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Javadizadeh E, Oudshoorn A, Letts L, Barbic S, Shanoff C, Marshall CA. Participatory Research with Persons who Experience Mental Illness in Occupational Therapy: A Scoping Review. Can J Occup Ther 2024; 91:203-221. [PMID: 38240309 PMCID: PMC11088223 DOI: 10.1177/00084174231212760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
Background. Persons who experience mental illness also face stigma and discrimination that frequently lead to a loss of ability to exercise autonomy and agency in their lives. Purpose. The range and breadth of literature exploring participatory research with persons living with mental illness are unknown in occupational therapy and occupation science. We initiated this study to fill this gap in the existing occupational therapy and occupational science literature. Method. Using the method of Arksey and O'Malley, we have conducted a scoping review to identify the range and breadth of literature. A qualitative content analysis was performed. Findings. A total of 34 articles were included in the narrative synthesis. The content analysis led to three related themes from the included studies: (1) coming together; (2) unique potential of participatory research; and (3) challenges in conducting participatory research. Conclusions. This review highlights that participatory research is well suited to research conducted with persons living with mental illness to support meaningful engagement and minimize stigma throughout the research process. This review can guide future participatory research and practice in occupational therapy and occupational science with persons living with mental illness.
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Affiliation(s)
- Elham Javadizadeh
- Elham Javadizadeh, Health & Rehabilitation Sciences, Elborn College, University of Western Ontario, London, Ontario, Canada.
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Oancea-Matei DA, Gherguț A, Maftei A. Do we react differently toward bionic devices vs. cochlear implants and wheelchairs? Possible links with personality traits. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1159663. [PMID: 37496700 PMCID: PMC10366533 DOI: 10.3389/fresc.2023.1159663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 06/27/2023] [Indexed: 07/28/2023]
Abstract
The present study explored the attitudes toward individuals with bionic eyes and limbs, cochlear implants, and people with disabilities that imply using a wheelchair. Our sample consisted of 474 Romanian adults aged 18-61 (M = 27.56, SD = 11.80). Participants were randomly divided into five groups. They all filled scales related to personality characteristics, i.e., agreeableness, neuroticism, openness to experience, comprehension/intellectual efficiency, and previous contact with disability. Then, each group was presented with a vignette describing a character (wheelchair/bionic eye/bionic leg/cochlear implant/control group). Finally, they answered questions about their emotions, cognitions, and behaviors related to that context. Overall, our results suggested that higher agreeability, extraversion, openness to experience, intellectual complexity, and lower neuroticism were generally associated with more positive attitudes toward disability. When examining the differences in participants' emotions, cognitions, and behaviors depending on the target's characteristics, our results generally suggested that the most negative reactions were toward the character with a bionic eye. We discuss these findings considering their importance for shaping positive attitudes related to disability, especially related to the future technological advances in bionic devices.
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Affiliation(s)
| | | | - Alexandra Maftei
- Department of Education Sciences, Faculty of Psychology and Education Sciences, Alexandru Ioan Cuza University, Iași, Romania
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Gamieldien F, Galvaan R, Myers B, Sorsdahl K. Mental Health Service Users and Their Caregivers Perspectives on Personal Recovery from Severe Mental Health Conditions in Cape Town, South Africa: A Qualitative Study. JOURNAL OF PSYCHOSOCIAL REHABILITATION AND MENTAL HEALTH 2023; 11:201-219. [PMID: 38887754 PMCID: PMC11180021 DOI: 10.1007/s40737-023-00341-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 03/25/2023] [Indexed: 06/20/2024]
Abstract
Severe mental health conditions (SMHCs) significantly contribute to the global disease burden. In low-and-middle-income countries (LMICs) like South Africa, the long-term impact of SMHCs on individuals and their families is serious. However, mental health services focus on clinical recovery, with little attention given to the personal recovery needs of mental health service users (MHSUs) and their caregivers. The CHIME framework outlines five domains characterising personal recovery: connectedness, hope and optimism about the future, identity, meaning in life, and empowerment. This qualitative, descriptive study sought insights from male MHSUs and their caregivers on their perspectives of personal recovery from SMHCs. Four male MHSUs and three of their caregivers were purposively selected from Cape Flats communities in the Western Cape. Data were collected using visual participatory methods, including photovoice, life graphs, community maps, and photo-elicitation interviews with MHSUs. In addition, semi-structured interviews were held with caregivers. Data were thematically analysed, and two main themes emerged: Finding meaningful participation and affirming agency. These themes describe how diverse contextual, socioeconomic, political, demographic, cultural, and spiritual factors help and hinder personal recovery. MHSUs and their caregivers sought support from mental health non-profit organisations (MH-NPOs) because of stigmatising attitudes from their communities. MH-NPOs provided MHSUs with long-term relational support and opportunities to build their capacities which helped them access living, learning, working and socialising opportunities. Understanding the diverse needs of MHSUs and including MH-NPOs in scaling up community-based mental health services in LMICs will enable more accessible services that support personal recovery.
