrenia Research Foundation, Chennai, Tamil Nadu, India. E-mail:
| | - Sujit John
- Schizophrenia Research Foundation, Chennai, Tamil Nadu, India. E-mail:
| | - R Thara
- Schizophrenia Research Foundation, Chennai, Tamil Nadu, India. E-mail:
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25
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Ryan GK, Bauer A, Endale T, Qureshi O, Doukani A, Cerga-Pashoja A, Brar SK, Eaton J, Bass JK. Lay-delivered talk therapies for adults affected by humanitarian crises in low- and middle-income countries. Confl Health 2021; 15:30. [PMID: 33892755 PMCID: PMC8062937 DOI: 10.1186/s13031-021-00363-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 04/01/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Published by the World Health Organization (WHO) and United Nations High Commissioner for Refugees (UNHCR) in 2015, the mental health Gap Action Programme Humanitarian Intervention Guide (mhGAP-HIG) recommends brief versions of structured psychological interventions for people experiencing symptoms of common mental disorders (CMDs). mhGAP-HIG acknowledges a growing body of evidence suggesting these interventions can be delivered by lay workers to people affected by humanitarian crises in low- and middle-income countries (LMICs). However, there has not yet been a systematic review and synthesis of this evidence. This paper reports the results of a systematic review of qualitative, quantitative, and mixed-methods studies assessing the implementation and/or effectiveness of talk therapies for CMDs when provided by lay workers in LMICs to adults who have survived or are currently living in humanitarian situations. METHODS Seven electronic databases were searched: MEDLINE, Embase, PsycINFO, PsycEXTRA, Global Health, Cochrane Library, and ClinicalTrials.gov . We also hand-searched the contents pages of three academic journals, reference lists of 30 systematic reviews, and online resource directories of two mental health networks. A preliminary list of included studies was circulated to topical experts for review, and all included studies were backward and forward searched. All titles, abstracts, and full-texts were independently double-screened. Quality appraisal and data extraction were carried out by a single reviewer and checked by a second reviewer, using standardised tools. Any disagreements were discussed and referred to a third reviewer as needed. RESULTS We identified 23 unique studies and carried out a narrative synthesis of patient and implementation outcome data. Every evaluation of the effectiveness of lay-delivered talk therapies for adults affected by humanitarian crises in LMICs showed some treatment effect for at least one CMD, and often multiple CMDs. Implementation research generally found these interventions to be acceptable, appropriate and feasible to implement, with good fidelity to manualised therapies. CONCLUSION Although results are promising, particularly for individually-delivered talk therapies based on cognitive behavioural therapy techniques, there is a high degree of heterogeneity in this literature. We make several recommendations on how to improve the quality and generalisability of research on this topic, to facilitate further evidence synthesis. TRIAL REGISTRATION PROSPERO registration number: CRD42017058287 .
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Affiliation(s)
- Grace K Ryan
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK. .,Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, Office 142A, Keppel Street, London, WC1E 7HT, UK.
| | - Andreas Bauer
- Department of Psychology, University of Bath, Bath, UK
| | - Tarik Endale
- Department of Counseling and Clinical Psychology, Teachers College of Columbia University, New York City, New York, USA
| | - Onaiza Qureshi
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.,Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, Office 142A, Keppel Street, London, WC1E 7HT, UK
| | - Asmae Doukani
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.,Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, Office 142A, Keppel Street, London, WC1E 7HT, UK
| | - Arlinda Cerga-Pashoja
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.,Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, Office 142A, Keppel Street, London, WC1E 7HT, UK.,Global Health Training, Public Health England, London, UK
| | - Savvy K Brar
- Division of Data, Analytics, Planning and Monitoring, UNICEF, New York City, New York, USA
| | - Julian Eaton
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.,Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, Office 142A, Keppel Street, London, WC1E 7HT, UK.,Mental Health, CBM Global, Laudenbach, Germany
| | - Judith K Bass
- Department of Mental Health, Johns Hopkins University, Baltimore, MD, USA.,Center for Humanitarian Health, Johns Hopkins University, Baltimore, MD, USA
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26
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Okumu M, Nyoni T, Byansi W. Alleviating psychological distress and promoting mental wellbeing among adolescents living with HIV in sub-Saharan Africa, during and after COVID-19. Glob Public Health 2021; 16:964-973. [PMID: 33843460 DOI: 10.1080/17441692.2021.1912137] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
COVID-19 social control measures (e.g. physical distancing and lockdowns) can have both immediate (social isolation, loneliness, anxiety, stress) and long-term effects (depression, post-traumatic stress disorder) on individuals' mental health. This may be particularly true of adolescents living with HIV (ALHIV) and their caregivers - populations already overburdened by intersecting stressors (e.g. psychosocial, biomedical, familial, economic, social, or environmental). Addressing the adverse mental health sequelae of COVID-19 among ALHIV requires a multi-dimensional approach that at once (a) economically empowers ALHIV and their households and (b) trains, mentors, and supervises community members as lay mental health services providers. Mental health literacy programming can also be implemented to increase mental health knowledge, reduce stigma, and improve service use among ALHIV. Schools and HIV care clinics offer ideal environments for increasing mental health literacy and improving access to mental health services.
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Affiliation(s)
- Moses Okumu
- School of Social Work, University of North Carolina, Chapel Hill, NC, USA
| | - Thabani Nyoni
- Brown School of Social Work, Washington University, St. Louis, MO, USA
| | - William Byansi
- Brown School of Social Work, Washington University, St. Louis, MO, USA
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27
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Bunn M, Gonzalez N, Falek I, Weine S, Acri M. Supporting and Sustaining Nonspecialists to Deliver Mental Health Interventions in Low- and Middle-Income Countries: An Umbrella Review. INTERVENTION 2021. [DOI: 10.4103/intv.intv_47_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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28
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Luitel NP, Jordans MJD, Subba P, Komproe IH. Perception of service users and their caregivers on primary care-based mental health services: a qualitative study in Nepal. BMC FAMILY PRACTICE 2020; 21:202. [PMID: 32988367 PMCID: PMC7523041 DOI: 10.1186/s12875-020-01266-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 09/10/2020] [Indexed: 11/13/2022]
Abstract
Background Integration of mental health services into primary health care systems has been advocated as a strategy to minimize the tremendous mental health treatment gap, particularly in low- and middle-income countries. Barriers to integration of mental health into primary health care have been widely documented; however, very little is known about the perception of service users and their caregivers on primary care-based mental health services. This study assessed service users’ and caregivers’ perceptions of mental health services provided by trained primary health care workers in Nepal. Methods A qualitative study was conducted among people with depression, psychosis, alcohol use disorder and epilepsy, and their caregivers in Chitwan, a district in southern Nepal. Semi-structured interviews were conducted with 43 service users and 38 caregivers to assess their perceptions about the accessibility of the services, types of services they received, skills and competencies of health care providers, satisfaction and barriers to receiving services. Results Overall, both service users and caregivers were satisfied with the mental health services provided by primary health care providers. They also perceived health workers to be competent and skillful because the services they received were effective in reducing their mental health problems. Both psychological and pharmacological services were made available free of cost, however, they considered psychological services more effective than pharmacological treatment. Major challenges and difficulties accessing services were associated with frequent transfer of trained health workers, non-availability of the same health care provider at follow-ups, frequent stock-out of medicines or non-availability of required medicines, lack of a confidential space for consultation in health facilities, and stigmatizing and negative behavior of some health workers. Conclusion The results demonstrated that both service users and caregivers perceived primary care-based mental health services to be accessible, acceptable and effective. The key recommendations emerging from this study for improving mental health services in primary care include the provision of a separate cadre of psychosocial workers to provide psychological interventions, developing quick and efficient mechanisms for the procurement and supply of psychotropic medicines, establishing a confidential place within health facilities for consultation, and further training of health workers to reduce stigma.