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Affiliation(s)
- Fadia Gamieldien
- Department of Psychiatry and Mental Health, Alan J. Flisher Centre for Public Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town, 7700 South Africa
- Division of Occupational Therapy, Department of Health and Rehabilitation Sciences, University of Cape Town, Cape Town, South Africa
- Inclusive Practices Africa Research Unit, Department of Health and Rehabilitation Sciences, University of Cape Town, Cape Town, South Africa
| | - Roshan Galvaan
- Division of Occupational Therapy, Department of Health and Rehabilitation Sciences, University of Cape Town, Cape Town, South Africa
- Inclusive Practices Africa Research Unit, Department of Health and Rehabilitation Sciences, University of Cape Town, Cape Town, South Africa
| | - Bronwyn Myers
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA Australia
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
- Division of Addiction Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Katherine Sorsdahl
- Department of Psychiatry and Mental Health, Alan J. Flisher Centre for Public Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town, 7700 South Africa
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Merner B, Schonfeld L, Virgona A, Lowe D, Walsh L, Wardrope C, Graham-Wisener L, Xafis V, Colombo C, Refahi N, Bryden P, Chmielewski R, Martin F, Messino NM, Mussared A, Smith L, Biggar S, Gill M, Menzies D, Gaulden CM, Earnshaw L, Arnott L, Poole N, Ryan RE, Hill S. Consumers' and health providers' views and perceptions of partnering to improve health services design, delivery and evaluation: a co-produced qualitative evidence synthesis. Cochrane Database Syst Rev 2023; 3:CD013274. [PMID: 36917094 PMCID: PMC10065807 DOI: 10.1002/14651858.cd013274.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
BACKGROUND Partnering with consumers in the planning, delivery and evaluation of health services is an essential component of person-centred care. There are many ways to partner with consumers to improve health services, including formal group partnerships (such as committees, boards or steering groups). However, consumers' and health providers' views and experiences of formal group partnerships remain unclear. In this qualitative evidence synthesis (QES), we focus specifically on formal group partnerships where health providers and consumers share decision-making about planning, delivering and/or evaluating health services. Formal group partnerships were selected because they are widely used throughout the world to improve person-centred care. For the purposes of this QES, the term 'consumer' refers to a person who is a patient, carer or community member who brings their perspective to health service partnerships. 'Health provider' refers to a person with a health policy, management, administrative or clinical role who participates in formal partnerships in an advisory or representative capacity. This QES was co-produced with a Stakeholder Panel of consumers and health providers. The QES was undertaken concurrently with a Cochrane intervention review entitled Effects of consumers and health providers working in partnership on health services planning, delivery and evaluation. OBJECTIVES 1. To synthesise the views and experiences of consumers and health providers of formal partnership approaches that aimed to improve planning, delivery or evaluation of health services. 2. To identify best practice principles for formal partnership approaches in health services by understanding consumers' and health providers' views and experiences. SEARCH METHODS We searched MEDLINE, Embase, PsycINFO and CINAHL for studies published between January 2000 and October 2018. We also searched grey literature sources including websites of relevant research and policy organisations involved in promoting person-centred care. SELECTION CRITERIA We included qualitative studies that explored consumers' and health providers' perceptions and experiences of partnering in formal group formats to improve the planning, delivery or evaluation of health services. DATA COLLECTION AND ANALYSIS Following completion of abstract and full-text screening, we used purposive sampling to select a sample of eligible studies that covered a range of pre-defined criteria, including rich data, range of countries and country income level, settings, participants, and types of partnership activities. A Framework Synthesis approach was used to synthesise the findings of the sample. We appraised the quality of each study using the CASP (Critical Appraisal Skill Program) tool. We assessed our confidence in the findings using the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach. The Stakeholder Panel was involved in each stage of the review from development of the protocol to development of the best practice principles. MAIN RESULTS We found 182 studies that were eligible for inclusion. From this group, we selected 33 studies to include in the final synthesis. These studies came from a wide range of countries including 28 from high-income countries and five from low- or middle-income countries (LMICs). Each of the studies included the experiences and views of consumers and/or health providers of partnering in formal group formats. The results were divided into the following categories. Contextual factors influencing partnerships: government policy, policy implementation processes and funding, as well as the organisational context of the health service, could facilitate or impede partnering (moderate level of confidence). Consumer recruitment: consumer recruitment occurred in different ways and consumers managed the recruitment process in a minority of studies only (high level of confidence). Recruiting a range of consumers who were reflective of the clinic's demographic population was considered desirable, particularly by health providers (high level of confidence). Some health providers perceived that individual consumers' experiences were not generalisable to the broader population whereas consumers perceived it could be problematic to aim to represent a broad range of community views (high level of confidence). Partnership dynamics and processes: positive interpersonal dynamics between health providers and consumers facilitated partnerships (high level of confidence). However, formal meeting formats and lack of clarity about the consumer role could constrain consumers' involvement (high level of confidence). Health providers' professional status, technical knowledge and use of jargon were intimidating for some consumers (high level of confidence) and consumers could feel their experiential knowledge was not valued (moderate level of confidence). Consumers could also become frustrated when health providers dominated the meeting agenda (moderate level of confidence) and when they experienced token involvement, such as a lack of decision-making power (high level of confidence) Perceived impacts on partnership participants: partnering could affect health provider and consumer participants in both positive and negative ways (high level of confidence). Perceived impacts on health service planning, delivery and evaluation: partnering was perceived to improve the person-centredness of health service culture (high level of confidence), improve the built environment of the health service (high level of confidence), improve health service design and delivery e.g. facilitate 'out of hours' services or treatment closer to home (high level of confidence), enhance community ownership of health services, particularly in LMICs (moderate level of confidence), and improve consumer involvement in strategic decision-making, under certain conditions (moderate level of confidence). There was limited evidence suggesting partnering may improve health service evaluation (very low level of confidence). Best practice principles for formal partnering to promote person-centred care were developed from these findings. The principles were developed collaboratively with the Stakeholder Panel and included leadership and health service culture; diversity; equity; mutual respect; shared vision and regular communication; shared agendas and decision-making; influence and sustainability. AUTHORS' CONCLUSIONS Successful formal group partnerships with consumers require health providers to continually reflect and address power imbalances that may constrain consumers' participation. Such imbalances may be particularly acute in recruitment procedures, meeting structure and content and decision-making processes. Formal group partnerships were perceived to improve the physical environment of health services, the person-centredness of health service culture and health service design and delivery. Implementing the best practice principles may help to address power imbalances, strengthen formal partnering, improve the experiences of consumers and health providers and positively affect partnership outcomes.
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Affiliation(s)
- Bronwen Merner
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Lina Schonfeld
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Ariane Virgona
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Dianne Lowe
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
- Child and Family Evidence, Australian Institute of Family Studies, Melbourne, Australia
| | - Louisa Walsh
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Cheryl Wardrope
- Clinical Governance, Metro South Hospital and Health Service, Eight Mile Plains, Australia
| | | | - Vicki Xafis
- The Sydney Children's Hospitals Network, Sydney, Australia
| | - Cinzia Colombo
- Laboratory for medical research and consumer involvement, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Nora Refahi
- Consumer Representative, Melbourne, Australia
| | - Paul Bryden
- Consumer Representative, Caboolture, Australia
| | - Renee Chmielewski
- Planning and Patient Experience, The Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | | | | | | | - Lorraine Smith
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Susan Biggar
- Consumer Representative, Melbourne, Australia
- Australian Health Practitioner Regulation Agency (AHPRA), Melbourne, Australia
| | - Marie Gill
- Gill and Wilcox Consultancy, Melbourne, Australia
| | - David Menzies
- Chronic Disease Programs, South Eastern Melbourne Primary Health Network, Heatherton, Australia
| | - Carolyn M Gaulden
- Detroit Wayne County Authority Health Residency Program, Michigan State University, Providence Hospital, Southfield, Michigan, USA
| | | | | | - Naomi Poole
- Strategy and Innovation, Australian Commission on Safety and Quality in Health Care, Sydney, Australia
| | - Rebecca E Ryan
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Sophie Hill
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
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Odongo DA, Forkuor JB, Ofori-Dua K, Dapaah JM, Dwumah P. The nature and extent of healthcare provision for people with intellectual disabilities in Ghana: A qualitative study. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2022; 26:637-656. [PMID: 34219545 DOI: 10.1177/17446295211016171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Ghana has designated special schools with the mandate of training and equipping persons with intellectual disabilities with social functioning and vocational skills needed to promote their social inclusion. This study investigates the nature and extent of healthcare provision for persons with intellectual disabilities in their respective special schools. This research adopted a qualitative, but participatory approach to collect data from respective stakeholders. The findings reveal that some of these special schools do not have professional health workers, and most healthcare providers have challenges diagnosing and prescribing medication for this population due to the health workers' limited understanding of their healthcare needs, coupled with communication barriers. The researchers have suggested setting up of a special health department with personnel who have received training on intellectual disabilities. This department must undertake training for the housemothers in special schools, parents in the communities, and teachers in special schools.
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Affiliation(s)
| | | | - Kwadwo Ofori-Dua
- Kwame Nkrumah University of Science and Technology (KNUST), Ghana
| | | | - Peter Dwumah
- Kwame Nkrumah University of Science and Technology (KNUST), Ghana
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de Wet A, Pretorius C. From darkness to light: Barriers and facilitators to mental health recovery in the South African context. Int J Soc Psychiatry 2022; 68:82-89. [PMID: 33307927 DOI: 10.1177/0020764020981126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND South Africa is a low and middle income country facing many challenges in public mental health care and implementation of recovery. AIMS To contribute to what barriers and facilitators to recovery might be for service users in South Africa, from the perspective of service users, carers and service providers from three psychiatric hospitals in the Western Cape province. METHOD Interviews and focus groups were conducted with service users, carers and service providers. Interviews and focus groups were transcribed and analysed using atlas.ti software and reflexive thematic analysis, from the bottom up. RESULTS The barriers, environment, family, public mental health services, stigma and service users' attitude or behaviour generated, were found to be the most salient. The facilitators to recovery generated were support, family or friends, service providers, structure and empowerment. The need for support was identified as an underlying component to all these themes. CONCLUSION Barriers and facilitators to recovery seemed to have both intrapersonal and external sources that intersect at times. Recovery needs to be supported at an individual level, especially through an under-utilised resource such as peer support work, but in conjunction with the development of recovery-enabling environments in services and communities in South Africa.
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Affiliation(s)
- Anneliese de Wet
- Psychology Department, Stellenbosch University, Matieland, Western Cape, South Africa
| | - Chrisma Pretorius
- Psychology Department, Stellenbosch University, Matieland, Western Cape, South Africa
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Wang Z, Xu X, Han Q, Chen Y, Jiang J, Ni GX. Factors associated with public attitudes towards persons with disabilities: a systematic review. BMC Public Health 2021; 21:1058. [PMID: 34082734 PMCID: PMC8173851 DOI: 10.1186/s12889-021-11139-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 05/18/2021] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE The aim of this review is to identify and summarize factors that are associated with public attitudes towards people with various disabilities systematically. METHODS An electronic search of three databases was performed (Medline, EMBASE and Cochrane) covering the period from 1950 to present. A comprehensive search strategy was developed and the lists of citations were screened for potential eligible studies. Only quantitative studies using valid measurements were included, and the methodological quality of included studies was appraised based on three criteria (sample, measurement, analysis) by two independent reviewers. RESULTS The initial electronic search yielded 995 articles after duplicates removed, and 27 studies met the eligibility criteria were included in the study. Three categories of the factors were found to be associated with the public attitudes, which are related to the attitude provider, disabled people, and society respectively. Specifically, the more people know about disabilities, the more likely they were to have positive attitude; and the frequency and quality of the contact with the disabled are also proved to be influential to the attitudes. Meanwhile, the type of disability is also closely correlated to the public's attitude towards the disabilities. CONCLUSION People's knowledge of the disability and their contact with individuals with disabilities are the main influential factors in public attitudes towards persons with disabilities.
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Affiliation(s)
- Ziru Wang
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, 10084, China
| | - Xiaoli Xu
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Qiong Han
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yan Chen
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, 10084, China
| | - Jiayao Jiang
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, 10084, China
| | - Guo-Xin Ni
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, 10084, China.
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Asrat B, Lund C, Ambaw F, Schneider M. Adaptation of the WHO group interpersonal therapy for people living with HIV/AIDS in Northwest Ethiopia: A qualitative study. PLoS One 2020; 15:e0238321. [PMID: 32853261 PMCID: PMC7451549 DOI: 10.1371/journal.pone.0238321] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 08/13/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Psychological treatments improve depressive symptoms in people living with HIV/AIDS (PLWHA). Adaptation of treatments should be based on explanatory models of depression and other elements within the given context. AIM This study aimed to examine explanatory models of depression and acceptable approaches for implementation of group IPT in Northwest Ethiopia. METHODS Qualitative data were collected from April to May 2019 from case managers, adherence supporters and service users using focus group discussion and analysed thematically. RESULTS PLWHA attributed depression to psychosocial problems, spiritual factors and biological factors. Depression had several impacts at individual and family level. Group-based interpersonal therapy (IPT) was acceptable if provided by trained peer counselors. CONCLUSION The current study findings informed how to conduct feasibility and acceptability trials of group IPT in the HIV population in Ethiopia.