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Affiliation(s)
- N P Luitel
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Kathmandu, Nepal.
| | - M J D Jordans
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Faculty of Social and Behavioural Sciences; Department of Anthropology, University of Amsterdam, Armsterdam, the Netherlands
| | - P Subba
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Kathmandu, Nepal
| | - I H Komproe
- Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, the Netherlands
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29
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Verhey IJ, Ryan GK, Scherer N, Magidson JF. Implementation outcomes of cognitive behavioural therapy delivered by non-specialists for common mental disorders and substance-use disorders in low- and middle-income countries: a systematic review. Int J Ment Health Syst 2020; 14:40. [PMID: 32514304 PMCID: PMC7260765 DOI: 10.1186/s13033-020-00372-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 05/19/2020] [Indexed: 02/02/2023] Open
Abstract
Due to severe shortages of specialist mental health personnel in low- and middle-income countries (LMICs), psychological therapies are increasingly being delivered by non-specialist health workers (NSHWs). Previous reviews have investigated the effectiveness of NSHW-delivered psychological therapies, including cognitive behavioural therapy (CBT), in LMIC settings. This systematic review aims to synthesise findings on the implementation outcomes of NSHW-delivered CBT interventions addressing common mental disorders and substance-use disorders in LMICs. Four databases were searched, yielding 3211 records, 18 of which met all inclusion criteria. We extracted and synthesised qualitative and quantitative data across eight implementation outcomes: acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, penetration and sustainability. Findings suggest that delivery of CBT-based interventions by NSHWs can be acceptable, appropriate and feasible in LMIC settings. However, more research is needed to better evaluate these and other under-reported implementation outcomes.
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Affiliation(s)
- Ibone J Verhey
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London, WC1E 7HT UK
| | - Grace K Ryan
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London, WC1E 7HT UK
| | - Nathaniel Scherer
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London, WC1E 7HT UK
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30
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Heller DJ, Kumar A, Kishore SP, Horowitz CR, Joshi R, Vedanthan R. Assessment of Barriers and Facilitators to the Delivery of Care for Noncommunicable Diseases by Nonphysician Health Workers in Low- and Middle-Income Countries: A Systematic Review and Qualitative Analysis. JAMA Netw Open 2019; 2:e1916545. [PMID: 31790570 PMCID: PMC6902752 DOI: 10.1001/jamanetworkopen.2019.16545] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
IMPORTANCE Cardiovascular disease, cancer, and other noncommunicable diseases (NCDs) are the leading causes of mortality in low- and middle-income countries. Previous studies show that nonphysician health workers (NPHWs), including nurses and volunteers, can provide effective diagnosis and treatment of NCDs. However, the factors that facilitate and impair these programs are incompletely understood. OBJECTIVE To identify health system barriers to and facilitators of NPHW-led care for NCDs in low- and middle-income countries. DATA SOURCES All systematic reviews in PubMed published by May 1, 2018. STUDY SELECTION The search terms used for this analysis included "task shifting" and "non-physician clinician." Only reviews of NPHW care that occurred entirely or mostly in low- and middle-income countries and focused entirely or mostly on NCDs were included. All studies cited within each systematic review that cited health system barriers to and facilitators of NPHW care were reviewed. DATA EXTRACTION AND SYNTHESIS Assessment of study eligibility was performed by 1 reviewer and rechecked by another. The 2 reviewers extracted all data. Reviews were performed from November 2017 to July 2018. All analyses were descriptive. MAIN OUTCOMES AND MEASURES All barriers and facilitators mentioned in all studies were tallied and sorted according to the World Health Organization's 6 building blocks for health systems. RESULTS This systematic review and qualitative analysis identified 15 review articles, which cited 156 studies, of which 71 referenced barriers to and facilitators of care. The results suggest 6 key lessons: (1) select qualified NPHWs embedded within the community they serve; (2) provide detailed, ongoing training and supervision; (3) authorize NPHWs to prescribe medication and render autonomous care; (4) equip NPHWs with reliable systems to track patient data; (5) furnish NPHWs consistently with medications and supplies; and (6) compensate NPHWs adequately commensurate with their roles. CONCLUSIONS AND RELEVANCE Although the health system barriers to NPHW screening, treatment, and control of NCDs and their risk factors are numerous and complex, a diverse set of care models has demonstrated strategies to address nearly all of these challenges. These facilitating approaches-which relate chiefly to strong, consistent NPHW training, guidance, and logistical support-generate a blueprint for the creation and scale-up of such programs adaptable across multiple chronic diseases, including in high-income countries.
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Affiliation(s)
- David J. Heller
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Anirudh Kumar
- Department of Medicine, New York University School of Medicine, New York
| | - Sandeep P. Kishore
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Carol R. Horowitz
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Rohina Joshi
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health, New Delhi, India
- Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Rajesh Vedanthan
- Department of Population Health, New York University School of Medicine, New York
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Arriola-Vigo JA, Stovall JG, Moon TD, Audet CM, Diez-Canseco F. Perceptions of Community Involvement in the Peruvian Mental Health Reform Process Among Clinicians and Policy-Makers: A Qualitative Study. Int J Health Policy Manag 2019; 8:711-722. [PMID: 31779299 PMCID: PMC6885866 DOI: 10.15171/ijhpm.2019.68] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 08/03/2019] [Indexed: 11/25/2022] Open
Abstract
Background: The global burden of mental health conditions has led to the implementation of new models of care for persons with mental illness. Recent mental health reforms in Peru include the implementation of a community mental health model (CMHM) that, among its core objectives, aims to provide care in the community through specialized facilities, the community mental health centers (CMHCs). Community involvement is a key component of this model. This study aims to describe perceptions of community engagement activities in the current model of care in three CMHCs and identify barriers and potential solutions to implementation. Methods: A qualitative research study using in-depth semi-structured interviews with clinicians from three CMHCs and with policy-makers involved in the implementation of the mental health reforms was conducted in two regions of Peru. The interviews, conducted in Spanish, were digitally recorded with consent, transcribed and analyzed using principles of grounded theory applying a framework approach. Community engagement activities are described at different stages of patient care. Results: Twenty-five full-time employees (17 women, 8 men) were interviewed, of which 21 were clinicians (diverse health professions) from CMHCs, and 4 were policy-makers. Interviews elucidated community engagement activities currently being utilized including: (1) employing community mental health workers (CMHWs); (2) home visits; (3) psychosocial clubs; (4) mental health workshops and campaigns; and (5) peer support groups. Inadequate infrastructure and financial resources, lack of knowledge about the CMHM, poorly defined catchment areas, stigma, and inadequate productivity approach were identified as barriers to program implementation. Solutions suggested by participants included increasing knowledge and awareness about mental health and the new model, implementation of peer-training, and improving productivity evaluation and research initiatives. Conclusion: Community engagement activities are being conducted in Peru as part of a new model of care. However, their structure, frequency, and content are perceived by clinicians and policy-makers as highly variable due to a lack of consistent training and resources across CMHCs. Barriers to implementation should be quickly addressed and potential solutions executed, so that scale-up best optimizes the utilization of resources in the implementation process.
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Affiliation(s)
- Jose A Arriola-Vigo
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jeffrey G Stovall
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Troy D Moon
- Department of Pediatrics, Division of Infectious Diseases, and Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Carolyn M Audet
- Department of Health Policy, and Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Francisco Diez-Canseco
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
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Treatment gap and mental health service use among Syrian refugees in Sultanbeyli, Istanbul: a cross-sectional survey. Epidemiol Psychiatr Sci 2019; 29:e70. [PMID: 31727205 PMCID: PMC8061186 DOI: 10.1017/s2045796019000660] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
AIMS Syrian refugees may have increased mental health needs due to the frequent exposure to potentially traumatic events and violence experienced during the flight from their home country, breakdown of supportive social networks and daily life stressors related to refugee life. The aim of this study is to report evidence on mental health needs and access to mental health and psychosocial support (MHPSS) among Syrians refugees living in Sultanbeyli-Istanbul, Turkey. METHODS A cross-sectional survey was conducted among Syrian refugees aged 18 years or over in Sultanbeyli between February and May 2018. We used random sampling to select respondents by using the registration system of the municipality. Data among 1678 Syrian refugees were collected on mental health outcomes using the Posttraumatic Stress Disorder (PTSD) Checklist (PCL-5) and the Hopkins Symptoms Checklist (HSCL-25) for depression and anxiety. We also collected data on health care utilisation, barriers to seeking and continuing care as well as knowledge and attitudes towards mental health. Descriptive analyses were used. RESULTS The estimated prevalence of symptoms of PTSD, depression and anxiety was 19.6, 34.7 and 36.1%, respectively. In total, 249 respondents (15%) screened positive for either PTSD, depression or anxiety in our survey and self-reported emotional/behavioural problems since arriving in Sultanbeyli. The treatment gap (the proportion of these 249 people who did not seek care) was 89% for PTSD, 90% for anxiety and 88% for depression. Several structural and attitudinal barriers for not seeking care were reported, including the cost of mental health care, the belief that time would improve symptoms, fear of being stigmatised and lack of knowledge on where and how to get help. Some negative attitudes towards people with mental health problems were reported by respondents. CONCLUSIONS Syrian refugees hardly access MHPSS services despite high mental health needs, and despite formally having access to the public mental health system in Turkey. To overcome the treatment gap, MHPSS programmes need to be implemented in the community and need to overcome the barriers to seeking care which were identified in this study. Mental health awareness raising activities should be provided in the community alongside the delivery of psychological interventions. This is to increase help-seeking and to tackle negative attitudes towards mental health and people with mental health problems.
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Malla A, Margoob M, Iyer S, Majid A, Lal S, Joober R, Issaoui Mansouri B. Testing the Effectiveness of Implementing a Model of Mental Healthcare Involving Trained Lay Health Workers in Treating Major Mental Disorders Among Youth in a Conflict-Ridden, Low-Middle Income Environment: Part II Results. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2019; 64:630-637. [PMID: 30935214 PMCID: PMC6699027 DOI: 10.1177/0706743719839314] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To report the outcomes of young people (aged 14-30 years) treated for major mental disorders in a lay health worker (LHW) intervention model in a rural district of conflict-ridden Kashmir, India. METHODS Over a 12-month follow-up, LHWs collected data on symptoms, functioning, quality of life and disability, and patients' and families' service engagement and satisfaction. RESULTS Forty trained LHWs (18 males and 22 females) identified 262 individuals who met the criteria for a diagnosis of a major mental disorder, connected them with specialists for treatment initiation (within 14 days), and provided follow-up and support to patients and families. Significantly more patients (14-30 years) were identified during the 14 months of the project than those in all age groups in the preceding 2 years. At 12 months, 205 patients (78%) remained engaged with the service and perceived it as very helpful. Repeated measures ANOVA showed significant improvements in scores on the global assessment of functioning (GAF) scale (F[df, 3.449] = 104.729, p < 0.001) and all 4 domains of the World Health Organization quality of life (WHOQOL) brief version (WHOQOL-BREF) of the survey-Physical F(df, 1.861) = 40.82; Psychological F(df, 1.845) = 55.490; Social F(df, 1.583) = 25.189; Environment F(df, 1.791) = 40.902, all ps < 0.001-and a decrease in disability (F[df, 1.806] = 4.364, p = 0.016). An interaction effect between time and sex was observed for the physical health domain of the WHOQOL-BREF. DISCUSSION AND CONCLUSIONS Our results show that an LHW-based service model, implemented in a rural setting of a low-to-middle income region plagued by long-term conflict, benefits young people with major mental disorders. We discuss the implications of our findings in the context of similar environments and the challenges encountered.
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Affiliation(s)
- Ashok Malla
- 1 Department of Psychiatry, Douglas Hospital Research Centre, McGill University, Montreal, Quebec, Canada.,2 Douglas Hospital Research Centre, ACCESS Open Minds Network, Montreal, Quebec, Canada
| | - Mushtaq Margoob
- 3 Cognitive and Behavioral Sciences Studies Research Centre, Islamic University of Science and Technology, Awantipore, Kashmir, India.,4 Advanced Institute of Management of Stress and Lifestyle-related Problems (AIMS), Nigeen, Hazratbal, Srinagar, Kashmir, India.,5 Supporting Always Wholeheartedly All Broken-hearted (SAWAB), Kashmir, India
| | - Srividya Iyer
- 1 Department of Psychiatry, Douglas Hospital Research Centre, McGill University, Montreal, Quebec, Canada.,2 Douglas Hospital Research Centre, ACCESS Open Minds Network, Montreal, Quebec, Canada.,6 Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Abdul Majid
- 7 Department of Psychiatry, Sher-i-Kashmir Institute of Medical Sciences Medical College, Srinagar, Kashmir, India
| | - Shalini Lal
- 8 School of Rehabilitation, CHUM Research Center, Faculté de Médecine, Université de Montréal, Montreal, Quebec, Canada.,9 CHUM Research Center, University of Montreal Hospital Research Center (CRCHUM), Montreal, Quebec, Canada.,10 CHUM Research Center, Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Ridha Joober
- 1 Department of Psychiatry, Douglas Hospital Research Centre, McGill University, Montreal, Quebec, Canada.,6 Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montreal, Quebec, Canada.,11 Prevention and Early Intervention Program for Psychosis, Montreal, Quebec, Canada.,12 Research Program on Psychotic and Neurodevelopmental Disorders, Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Bilal Issaoui Mansouri
- 6 Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montreal, Quebec, Canada
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Malla A, Margoob M, Iyer S, Joober R, Lal S, Thara R, Mushtaq H, Mansouri BI. A Model of Mental Health Care Involving Trained Lay Health Workers for Treatment of Major Mental Disorders Among Youth in a Conflict-Ridden, Low-Middle Income Environment: Part I Adaptation and Implementation. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2019; 64:621-629. [PMID: 30917693 PMCID: PMC6699030 DOI: 10.1177/0706743719839318] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES In low- and middle-income countries (LMIC), major mental disorders often remain untreated because of barriers related to access and resources. In rural areas and in conflict-ridden regions, the problem can be exacerbated by increased rates of mental illness and by reduced access to care. This paper describes a project designed to provide mental health services for major mental disorders among youth using a low-cost model in a rural district of the troubled Kashmir valley. METHODS We describe the geographic and political context, the guiding principles and adaptation of the service model (through partnership with a voluntary organization and use of technology), and the implementation of the model using Theory of Change framework. The core of the intervention was to train a pool of lay health workers (LHWs) to provide mental health services to young (aged 14-30 years) people with major mental disorders in their own communities, supported by clinical professionals. RESULTS Despite political turmoil and major floods, 40 (male and female) LHWs were trained. The LHWs efficiently engaged in case identification, basic interventions, and data collection on outcomes. Several different stakeholders were engaged in activities relevant to the objectives of the project; however, the use of technologies was moderated by several challenges, including access to internet services and patient preference for personal contact. CONCLUSIONS This service model is applicable in an environment where protracted political and armed conflict, low resources, and geographical isolation make exclusive reliance on scarce professional services impractical.