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Affiliation(s)
- Biksegn Asrat
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Crick Lund
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Centre for Global Mental Health, King’s Global Health Institute, Department of Health Services and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Fentie Ambaw
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
- Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Marguerite Schneider
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Susanti H, James K, Utomo B, Keliat B, Lovell K, Irmansyah I, Rose D, Colucci E, Brooks H. Exploring the potential use of patient and public involvement to strengthen Indonesian mental health care for people with psychosis: A qualitative exploration of the views of service users and carers. Health Expect 2020; 23:377-387. [PMID: 31782266 PMCID: PMC7104636 DOI: 10.1111/hex.13007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/12/2019] [Accepted: 11/12/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Patient and public involvement (PPI) has the potential to strengthen mental health systems in Indonesia and improve care for people living with psychosis. Current evidence from other parts of the world demonstrates the need to understand the contexts in which PPI is to be enacted to ensure optimal implementation. OBJECTIVE To understand service users' and carers' views on the current use and potential applicability of PPI within Indonesian mental health services. DESIGN Qualitative study incorporating focus groups analysed using thematic analysis. SETTING AND PARTICIPANTS Participants included 22 service users and 21 carers recruited from two study sites in Indonesia (Jakarta and Bogor). All participants had experience of psychosis either as a service user or carer. RESULTS Despite the value attributed to PPI in relation to improving services and promoting recovery, current use of such activities in Indonesian mental health services was limited. Participants expressed a desire for greater levels of involvement and more holistic care but felt community organizations were best placed to deliver this because PPI was considered more congruent with the ethos of third-sector organizations. Additional barriers to PPI included stigma and low levels of mental health literacy in both health services and communities. DISCUSSION AND CONCLUSION Participants felt that there was potential value in the use of PPI within Indonesian mental health services with careful consideration of individual contexts. Future aspirations of involvement enactment should ensure a central design and delivery role for third-sector organizations. Facilitators to global collaborative research in the context of the current study are also discussed.
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Affiliation(s)
- Herni Susanti
- Faculty of NursingUniversitas IndonesiaDepokIndonesia
| | - Karen James
- Faculty of Health, Social Care and EducationCentre for Health and Social Care ResearchKingston and St GeorgesLondonUK
| | | | | | - Karina Lovell
- Division of Nursing, Midwifery and Social WorkSchool of Health SciencesFaculty of Biology, Medicine and HealthUniversity of ManchesterManchester Academic Health Science CentreManchesterUK
- Greater Manchester Mental Health NHS Foundation TrustManchesterUK
| | - I Irmansyah
- National Institute of Health Research and DevelopmentJakartaIndonesia
- Marzoeki Mahdi HospitalBogorIndonesia
| | - Diana Rose
- Department of Health Services ResearchKings College LondonLondonUK
| | | | - Helen Brooks
- Department of Health Services ResearchInstitute of Population Health SciencesUniversity of LiverpoolLiverpoolUK
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Hall T, Kakuma R, Palmer L, Minas H, Martins J, Armstrong G. Service user and family participation in mental health policy making in Timor-Leste: a qualitative study with multiple stakeholders. BMC Psychiatry 2020; 20:117. [PMID: 32164633 PMCID: PMC7069011 DOI: 10.1186/s12888-020-02521-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 02/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Participation in mental health system strengthening by people with mental health problems and their families is a cornerstone of people-centred mental health care, yet there is a dearth of research about participation from low- and middle-income countries (LMICs), particularly from the Asia Pacific region. Hence, this study aimed to assess the current situation, challenges, enabling factors and future actions for service user and family participation in mental health policy making in Timor-Leste. METHODS In-depth interviews were conducted with 85 adults (≥18 years) who were: (1) mental health service users (n = 20) and their families (n = 10); (2) government decision makers (n = 10); (3) mental health and social service providers (n = 23); (4) civil society (n = 9); and (5) other groups (n = 13). Interview data was analysed using framework analysis. RESULTS There was limited service user, family and community participation in mental health policy making in Timor-Leste. Perceptions that policy making is a technical exercise and that people with mental health problems lack cognitive capacity, and a lack of supportive mechanisms challenged participation. Enabling factors were a strong focus on human rights within the social sector, and existing mechanisms for advocacy and representation of people with disabilities in social policy making. Participants suggested bolstering civil society representation of people with mental health problems, and increasing mental health awareness and literacy, including government competencies to facilitate service user participation. CONCLUSION The findings highlight the need for theoretical and practical focus on the role of family within mental health system development in LMICs. Global mental health research and practice should adopt a critical approach to mental health service user and family participation to ensure that the concept and strategies to achieve this are embedded in LMIC knowledge.
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Affiliation(s)
- Teresa Hall
- Nossal Institute for Global Health, The University of Melbourne, Exhibition Street, Melbourne, 3004, Australia.
| | - Ritsuko Kakuma
- grid.8991.90000 0004 0425 469XLondon School of Hygiene and Tropical Medicine, London, UK ,grid.1008.90000 0001 2179 088XCentre for Mental Health, The University of Melbourne, Melbourne, Australia
| | - Lisa Palmer
- grid.1008.90000 0001 2179 088XSchool of Geography, The University of Melbourne, Melbourne, Australia
| | - Harry Minas
- grid.1008.90000 0001 2179 088XCentre for Mental Health, The University of Melbourne, Melbourne, Australia
| | - João Martins
- grid.449369.5Faculty of Medicine and Health Sciences, National University of Timor-Leste, Dili, Timor-Leste
| | - Greg Armstrong
- grid.1008.90000 0001 2179 088XNossal Institute for Global Health, The University of Melbourne, Melbourne, Australia
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Marais DL, Quayle M, Petersen I. Making consultation meaningful: Insights from a case study of the South African mental health policy consultation process. PLoS One 2020; 15:e0228281. [PMID: 31995612 PMCID: PMC6988953 DOI: 10.1371/journal.pone.0228281] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 01/12/2020] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND It is widely recognised that mental health policies should be developed in consultation with those tasked with their implementation and the users affected by them. In the South African legislative context public participation in policymaking is assumed, with little guidance on how to conduct consultation processes, nor how to use consultation inputs in policy decisions. METHODS The South African Mental Health Policy Framework and Strategic Plan was adopted in 2013 after an extensive consultation process. Focussing on the 2012 provincial and national consultation summit, this case-study conducted key informant interviews and undertook documentary analysis to explore the process through which consultation inputs were-or were not-transferred to inform this policy. Between 2013 and 2016 seven interviews were conducted, and 11 documents (policy drafts and summit outputs) and transcripts of 23 audio-recorded sessions from the national summit were analysed. RESULTS Findings revealed that no substantive changes were made to the mental health policy following the consultation summits. There do not seem to have been systematic processes for facilitating and capturing knowledge inputs, or for transferring these inputs between provincial and national levels. There was also no further consultation regarding priorities identified for implementation prior to finalisation of the policy, with participants highlighting concerns about policy implementation at local levels as a result. This represents a lost opportunity for greater involvement of service users in policy development. CONCLUSIONS Together with poor service-user representation, the format of the consultation process limited participant interaction and the possibility for engagement with, or uptake of, more experiential forms of knowledge. Several procedural elements were found to limit the elicitation and transference of consultation contributions for uptake into policy. Recommendations for future policy consultations include adapting the format of participatory processes to enable optimal use of participant knowledge, as well as greater service-user participation.