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Affiliation(s)
- Ashok Malla
- Department of Psychiatry, Douglas Hospital Research Centre, McGill
University, Montréal, Quebec, Canada
- Douglas Hospital Research Centre, ACCESS Open Minds network, Montréal,
Quebec, Canada
| | - Mushtaq Margoob
- Cognitive and Behavioral Sciences Studies Research Centre, Islamic
University of Science and Technology, Awantipore, Kashmir, India
- Advanced Institute of Management of Stress and life style related Problems
(AIMS), Nigeen, Hazratbal, Srinagar, Kashmir, India
- Supporting Always Wholeheartedly All Broken-hearted (SAWAB), Kashmir,
India
| | - Srividya Iyer
- Department of Psychiatry, Douglas Hospital Research Centre, McGill
University, Montréal, Quebec, Canada
- Douglas Hospital Research Centre, ACCESS Open Minds network, Montréal,
Quebec, Canada
- Douglas Hospital Research Centre, Douglas Mental Health University
Institute, Montréal, Quebec, Canada
| | - Ridha Joober
- Department of Psychiatry, Douglas Hospital Research Centre, McGill
University, Montréal, Quebec, Canada
- Program of Early intervention and Prevention of Psychoses, Douglas
Institute, Montreal, Quebec, Canada
- Research Program on Psychotic and Neurodevelopmental Disorders, Douglas
Mental Health University Institute, Montreal, Quebec, Canada
| | - Shalini Lal
- School of Rehabilitation, CHUM Research Center, Faculté de Médecine,
Université de Montréal, Montreal, Quebec, Canada
- CHUM Research Center, University of Montreal Hospital Research Center
(CRCHUM), Montreal, Quebec, Canada
- CHUM Research Center, Douglas Mental Health University Institute, Montreal,
Quebec, Canada
| | | | - Huda Mushtaq
- Supporting Always Wholeheartedly All Broken-hearted (SAWAB), Kashmir,
India
- Consultant Clinical Psychology Research Unit, Advanced Institute of
Management of Stress and life style related Problems (AIMS), Nigeen Hazratbal, Srinagar,
Kashmir, India
| | - Bilal Issaoui Mansouri
- Department of Psychiatry, Douglas Hospital Research Centre, McGill
University, Montréal, Quebec, Canada
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Malla A, Iyer S, Shah J, Joober R, Boksa P, Lal S, Fuhrer R, Andersson N, Abdel‐Baki A, Hutt‐MacLeod D, Beaton A, Reaume‐Zimmer P, Chisholm‐Nelson J, Rousseau C, Chandrasena R, Bourque J, Aubin D, Levasseur MA, Winkelmann I, Etter M, Kelland J, Tait C, Torrie J, Vallianatos H. Canadian response to need for transformation of youth mental health services: ACCESS Open Minds (Esprits ouverts). Early Interv Psychiatry 2019; 13:697-706. [PMID: 30556335 PMCID: PMC6563151 DOI: 10.1111/eip.12772] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 10/18/2018] [Accepted: 11/04/2018] [Indexed: 01/02/2023]
Abstract
AIM Youth mental health is of paramount significance to society globally. Given early onset of mental disorders and the inadequate access to appropriate services, a meaningful service transformation, based on globally recognized principles, is necessary. The aim of this paper is to describe a national Canadian project designed to achieve transformation of mental health services and to evaluate the impact of such transformation on individual and system related outcomes. METHOD We describe a model for transformation of services for youth with mental health and substance abuse problems across 14 geographically, linguistically and culturally diverse sites, including large and small urban, rural, First Nations and Inuit communities as well as homeless youth and a post-secondary educational setting. The principles guiding service transformation and objectives are identical across all sites but the method to achieve them varies depending on prevailing resources, culture, geography and the population to be served and how each community can best utilize the extra resources for transformation. RESULTS Each site is engaged in community mapping of services followed by training, active stakeholder engagement with youth and families, early case identification initiatives, providing rapid access (within 72 hours) to an assessment of the presenting problems, facilitating connection to an appropriate service within 30 days (if required) with no transition based on age within the 11 to 25 age group and a structured evaluation to track outcomes over the period of the study. CONCLUSIONS Service transformation that is likely to achieve substantial change involves very detailed and carefully orchestrated processes guided by a set of values, principles, clear objectives, training and evaluation. The evidence gathered from this project can form the basis for scaling up youth mental health services in Canada across a variety of environments.
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Affiliation(s)
- Ashok Malla
- Department of PsychiatryMcGill UniversityMontréal, QuébecCanada
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Prevention and Early Intervention Program for Psychosis (PEPP)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Douglas Mental Health University InstituteMontréal, QuébecCanada
| | - Srividya Iyer
- Department of PsychiatryMcGill UniversityMontréal, QuébecCanada
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Prevention and Early Intervention Program for Psychosis (PEPP)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Douglas Mental Health University InstituteMontréal, QuébecCanada
| | - Jai Shah
- Department of PsychiatryMcGill UniversityMontréal, QuébecCanada
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Prevention and Early Intervention Program for Psychosis (PEPP)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Douglas Mental Health University InstituteMontréal, QuébecCanada
| | - Ridha Joober
- Department of PsychiatryMcGill UniversityMontréal, QuébecCanada
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Prevention and Early Intervention Program for Psychosis (PEPP)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Douglas Mental Health University InstituteMontréal, QuébecCanada
| | - Patricia Boksa
- Department of PsychiatryMcGill UniversityMontréal, QuébecCanada
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Douglas Mental Health University InstituteMontréal, QuébecCanada
| | - Shalini Lal
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Douglas Mental Health University InstituteMontréal, QuébecCanada
- School of Rehabilitation, Faculty of MedicineUniversité de MontréalMontréal, QuébecCanada
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM)Montréal, QuébecCanada
| | - Rebecca Fuhrer
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Department of Epidemiology, Biostatistics and Occupational HealthMcGill UniversityMontréal, QuébecCanada
| | - Neil Andersson
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Department of Family Medicine, Community Information and Epidemiological Technologies (CIET) Institute and Participatory Research at McGill (PRAM)McGill UniversityMontréal, QuébecCanada
- McGill University Institute for Human Development and Well‐beingMontréal, QuébecCanada
| | - Amal Abdel‐Baki
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Department of PsychiatryUniversité de MontréalMontréal, QuébecCanada
- Centre hospitalier de l'Université de Montréal (CHUM), CRCHUMMontréal, QuébecCanada
| | - Daphne Hutt‐MacLeod
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Eskasoni Mental Health ServicesEskasoni, Nova ScotiaCanada
| | - Ann Beaton
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
- School of Psychology, Faculty of Health Sciences and Community ServicesUniversité de MonctonMonctonNew BrunswickCanada
| | - Paula Reaume‐Zimmer
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Mental Health and Addictions ServicesBluewater Health and Canadian Mental Health AssociationLambton Kent, OntarioCanada
| | - Jessica Chisholm‐Nelson
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
| | - Cécile Rousseau
- Department of PsychiatryMcGill UniversityMontréal, QuébecCanada
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Centre de recherche SHERPA, Institut Universitaire au regard des communautés culturellesCentre intégré universitaire de santé et de services sociaux (CIUSSS) du Centre‐Ouest‐de‐l'Île‐de‐MontréalMontréal, QuébecCanada
| | - Ranjith Chandrasena
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Schulich School of MedicineWestern UniversityLondonOntarioCanada
| | - Jimmy Bourque
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Faculty of EducationUniversité de MonctonMonctonNew BrunswickCanada
| | - Diane Aubin