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Affiliation(s)
- Debra Leigh Marais
- Undergraduate Research Office, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Michael Quayle
- Centre for Social Issues Research, Department of Psychology, University of Limerick, Limerick, Ireland
- Department of Psychology, School of Applied Human Sciences University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Inge Petersen
- Centre for Rural Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Musuva RM, Odhiambo GO, Atuncha VO, Mutete ET, Odiere MR, Abong'o B, Alaii J, Mwinzi PNM. A Qualitative Description of Community Participation in Water and Sanitation Activities in the Control of Schistosomiasis in Nyalenda B, an Informal Settlement in Kisumu City, Western Kenya. East Afr Health Res J 2019; 3:48-56. [PMID: 34308195 PMCID: PMC8279324 DOI: 10.24248/eahrj-d-18-00032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 07/15/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Community participation is central to the success of primary health care. However, over 30 years since the Alma Ata declaration, the absence of universal community participation remains a major obstacle to combating all types of diseases. This study investigated community participation in water and sanitation activities towards schistosomiasis control in Nyalenda B, an informal settlement in Kisumu City. METHODS Eight key informant interviews (KIIs) and 8 focus group discussions (FGDs) were conducted. Additionally, data on NGOs dealing with water and sanitation activities in Kisumu was collected from the local NGO registration Board. Qualitative data was organised into themes and concepts and analyzed using Atlas.ti. RESULTS Most participants felt that project implementers did not involve them in key levels of project implementation, leading to unsustainable projects and unacceptance from the community. Community structures identified that could be used as avenues of engaging the community in improving water and sanitation situation included the use of organised groups, such as youth, gender-based, farmers and HIV support groups, and merry-go-rounds. Factors mentioned that hindered community participation included negative attitude from community members, poor monitoring and evaluation strategies, limited disclosure of project details, and overdependence from the community. CONCLUSION Effective community participation in water and sanitation activities requires a multipronged paradigm that incorporates a change of attitude from the community, information sharing and consultation, improved monitoring and evaluation, transparency and accountability.
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Affiliation(s)
- Rosemary M Musuva
- Neglected Tropical Diseases Branch, Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
- Public Health Department, School of Public Health and Community Development, Maseno University, Maseno, Kenya
| | - Gladys O Odhiambo
- Neglected Tropical Diseases Branch, Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
- Public Health Department, School of Public Health and Community Development, Maseno University, Maseno, Kenya
| | - Vincent O Atuncha
- Neglected Tropical Diseases Branch, Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
- Public Health Department, School of Public Health and Community Development, Maseno University, Maseno, Kenya
| | - Elizabeth T Mutete
- Neglected Tropical Diseases Branch, Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Maurice R Odiere
- Neglected Tropical Diseases Branch, Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Bernard Abong'o
- Public Health Department, School of Public Health and Community Development, Maseno University, Maseno, Kenya
| | | | - Pauline NM Mwinzi
- Neglected Tropical Diseases Branch, Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
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13
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Yoma SM. [User participation in public policies of mental health: an integrative review]. CIENCIA & SAUDE COLETIVA 2019; 24:2499-2512. [PMID: 31340269 DOI: 10.1590/1413-81232018247.14402017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 09/21/2017] [Indexed: 11/22/2022] Open
Abstract
The scope of this integrative review was to identify and analyze scientific articles regarding user participation in public policies of mental health. A bibliographic search was performed between November 2016 and May 2017 in the Pubmed, Scielo and Lilacs databases. The sample of the integrative review was comprised of seven relevant articles that met the inclusion criteria. The documents obtained were analyzed using Atlas Ti 6.1 hermeneutic analysis software. As a result, the review found a growing legislative and governmental recognition of user participation in public policies of mental health; persistent questions about their "capacity" to participate; several barriers to successful participation; and some strategies to bolster this participation. One of the main challenges identified is to overcome prejudiced and stigmatizing beliefs that operate as barriers to effective user participation, and to build the necessary adaptations that enable people with psychosocial disabilities to participate on equal terms with the rest of the population.
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Affiliation(s)
- Solana María Yoma
- Instituto de Investigación y Formación en Administración Pública, Pública, CONICET, Facultad de Ciencias Sociales, Universidad Nacional de Córdoba. Rondeau 467/2°piso. 5000 Córdoba Argentina.