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Dans La Rue and Réseau d'intervention de proximité auprès des jeunes de la rue (RIPAJ)‐Montréal/Homeless Youth NetworkMontréal, QuébecCanada
| | - Mary Anne Levasseur
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
- ACCESS Open Minds Family and Carers Council, Douglas Mental Health University Institute, MontréalQuébecCanada
| | - Ina Winkelmann
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
| | - Meghan Etter
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Counselling ServicesInuvialuit Regional CorporationInuvik, Northwest TerritoriesCanada
| | - Jill Kelland
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Young Adult and Cross Level Services, Addiction and Mental Health, Edmonton Zone, Alberta Health ServicesEdmontonAlbertaCanada
| | - Caroline Tait
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Department of PsychiatryUniversity of SaskatchewanSaskatoonSaskatchewanCanada
| | - Jill Torrie
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Public Health DepartmentCree Board of Health and Social Services of James BayMistissini, QuébecCanada
| | - Helen Vallianatos
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Department of AnthropologyUniversity of AlbertaEdmontonAlbertaCanada
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Mutedzi B, Langhaug L, Hunt J, Nkhoma K, Harding R. Improving bereavement outcomes in Zimbabwe: protocol for a feasibility cluster trial of the 9-cell bereavement tool. Pilot Feasibility Stud 2019; 5:66. [PMID: 31110775 PMCID: PMC6509823 DOI: 10.1186/s40814-019-0450-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 04/17/2019] [Indexed: 11/16/2022] Open
Abstract
Background The high burden of bereavement in sub-Saharan Africa is largely attributable to HIV, cancer, and other non-communicable diseases. However, interventions to improve grief and bereavement are rare. Given high rates of mortality in the context of weak health systems, community lay members are well placed to provide peer bereavement support. The 9-cell bereavement tool was developed in Zimbabwe to improve community members’ capacity to support the bereaved. This study aims to determine the feasibility of implementing the 9-cell bereavement tool and recruitment to experimental evaluation. Methods/design This feasibility cluster randomized trial with embedded qualitative interviews will be conducted in two comparable neighborhoods in Zimbabwe. Community leaders from each neighborhood will identify 25 potential community lay bereavement supporters, each of whom will recruit 2–3 bereaved community members into the trial. The intervention will be randomly allocated to one community, and the second community will form a wait-list control (n ≥ 75 in each community cluster). Recruitment is estimated to take place over 3 weeks. Measures at T0 (baseline, i.e., week 0), T1 (midline, i.e., week 14 or 3 months post-baseline) and T2 (endline, i.e., week 27 or 3 months post-midline) will address mental health, social support, and levels of grief per individual. Qualitative data will describe lay supporters’ views of intervention training and delivery, and participants’ experience of bereavement support. Discussion This is the first documented trial evaluating a bereavement intervention in sub-Saharan Africa. Recruitment, retention, and measurement data will determine the feasibility of a full trial. Trial registration ISRCTN, ISRCTN16484746. Registered 6 February 2018
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Affiliation(s)
- Barbara Mutedzi
- Island Hospice and Healthcare, 6 Natal Road, Belgravia, Harare, Zimbabwe
| | | | | | - Kennedy Nkhoma
- 3Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, Bessemer Road, London, SE5 9PJ UK
| | - Richard Harding
- 3Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, Bessemer Road, London, SE5 9PJ UK
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Li J, Fan Y, Zhong HQ, Duan XL, Chen W, Evans-Lacko S, Thornicroft G. Effectiveness of an anti-stigma training on improving attitudes and decreasing discrimination towards people with mental disorders among care assistant workers in Guangzhou, China. Int J Ment Health Syst 2019; 13:1. [PMID: 30622627 PMCID: PMC6317233 DOI: 10.1186/s13033-018-0259-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 12/27/2018] [Indexed: 01/01/2023] Open
Abstract
Background Care assistant workers as a new pattern of care providers in China play an important role in bridging the mental health treatment gap. Stigma and discrimination against people with mental disorders among care assistant workers is a barrier which adversely influences mental health service delivery. However, programs aimed at reducing stigma among care assistant workers are rare in China. Methods A total of 293 care assistant workers from four districts of Guangzhou, China were randomly divided into an intervention group (n = 139) and a control group (n = 154). The intervention group received anti-stigma training and the control group received traditional mental health training. Both trainings lasted for 3 h. Participants were measured before and after training using Perceived Devaluation and Discrimination Scale (PDD), Mental illness: Clinicians' Attitudes (MICA) and Mental Health Knowledge Schedule (MAKS). Data were analyzed by descriptive statistics, t-test, Chi square test or Fisher's exact test. Multilinear regression models were performed to calculate adjusted regression coefficient of the intervention on PPD, MAKS, and MICA. Results There were significant lower scores on PDD and MICA in the intervention group after training when compared with the control group (both P < 0.001). No significant difference was found on MAKS total score between the two groups after training (P = 0.118). Both groups had better correct identification of schizophrenia, depression and bipolar disorder before and after training. Conclusions These findings suggest that anti-stigma training may be effective in reducing the perception of devaluation-discrimination against people with mental illness and decreasing the level of negative stigma-related mental health attitudes among care assistant workers.
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Affiliation(s)
- Jie Li
- 1The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), NO. 36 Mingxin Road, Liwan District, Guangzhou, 510370 China
| | - Yu Fan
- 1The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), NO. 36 Mingxin Road, Liwan District, Guangzhou, 510370 China
| | - Hua-Qing Zhong
- 1The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), NO. 36 Mingxin Road, Liwan District, Guangzhou, 510370 China
| | - Xiao-Ling Duan
- 1The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), NO. 36 Mingxin Road, Liwan District, Guangzhou, 510370 China
| | - Wen Chen
- 2Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, China
| | - Sara Evans-Lacko
- 3Personal Social Services Research Unit, London School of Economics and Political Science, London, UK.,4Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF UK
| | - Graham Thornicroft
- 4Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF UK
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Snell-Rood C, Feltner F, Schoenberg N. What Role Can Community Health Workers Play in Connecting Rural Women with Depression to the "De Facto" Mental Health Care System? Community Ment Health J 2019; 55:63-73. [PMID: 29299719 DOI: 10.1007/s10597-017-0221-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 12/26/2017] [Indexed: 01/18/2023]
Abstract
The prevalence of depression among rural women is nearly twice the national average, yet limited mental health services and extensive social barriers restrict access to needed treatment. We conducted key informant interviews with community health workers (CHWs) and diverse health care professionals who provide care to Appalachian women with depression to better understand the potential roles that CHWs may play to improve women's treatment engagement. In the gap created by service disparities and social barriers, CHWs can offer a substantial contribution through improving recognition of depression; deepening rural women's engagement within existing services; and offering sustained, culturally appropriate support.
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Affiliation(s)
- Claire Snell-Rood
- Division of Community Health Sciences, School of Public Health, University of California, Berkeley, 207H University Hall #7360, Berkeley, CA, 94720, USA.