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14
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De Wet A, Parker J, Pretorius C. The Spring Foundation: a recovery approach to institutional public mental health services in South Africa. Perspect Public Health 2019; 139:123-124. [PMID: 31074345 DOI: 10.1177/1757913919838767] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - John Parker
- Department of Psychiatry, University of Cape Town, Cape Town, South Africa; Provincial Department of Health, Lentegeur Hospital, Cape Town, Western Cape Province, South Africa
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Abayneh S, Lempp H, Manthorpe J, Hanlon C. Development of programme theory for integration of service user and caregiver involvement in mental health system strengthening: protocol for realist systematic review. Int J Ment Health Syst 2018; 12:41. [PMID: 30061922 PMCID: PMC6057009 DOI: 10.1186/s13033-018-0220-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 07/18/2018] [Indexed: 11/10/2022] Open
Abstract
Background There is international recognition of the need for service user and caregiver involvement in mental health system strengthening. However, little is known about how best to integrate this approach into the mental healthcare system; what works to advance involvement, under what conditions, how and when does involvement bring added value, and how can it work in resource-poor settings in low and middle-income countries. Objective To describe the methodology for a realist systematic review protocol to synthesise the evidence to explain the contexts, outcomes, and underlying mechanisms for involvement of service users with severe mental health problems and their caregivers in mental healthcare policy-making and planning, advocacy, service development, monitoring and improvement. Methods/designs The proposed realist systematic review will involve five steps: (i) clarifying the review scope, (ii) a systematic search for evidence, (iii) evidence appraisal and data extraction, (iv) data analysis, (v) synthesis of evidence and formation of revised programme theory. Inputs from a formative qualitative study, consultative Theory of Change meetings with key stakeholder groups, and scoping reviews will be used to identify candidate theory/theories that will guide the selection, appraisal and analysis of studies, and refine the Theory of Change model that will be piloted and evaluated. Synthesis of data will be undertaken using realist logic, constant comparison and thematic analysis. In a consultative meeting with stakeholders the Theory of Change model will then be situated with respect to relevant programme theories and adapted to incorporate the synthesized evidence of relevance to the local context. The finalized Theory of Change model will be piloted and evaluated in a primary health care setting in rural Ethiopia. Discussion Realist review methodology has not been applied to the area of mental health service user involvement in low- and middle-income country settings. In this protocol, we describe how this contextualized approach will be applied to identify and refine a theory-driven and transferable model of involvement of service users, embedded in ongoing work in Ethiopia.Systematic review registration PROSPERO CRD42018084595.
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Affiliation(s)
- Sisay Abayneh
- 1Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Heidi Lempp
- 2Department of Inflammation Biology, Faculty of Life Sciences & Medicine, King's College London, Weston Education Centre, 10, Cutcombe Road, London, SE5 9RJ UK
| | - Jill Manthorpe
- 3Health &Social Care Workforce Research Unit, King's College London, Strand, London, WC2 4LL UK
| | - Charlotte Hanlon
- 1Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,4Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neurosciencem, King's College London, 16 De Crespigny Park, London, SE5 8AF UK
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Mathias K, Pant H, Marella M, Singh L, Murthy GVS, Grills N. Multiple barriers to participation for people with psychosocial disability in Dehradun district, North India: a cross-sectional study. BMJ Open 2018; 8:e019443. [PMID: 29487074 PMCID: PMC5855246 DOI: 10.1136/bmjopen-2017-019443] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES This study used a population-based cross-sectional survey to describe the prevalence of psychosocial disability and unmet need for access to services in North India. SETTING This study was conducted in Dehradun district, Uttarakhand, in 2014. PARTICIPANTS A population-based sample of 2441 people over the age of 18 years. PRIMARY OUTCOME MEASURES The Rapid Assessment of Disability survey tool identified people with disability and used an adapted version of the Kessler scale to identify those with psychosocial disability. It additionally collected information on socioeconomic variables, access to community services and barriers to participation. Prevalence of psychosocial disability and unmet needs and descriptions of barriers to services were calculated, and multivariable logistic regression was used to assess associations between risk factors and psychosocial disability. RESULTS Prevalence of psychosocial disability was 4.8% and 75% of participants with psychological distress also reported comorbid functional impairments. Adjusted ORs for depression of more than two were found for people who were unschooled, unemployed and of moderate or poor socioeconomic status. The unmet need for access to services was significantly higher in every domain for people with psychosocial disability and was more than 25% in the areas of employment, health service access and community consultation. People with psychosocial disability encountered greater barriers in each domain compared with controls. CONCLUSIONS People who are poor, uneducated and unemployed are two to four times more likely to have psychosocial disability in Dehradun district. They face unmet needs in accessing community services and perceive negative social attitudes, lack of physical accessibility and lack of information as barriers limiting their participation. Social policy must increase access to education and reduce poverty but additionally ensure action is taken in all community services to increase information, physical accessibility and social inclusion of people with psychosocial and other forms of disability.
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Affiliation(s)
- Kaaren Mathias
- Landour Community Hospital, Mussoorie, Uttarakhand, India
| | - Hira Pant
- Public Health Foundation of India, Indian Institute of Public Health, Hyderabad, Telangana, India
| | - Manju Marella
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | | | - GVS Murthy
- Public Health Foundation of India, Indian Institute of Public Health, Hyderabad, Telangana, India
| | - Nathan Grills
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Victoria, Australia
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Service user and caregiver involvement in mental health system strengthening in low- and middle-income countries: a cross-country qualitative study. Epidemiol Psychiatr Sci 2018; 27:29-39. [PMID: 29113598 PMCID: PMC6998885 DOI: 10.1017/s2045796017000634] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIMS The aims of this paper are to: (i) explore the experiences of involvement of mental health service users, their caregivers, mental health centre heads and policy makers in mental health system strengthening in three low- and middle-income countries (LMICs) (Ethiopia, Nepal and Nigeria); (ii) analyse the potential benefits and barriers of such involvement; and (iii) identify strategies required to achieve greater service user and caregiver participation. METHODS A cross-country qualitative study was conducted, interviewing 83 stakeholders of mental health services. RESULTS Our analysis showed that service user and caregiver involvement in the health system strengthening process was an alien concept for most participants. They reported very limited access to direct participation. Stigma and poverty were described as the main barriers for involvement. Several strategies were identified by participants to overcome existing hurdles to facilitate service user and caregiver involvement in the mental health system strengthening process, such as support to access treatment, mental health promotion and empowerment of service users. This study suggests that capacity building for service users, and strengthening of user groups would equip them to contribute meaningfully to policy development from informed perspectives. CONCLUSION Involvement of service users and their caregivers in mental health decision-making is still in its infancy in LMICs. Effective strategies are required to overcome existing barriers, for example making funding more widely available for Ph.D. studies in participatory research with service users and caregivers to develop, implement and evaluate approaches to involvement that are locally and culturally acceptable in LMICs.