| | | | - Nancy Schoenberg
- Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, USA
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Introducing post-discharge malaria chemoprevention (PMC) for management of severe anemia in Malawian children: a qualitative study of community health workers' perceptions and motivation. BMC Health Serv Res 2018; 18:984. [PMID: 30567567 PMCID: PMC6299958 DOI: 10.1186/s12913-018-3791-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 12/04/2018] [Indexed: 11/17/2022] Open
Abstract
Background Severe malarial anaemia is one of the leading causes of paediatric hospital admissions in Malawi. Post-discharge malaria chemoprevention (PMC) is the intermittent administration of full treatment courses of antimalarial to children recovering from severe anaemia and findings suggest that this intervention significantly reduces readmissions and deaths in these children. Community delivery of health interventions utilizing community health workers (CHWs) has been successful in some programmes and not very positive in others. In Malawi, there is an on-going cluster randomised trial that aims to find the optimum strategy for delivery of dihydroartemesinin-piperaquine (DHP) for PMC in children with severe anaemia. Our qualitative study aimed to explore the feasibility of utilizing CHWs also known as health surveillance assistants (HSAs) to remind caregivers to administer PMC medication in the existing Malawian health system. Methods Between December 2016 and March 2018, 20 individual in-depth-interviews (IDIs) and 2 focus group discussions (FGDs) were conducted with 39 HSAs who had the responsibility of conducting home visits to remind caregivers of children who were prescribed PMC medication in the trial. All interviews were conducted in the local language, transcribed verbatim, and translated into English. The transcripts were uploaded to NVIVO 11 and analysed using the thematic framework analysis method. Results Although intrinsic motivation was reportedly high, adherence to the required number of home visits was very poor with only 10 HSAs reporting full adherence. Positive factors for adherence were the knowledge and perception of the effectiveness of PMC and the recognition from the community as well as health system. Poor training, lack of supervision, high workload, as well as technical and structural difficulties; were reported barriers to adherence by the HSAs. Conclusions Post-discharge malaria chemoprevention with DHP is perceived as a positive approach to manage children recovering from severe anaemia by HSAs in Malawi. However, adherence to home visit reminders was very poor and the involvement of HSAs in a scale up of this intervention may pose a challenge in the existing Malawian health system. Trial registration ClinicalTrials.gov identifier NCT02721420. The trial was registered on 26 March 2016. Electronic supplementary material The online version of this article (10.1186/s12913-018-3791-5) contains supplementary material, which is available to authorized users.
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Woldie M, Feyissa GT, Admasu B, Hassen K, Mitchell K, Mayhew S, McKee M, Balabanova D. Community health volunteers could help improve access to and use of essential health services by communities in LMICs: an umbrella review. Health Policy Plan 2018; 33:1128-1143. [PMID: 30590543 PMCID: PMC6415721 DOI: 10.1093/heapol/czy094] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2018] [Indexed: 12/21/2022] Open
Abstract
A number of primary studies and systematic reviews focused on the contribution of community health workers (CHWs) in the delivery of essential health services. In many countries, a cadre of informal health workers also provide services on a volunteer basis [community health volunteers (CHV)], but there has been no synthesis of studies investigating their role and potential contribution across a range of health conditions; most existing studies are narrowly focused on a single condition. As this cadre grows in importance, there is a need to examine the evidence on whether and how CHVs can improve access to and use of essential health services in low- and middle-income countries (LMICs). We report an umbrella review of systematic reviews, searching PubMed, the Cochrane library, the database of abstracts of reviews of effects (DARE), EMBASE, ProQuest dissertation and theses, the Campbell library and DOPHER. We considered a review as 'systematic' if it had an explicit search strategy with qualitative or quantitative summaries of data. We used the Joanna Briggs Institute (JBI) critical appraisal assessment checklist to assess methodological quality. A data extraction format prepared a priori was used to extract data. Findings were synthesized narratively. Of 422 records initially found by the search strategy, we identified 39 systematic reviews eligible for inclusion. Most concluded that services provided by CHVs were not inferior to those provided by other health workers, and sometimes better. However, CHVs performed less well in more complex tasks such as diagnosis and counselling. Their performance could be strengthened by regular supportive supervision, in-service training and adequate logistical support, as well as a high level of community ownership. The use of CHVs in the delivery of selected health services for population groups with limited access, particularly in LMICs, appears promising. However, success requires careful implementation, strong policy backing and continual support by their managers.
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Affiliation(s)
- Mirkuzie Woldie
- Department of Health Policy and Management, Jimma University, Jimma, Ethiopia
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, U.S.A
| | | | - Bitiya Admasu
- Department of Population and Family Health, Jimma University, Jimma, Ethiopia
| | - Kalkidan Hassen
- Department of Population and Family Health, Jimma University, Jimma, Ethiopia
| | | | | | - Martin McKee
- London School of Hygiene and Tropical Medicine, London, UK
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Chibanda D. Programmes that bring mental health services to primary care populations in the international setting. Int Rev Psychiatry 2018; 30:170-181. [PMID: 30821529 DOI: 10.1080/09540261.2018.1564648] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The last decade has witnessed an exponential growth of evidence-based care packages for mental, neurological, and substance use disorders (MNS) aimed at primary care populations; however, few have been taken to scale. Several barriers to successful integration and scale-up, such as low acceptability, poor clinical engagement process, lack of targeted resources, and poor stakeholder and policy support have been cited. This review describes and highlights common features of some of the promising programmes that deliver mental health services through primary health clinics, communities, and digital platforms, with an emphasis on those that show some evidence of complete or partial scale-up. Three distinct overarching themes and initiatives are discussed in relation to the above; primary health facilities, community (outside of primary healthcare), and digital/internet-based platforms, with a focus on how the three may interact synergistically to enhance successful integration and scale-up.
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Affiliation(s)
- Dixon Chibanda
- a London School of Hygiene & Tropical Medicine , London , UK.,b University of Zimbabwe College of Health Sciences , Harare , Zimbabwe
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Ballard M, Schwarz R. Employing practitioner expertise in optimizing community healthcare systems. HEALTHCARE-THE JOURNAL OF DELIVERY SCIENCE AND INNOVATION 2018; 7:100334. [PMID: 30146473 DOI: 10.1016/j.hjdsi.2018.08.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 08/01/2018] [Accepted: 08/16/2018] [Indexed: 11/27/2022]
Abstract
To harness the potential of community health workers (CHWs) to extend health services to poor and marginalized populations and avoid the pitfalls of the post-Alma-Ata period, there is an urgent need to better understand how CHW programs can be optimized. Understanding that several operational questions are unresolved by current academic evidence, this viewpoint considers the role of practitioner expertise in optimizing community health systems and highlights findings from a recently published report that captures implementation experience from 15 countries. The viewpoint considers applications of the report's suggested community health design principles and implications for implementers, philanthropists, policymakers, and academic researchers.
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Affiliation(s)
| | - Ryan Schwarz
- Community Health Impact Coalition, Berlin, Germany; Possible, Achham, Nepal; Brigham and Women's Hospital, Department of Medicine, Division of Global Health Equity, Boston, MA, USA; Harvard Medical School, Department of Medicine, Boston, MA, USA
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Scott K, Beckham SW, Gross M, Pariyo G, Rao KD, Cometto G, Perry HB. What do we know about community-based health worker programs? A systematic review of existing reviews on community health workers. HUMAN RESOURCES FOR HEALTH 2018; 16:39. [PMID: 30115074 PMCID: PMC6097220 DOI: 10.1186/s12960-018-0304-x] [Citation(s) in RCA: 310] [Impact Index Per Article: 51.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 07/30/2018] [Indexed: 05/04/2023]
Abstract
OBJECTIVE To synthesize current understanding of how community-based health worker (CHW) programs can best be designed and operated in health systems. METHODS We searched 11 databases for review articles published between 1 January 2005 and 15 June 2017. Review articles on CHWs, defined as non-professional paid or volunteer health workers based in communities, with less than 2 years of training, were included. We assessed the methodological quality of the reviews according to AMSTAR criteria, and we report our findings based on PRISMA standards. FINDINGS We identified 122 reviews (75 systematic reviews, of which 34 are meta-analyses, and 47 non-systematic reviews). Eighty-three of the included reviews were from low- and middle-income countries, 29 were from high-income countries, and 10 were global. CHW programs included in these reviews are diverse in interventions provided, selection and training of CHWs, supervision, remuneration, and integration into the health system. Features that enable positive CHW program outcomes include community embeddedness (whereby community members have a sense of ownership of the program and positive relationships with the CHW), supportive supervision, continuous education, and adequate logistical support and supplies. Effective integration of CHW programs into health systems can bolster program sustainability and credibility, clarify CHW roles, and foster collaboration between CHWs and higher-level health system actors. We found gaps in the review evidence, including on the rights and needs of CHWs, on effective approaches to training and supervision, on CHWs as community change agents, and on the influence of health system decentralization, social accountability, and governance. CONCLUSION Evidence concerning CHW program effectiveness can help policymakers identify a range of options to consider. However, this evidence needs to be contextualized and adapted in different contexts to inform policy and practice. Advancing the evidence base with context-specific elements will be vital to helping these programs achieve their full potential.
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Affiliation(s)
- Kerry Scott
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, 21205 United States of America
| | - S. W. Beckham
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, 21205 United States of America
| | - Margaret Gross
- Welch Medical Library, Johns Hopkins Medical Institutions, 1900 E Monument Street, Baltimore, 21205 United States of America
| | - George Pariyo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, 21205 United States of America
| | - Krishna D Rao
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, 21205 United States of America
| | - Giorgio Cometto
- Health Workforce Department, World Health Organization, Avenue Appia 20, 1202 Geneva, Switzerland
| | - Henry B. Perry
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, 21205 United States of America
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Surjaningrum ER, Jorm AF, Minas H, Kakuma R. Personal attributes and competencies required by community health workers for a role in integrated mental health care for perinatal depression: voices of primary health care stakeholders from Surabaya, Indonesia. Int J Ment Health Syst 2018; 12:46. [PMID: 30123318 PMCID: PMC6090729 DOI: 10.1186/s13033-018-0224-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 07/30/2018] [Indexed: 11/16/2022] Open
Abstract
Background Non-professional community health workers have been widely reported as possibly having a role in mental health. In Indonesia, their role is currently being introduced in the national health system for perinatal depression. Prior publications have shown that it is generally considered feasible and acceptable by key stakeholders for community health workers to identify and refer women experiencing mental health issues during their perinatal phase to primary care. However, characteristics and competencies required for these workers have not yet been identified. Methods 62 participants from four groups of stakeholders in primary health care in Surabaya were interviewed, including program managers, health workers, community health workers (CHWs), mental health specialists, and pregnant and postpartum women. Semi-structured questions were used to explore participants’ views about characteristics and competencies required by CHWs to identify and refer perinatal depression. Results Literacy and social skills were seen as basic characteristics required for CHWs to contribute to perinatal identification, together with willingness to volunteer and time availability. Participants identified females in the age range 30–50 years who have experienced pregnancy as being preferable. To ensure competency, training addressing knowledge about maternal life and depression, and communication skills are regarded as prerequisites for the role. Conclusions The results are consistent with WHO guidelines for informal workers working with people with mental disorders in non-specialised settings. The results provide a rationale for the criteria to be met when informal workers are to be involved in primary care mental health area and provide information for the development of training in the identification of perinatal depression.
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Affiliation(s)
- Endang R Surjaningrum
- 1Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia.,2Faculty of Psychology, University Airlangga, Surabaya, Indonesia
| | - Anthony F Jorm
- 1Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Harry Minas
- 1Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Ritsuko Kakuma
- 1Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
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Mutamba BB, Kohrt BA, Okello J, Nakigudde J, Opar B, Musisi S, Bazeyo W, de Jong J. Contextualization of psychological treatments for government health systems in low-resource settings: group interpersonal psychotherapy for caregivers of children with nodding syndrome in Uganda. Implement Sci 2018; 13:90. [PMID: 29954423 PMCID: PMC6025709 DOI: 10.1186/s13012-018-0785-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 06/20/2018] [Indexed: 11/23/2022] Open
Abstract
Background Evidence for the effectiveness of psychological treatments in low- and middle-income countries is increasing. However, there is a lack of systematic approaches to guide implementation in government health systems. The objective of this study was to address this gap by employing the Replicating Effective Programs (REP) framework to guide contextualization of a psychological treatment in the Uganda public health system for caregivers of children affected by nodding syndrome, a neuropsychiatric disorder endemic to Sub-Saharan Africa associated with high morbidity and disability. Methods To contextualize a psychological treatment, we followed the four components of the REP framework: pre-conditions, pre-implementation, implementation, and maintenance and evolution. A three-step process involved reviewing health services available for nodding syndrome-affected families and current evidence for psychological treatments, qualitative formative research, and analysis and documentation of implementation activities. Stakeholders included members of affected communities, health care workers, therapists, local government leaders, and Ministry of Health officials. Detailed written, audio, and video documentation of the implementation activities was used for content analysis. Results During the pre-condition component of REP, we selected group interpersonal therapy (IPT-G) because of its feasibility, acceptability, effectiveness in the local setting, and availability of locally developed training materials. During the pre-implementation component, we adapted the training, logistics, and technical assistance strategies in conjunction with government and stakeholder working groups. Adaptations included content modification based on qualitative research with caregivers of children with nodding syndrome. During the implementation component, training was shortened for feasibility with government health workers. Peer-to-peer supervision was selected as a sustainable quality assurance method. IPT-G delivered by community health workers was evaluated for fidelity, patient outcomes, and other process-level variables. More than 90% of beneficiaries completed the treatment program, which was effective in reducing caregiver and child mental health problems. With the Ministry of Health, we conducted preparatory activities for the maintenance and evolution component for scale-up throughout the country. Conclusions The REP framework provides a systematic approach to guide contextualization of psychological treatments for delivery in low-resource public health systems. Specific recommendations are provided for REP’s application in global mental health. Trial registration ISRCTN11382067; 08/06/2016; retrospectively registered Electronic supplementary material The online version of this article (10.1186/s13012-018-0785-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Byamah B Mutamba
- Butabika National Mental Hospital, Kampala, Uganda. .,Amsterdam Institute of Social Science Research, Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, The Netherlands.
| | - Brandon A Kohrt
- Department of Psychiatry, George Washington University, Washington, DC, USA
| | - James Okello
- Department of Psychiatry, Gulu University, Gulu, Uganda
| | - Janet Nakigudde
- Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Bernard Opar
- Ministry of Health Headquarters, Kampala, Uganda
| | - Seggane Musisi
- Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda
| | - William Bazeyo
- Makerere University School of Public Health, Makerere University, Kampala, Uganda
| | - Joop de Jong
- Amsterdam Institute of Social Science Research, Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, The Netherlands
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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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Betancourt TS, Fazel M. Commentary: Advancing an implementation science agenda on mental health and psychosocial responses in war-affected settings: comment on trials of a psychosocial intervention for youth affected by the Syrian crisis - by Panter-Brick et al. (2018). J Child Psychol Psychiatry 2018; 59:542-544. [PMID: 29667736 DOI: 10.1111/jcpp.12870] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/20/2017] [Indexed: 11/30/2022]
Abstract
Syria's civil conflict has created the largest humanitarian disaster of our time, causing massive population displacement, tremendous exposure to trauma, and loss. Advancing the mental health and psychosocial responses of war-affected populations both during acute humanitarian emergencies and in post-conflict transition is imperative in forging a constructive implementation agenda. This study makes an important contribution in building evidence toward effective interventions to advance the mental health and well-being of those affected by the Syrian crisis. Using an innovative approach, this work demonstrates that a thoughtful, ethical, and scientifically valid trial can be carried out in the midst of mass displacement. Further research is urgently needed on the effectiveness of interventions for vulnerable populations, with a growing need to embed studies of evidence-based mental health interventions within humanitarian responses.