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18
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Di Lorenzo R, Ferri P, Biffarella C, Cabri G, Carretti E, Pollutri G, Spattini L, Del Giovane C, Chochinov HM. Psychometric properties of the Patient Dignity Inventory in an acute psychiatric ward: an extension study of the preliminary validation. Neuropsychiatr Dis Treat 2018; 14:903-913. [PMID: 29636615 PMCID: PMC5880412 DOI: 10.2147/ndt.s153902] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND During the last decades, dignity has been an emerging issue in mental health since its ethical and therapeutic implications became known. This study is an extension of the preliminary validation of the Patient Dignity Inventory (PDI) in a psychiatric setting, originally designed for assessing perceived dignity in terminal cancer patients. METHODS From October 21, 2015 to December 31, 2016, we administered the Italian PDI to all patients hospitalized in an acute psychiatric ward, who provided their consent and completed it at discharge (n=165). We performed Cronbach's alpha coefficient and principal factor analysis. We administered other scales concomitantly to analyze the concurrent validity of PDI. We applied stepwise multiple linear regression to identify the patients' demographic and clinical variables related to the PDI score. RESULTS Our response rate was 93%, with excellent internal consistency (Cronbach's alpha coefficient=0.94). The factorial analysis showed three factors with eigenvalue >1, which explained >80% of total variance: 1) "loss of self-identity and anxiety for the future", 2) "concerns for social dignity and spiritual life", and 3) "loss of personal autonomy". The PDI and the three factor scores were positively and significantly correlated with the Hamilton Scales for Depression and Anxiety but not with other scale scores. Among patients' variables, "suicide risk" and "insufficient social and economic condition" were positively and significantly correlated with the PDI total score. CONCLUSION The PDI can be a reliable tool to assess patients' dignity perception in a psychiatric setting, which suggests that both social and clinical severe conditions are closely related to dignity loss.
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Affiliation(s)
- Rosaria Di Lorenzo
- Psychiatric Intensive Treatment Facility, Mental Health Department, Azienda USL, Modena, Italy
| | - Paola Ferri
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Carlotta Biffarella
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Giulio Cabri
- Service of Psychiatric Diagnosis and Treatment, Mental Health Department, Azienda USL, Modena, Italy
| | | | - Gabriella Pollutri
- School of Specialization in Pscyhiatry, Faculty of Medicine, University of Modena and Reggio Emilia, Italy
| | - Ludovica Spattini
- School of Specialization in Pscyhiatry, Faculty of Medicine, University of Modena and Reggio Emilia, Italy
| | - Cinzia Del Giovane
- Faculty of Medicine, Institute of Primary Care (BIHAM), University of Bern, Bern, Switzerland
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Myers B, Joska JA, Lund C, Levitt NS, Butler CC, Naledi T, Milligan P, Stein DJ, Sorsdahl K. Patient preferences for the integration of mental health counseling and chronic disease care in South Africa. Patient Prefer Adherence 2018; 12:1797-1803. [PMID: 30271123 PMCID: PMC6154740 DOI: 10.2147/ppa.s176356] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
PURPOSE To describe patient perceptions of the acceptability of integrating mental health counseling within primary care facilities in the Western Cape province of South Africa and their preferences for the way in which this care is delivered. PATIENTS AND METHODS Qualitative interviews with 30 purposively selected patients receiving treatment for HIV or diabetes within primary care facilities who screened positive for depression using the Center for Epidemiological Studies Depression Scale or hazardous alcohol use through the Alcohol Use Disorders Identification Test. RESULTS Participants articulated high levels of unmet need for mental health services and strong associations between poor mental health and the challenges of living with a chronic disease. Consequently, they considered it acceptable to offer screening and mental health counseling within the context of chronic disease care. They thought counseling would be highly relevant if it helped patients develop adaptive strategies for coping with stress and negative emotions. Irrespective of chronic disease, patients indicated a preference for lay counselors rather than existing clinicians as potential delivery agents, supporting a task-shared approach to mental health counseling delivery in primary care settings. Some expressed concern about the feasibility of using lay counselors already present in facilities to deliver this service, suggesting that additional counselors might be needed. CONCLUSION Findings demonstrate a need for mental health counseling within the context of chronic disease care in South Africa. Task-shared approaches, using lay counselors, seem acceptable to patients - provided counselors are selected to ensure they possess the qualities associated with effective counselors. Findings have informed the design of a task-shared mental health program that is responsive to the preferences of patients with chronic diseases.
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Affiliation(s)
- Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa,
- Division of Addiction Psychiatry, Psychiatry and Mental Health,
| | - John A Joska
- HIV and Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health
| | - Crick Lund
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Naomi S Levitt
- Division for Diabetes and Endocrinology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Christopher C Butler
- Nuffield Department of Primary Care Health Services, Oxford University, Oxford, UK
| | - Tracey Naledi
- Western Cape Department of Health, Cape Town, South Africa
- Faculty of Health Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Peter Milligan
- KwaZulu-Natal Department of Health, KwaZulu-Natal, South Africa
| | - Dan J Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- SAMRC Unit on Anxiety and Stress Disorders, Cape Town, South Africa
| | - Katherine Sorsdahl
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Devkota HR, Murray E, Kett M, Groce N. Healthcare provider's attitude towards disability and experience of women with disabilities in the use of maternal healthcare service in rural Nepal. Reprod Health 2017; 14:79. [PMID: 28662710 PMCID: PMC5492880 DOI: 10.1186/s12978-017-0330-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 05/24/2017] [Indexed: 11/10/2022] Open
Abstract
Background Women with disabilities are less likely to receive maternal healthcare services compared to women without disabilities. While few studies have reviewed healthcare experience of women with disabilities, no studies have been conducted to understand provider’s attitude towards disability in Nepal, yet the attitude and behaviour of healthcare providers may have a significant influence on aspects of care and the use of service by women with disabilities. This study examines healthcare provider’s attitudes towards disability and explores the experience of women with disabilities in maternal healthcare service utilization during pregnancy and childbirth. Method The study used mixed method approach. An attitude survey was conducted among 396 healthcare providers currently working in public health facilities in Rupandehi district of Nepal. For additional insight, eighteen in-depth interviews with women with disabilities who used maternal healthcare services in a healthcare facility within the study district in their last pregnancy were undertaken. The Attitude Towards Disabled Persons (ATDP) scale score was used to measure the attitudes of healthcare providers. For quantitative data, univariate and multivariate analysis using ANOVA was used to understand the