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Ryan GK, Bauer A, Bass JK, Eaton J. Theory of change for the delivery of talking therapies by lay workers to survivors of humanitarian crises in low-income and middle-income countries: protocol of a systematic review. BMJ Open 2018; 8:e018193. [PMID: 29455163 PMCID: PMC5855449 DOI: 10.1136/bmjopen-2017-018193] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 12/13/2017] [Accepted: 12/14/2017] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION There is a severe shortage of specialist mental healthcare providers in low-income and middle-income countries (LMICs) affected by humanitarian crises. In these settings, talking therapies may be delivered by non-specialists, including lay workers with no tertiary education or formal certification in mental health. This systematic review will synthesise the literature on the implementation and effectiveness of talking therapies delivered by lay workers in LMICs affected by humanitarian crises, in order to develop a Theory of Change (ToC). METHODS AND ANALYSIS Qualitative, quantitative and mixed-methods studies assessing the implementation or effectiveness of lay-delivered talking therapies for common mental disorders provided to adult survivors of humanitarian crises in LMICs will be eligible for inclusion. Studies set in high-income countries will be excluded. No restrictions will be applied to language or year of publication. Unpublished studies will be excluded. Seven electronic databases will be searched: MEDLINE, Embase, PsycINFO, PsycEXTRA, Global Health, Cochrane Library and ClinicalTrials.gov. Contents pages of three peer-reviewed journals will be hand-searched. Sources of grey literature will include resource directories of two online mental health networks (MHPSS.net and MHInnovation.net) and expert consultation. Forward and backward citation searches of included studies will be performed. Two reviewers will independently screen studies for inclusion, extract data and assess study quality. A narrative synthesis will be conducted, following established guidelines. A ToC map will be amended iteratively to take into account the review results and guide the synthesis. ETHICS AND DISSEMINATION Findings will be presented in a manuscript for publication in a peer-reviewed journal and disseminated through a coordinated communications strategy targeting knowledge generators, enablers and users. PROSPERO REGISTRATION NUMBER CRD42017058287.
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Affiliation(s)
- Grace Kathryn Ryan
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
- Centre for Global Mental Health, London, UK
| | - Andreas Bauer
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
- Centre for Global Mental Health, London, UK
| | - Judith K Bass
- Department of Mental Health, Johns Hopkins University, Baltimore, Maryland, USA
- Center for Humanitarian Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Julian Eaton
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
- Centre for Global Mental Health, London, UK
- CBM International, Bensheim, Germany
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Trained lay health workers reduce common mental disorder symptoms of adults with suicidal ideation in Zimbabwe: a cohort study. BMC Public Health 2018; 18:227. [PMID: 29422023 PMCID: PMC5806479 DOI: 10.1186/s12889-018-5117-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 01/24/2018] [Indexed: 12/28/2022] Open
Abstract
Background Suicidal ideation may lead to deliberate self-harm which increases the risk of death by suicide. Globally, the main cause of deliberate self-harm is depression. The aim of this study was to explore prevalence of, and risk factors for, suicidal ideation among men and women with common mental disorder (CMD) symptoms attending public clinics in Zimbabwe, and to determine whether problem solving therapy delivered by lay health workers can reduce common mental disorder symptoms among people with suicidal ideation, using secondary analysis of a randomised controlled trial. Methods At trial enrolment, the Shona Symptom Questionnaire (SSQ) was used to screen for CMD symptoms. In the intervention arm, participants received six problem-solving therapy sessions conducted by trained and supervised lay health workers, while those in the control arm received enhanced usual care. We used multivariate logistic regression to identify risk factors for suicidal ideation at enrolment, and cluster-level logistic regression to compare SSQ scores at endline (6 months follow-up) between trial arms, stratified by suicidal ideation at enrolment. Results There were 573 participants who screened positive for CMD symptoms and 75 (13.1%) reported suicidal ideation at baseline. At baseline, after adjusting for confounders, suicidal ideation was independently associated with being aged over 24, lack of household income (household income yes/no; adjusted odds ratio 0.52 (95% CI 0.29, 0.95); p = 0.03) and with having recently skipped a meal due to lack of food (adjusted odds ratio 3.06 (95% CI 1.81, 5.18); p < 0.001). Participants who reported suicidal ideation at enrolment experienced similar benefit to CMD symptoms from the Friendship Bench intervention (adjusted mean difference − 5.38, 95% CI −7.85, − 2.90; p < 0.001) compared to those who had common mental disorder symptoms but no suicidal ideation (adjusted mean difference − 4.86, 95% CI −5.68, − 4.04; p < 0.001). Conclusions Problem-solving therapy delivered by trained and supervised lay health workers reduced common mental disorder symptoms among participants with suicidal thoughts who attended primary care facilities in Zimbabwe. Trial registration pactr.org ldentifier: PACTR201410000876178
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Perales J, Reininger BM, Lee M, Linder SH. Participants' perceptions of interactions with community health workers who promote behavior change: a qualitative characterization from participants with normal, depressive and anxious mood states. Int J Equity Health 2018; 17:19. [PMID: 29402278 PMCID: PMC5800056 DOI: 10.1186/s12939-018-0729-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 01/16/2018] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Interventions that promote healthier lifestyles among Latinos often involve community health workers (CHWs). CHWs can effectively advocate for healthier lifestyles and may be pivotal in addressing such mental health conditions as depression and anxiety. The goal of this study was to characterize the relationship dynamics between Latino participants and CHWs, from the participant's perspective. We aimed to determine if CHW-delivered community interventions effected behavior change, especially among participants who reported anxiety and depression. METHODS Semi-structured interviews were conducted with a purposive sample of 28 Latino participants that was based on a mental health scoring strata. Participants completed a lifestyle intervention that included multiple home visits from CHWs to promote physical activity and healthful food choice. Interviews were conducted in the participant's preferred language (English or Spanish). Transcribed interviews were analyzed using a grounded theory approach until concept saturation was achieved. RESULTS The sample was primarily female (82%), lower socioeconomic status (64%), and mean age of 50 years. Participants discussed the rapport building and professionalism of CHWs as a feature that facilitated strong, positive relationships and lifestyle behavior changes. Participants described how CHWs patterned their change approaches, which were similar to commonly used therapeutic techniques in the treatment of anxiety and depression. While anxiety and depression were described as having an impact on behavior change, most, but not all, participants who reported negative mood states said that the CHW relationship helped in changing that state to some extent. CONCLUSIONS Participants' perceptions indicated that positive personal changes were influenced by CHWs. Only participants who reported consistently poor scores for depression, anxiety or both reported negative or neutral experiences with the CHWs. This study lends qualitative support to the use of CHWs as extenders of care, particularly in areas that have a shortage of primary and mental health care providers.
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Affiliation(s)
- Joseph Perales
- La Clínica - Casa del Sol, 1501 Fruitvale Ave, Oakland, California, 94601, USA
| | - Belinda M Reininger
- UT Health School of Public Health in Brownsville, Division of Health Promotion & Behavioral Sciences and Hispanic Health Research Center, One West University Blvd, Brownsville, TX, 78520, USA. .,Michael & Susan Dell Center for Healthy Living, UT School of Public Health, Austin Regional Campus, University of Texas Administration Building (UTA), 1616 Guadalupe Street, Suite 6.300, Austin, Texas, 78701, USA. .,University of Texas Health Science Center at Houston, Center for Clinical and Translational Sciences, 7000 Fannin, Suite 1800, Houston, Texas, 77030, USA.
| | - MinJae Lee
- University of Texas Health Science Center at Houston, Center for Clinical and Translational Sciences, 7000 Fannin, Suite 1800, Houston, Texas, 77030, USA.,University of Texas Health Science Center at Houston, Biostatistics/Epidemiology/Research Design (BERD) Core, Center for Clinical and Translational Sciences, 7000 Fannin, Suite 1800, Houston, Texas, 77030, USA
| | - Stephen H Linder
- UT Health School of Public Health, Institute for Health Policy, Division of Management, Policy and Community Health, 6410 Fannin, Houston, TX, 77030, USA
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