association between outcome and independent variables and qualitative analysis generated and described themes. Results Mean ATDP score among healthcare providers (78.52; SD = 14.75), was low compared to the normative score of 100 or higher. Nurses/auxiliary nurse midwives obtained the highest mean score (85.59, SD = 13.45), followed by general clinical health workers (Mean score = 82.64, SD 15.10). The lowest score was obtained by Female Community Health Volunteers (FCHV) (Score = 73.75, SD = 13.40) (P < 0.001). Younger providers were more positive compared to older age groups (P < 0.001). Similarly, providers working in urban health facilities compared to those working in rural health facilities, and non-Dalit providers compared to Dalit providers reported more positive attitudes towards disability (P < 0.05). However, there were no significant differences in ATDP mean scores between those who had or had not previously provided services for women with disabilities. The mean score difference between those who received disability training and who did not was also found statistically insignificant (P > 0.05). This may reflect the small number of individuals, who have had training on disability thus far, or the nature or quality of the training currently available. The majority of qualitative interview participants perceived providers to have the negative attitude with poor knowledge, skills and preparation for providing care to persons with disabilities. Few participants perceived the providers as kind, respectful, caring or helpful. Conclusion Overall, provider’s attitude towards disability was found to be negative with poor knowledge and skills about providing services. This may have adversely impact maternal healthcare service utilization by women with disabilities. More organized, effective training for healthcare providers is required through on-going mainstream efforts to develop favorable attitudes towards disability. Further research on this subject is also needed. Electronic supplementary material The online version of this article (doi:10.1186/s12978-017-0330-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | - Maria Kett
- Leonard Cheshire Disability and Inclusive Development Center, Department of Epidemiology and Public Health, University College London (UCL), London, UK
| | - Nora Groce
- Leonard Cheshire Disability and University College London (UCL), London, UK
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Abayneh S, Lempp H, Alem A, Alemayehu D, Eshetu T, Lund C, Semrau M, Thornicroft G, Hanlon C. Service user involvement in mental health system strengthening in a rural African setting: qualitative study. BMC Psychiatry 2017; 17:187. [PMID: 28521749 PMCID: PMC5437561 DOI: 10.1186/s12888-017-1352-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Accepted: 05/05/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is essential to involve service users in efforts to expand access to mental health care in integrated primary care settings in low- and middle-income countries (LMICs). However, there is little evidence from LMICs to guide this process. The aim of this study was to explore barriers to, and facilitators of, service user/caregiver involvement in rural Ethiopia to inform the development of a scalable approach. METHODS Thirty nine semi-structured interviews were carried out with purposively selected mental health service users (n = 13), caregivers (n = 10), heads of primary care facilities (n = 8) and policy makers/planners/service developers (n = 8). The interviews were audio-recorded and transcribed in Amharic, and translated into English. Thematic analysis was applied. RESULTS All groups of participants supported service user and caregiver involvement in mental health system strengthening. Potential benefits were identified as (i) improved appropriateness and quality of services, and (ii) greater protection against mistreatment and promotion of respect for service users. However, hardly any respondents had prior experience of service user involvement. Stigma was considered to be a pervasive barrier, operating within the health system, the local community and individuals. Competing priorities of service users included the need to obtain adequate individual care and to work for survival. Low recognition of the potential contribution of service users seemed linked to limited empowerment and mobilization of service users. Potential health system facilitators included a culture of community oversight of primary care services. All groups of respondents identified a need for awareness-raising and training to equip service users, caregivers, service providers and local community for involvement. Empowerment at the level of individual service users (information about mental health conditions, care and rights) and the group level (for advocacy and representation) were considered essential, alongside improved, accessible mental health care and livelihood interventions. CONCLUSION As Ethiopia increases access to mental health care, a fundamental barrier to service user involvement is beginning to be addressed. Our study identified further barriers that need to be tackled, including a supportive political climate, and receptiveness amongst stakeholders. The findings will inform the development of a model of service user involvement, which will be piloted and evaluated.
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Affiliation(s)
- Sisay Abayneh
- Department of Psychiatry, University College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia
| | - Heidi Lempp
- 0000 0001 2322 6764grid.13097.3cKing’s College London, Academic Rheumatology, Weston Education Centre, 10, Cutcombe Rd., London, SE5 9RJ UK
| | - Atalay Alem
- Department of Psychiatry, University College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia
| | - Daniel Alemayehu
- Department of Psychiatry, University College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia
| | - Tigist Eshetu
- Department of Psychiatry, University College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia
| | - Crick Lund
- 0000 0004 1937 1151grid.7836.aDepartment of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, Rondebosch, Cape Town, 7700 South Africa ,0000 0001 2322 6764grid.13097.3cKing’s College London, Institute of Psychiatry, Psychology and Neuroscience, Centre for Global Mental Health, London, UK
| | - Maya Semrau
- 0000 0001 2322 6764grid.13097.3cHealth Service and Population Research Department, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Graham Thornicroft
- 0000 0001 2322 6764grid.13097.3cHealth Service and Population Research Department, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Charlotte Hanlon
- Department of Psychiatry, University College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia. .,King's College London, Institute of Psychiatry, Psychology and Neuroscience, Centre for Global Mental Health, London, UK.
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Wanyama JN, Tsui S, Kwok C, Wanyenze RK, Denison JA, Koole O, van Praag E, Castelnuovo B, Wabwire-Mangen F, Kwesigabo GP, Colebunders R. Persons living with HIV infection on antiretroviral therapy also consulting traditional healers: a study in three African countries. Int J STD AIDS 2017; 28:1018-1027. [PMID: 28162034 DOI: 10.1177/0956462416685890] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Traditional healers provide healthcare to a substantial proportion of people living with HIV infection (PLHIV) in high HIV burden countries in sub-Saharan Africa. However, the impact on the health of retained patients visiting traditional healers is unknown. In 2011, a study to asses adherence to anti-retroviral therapy (ART) performed in 18 purposefully selected HIV treatment centers in Tanzania, Zambia and Uganda showed that 'consulting a traditional healer/herbalist because of HIV' was an independent risk factor for incomplete ART adherence. To identify characteristics of PLHIV on ART who were also consulting traditional healers, we conducted a secondary analysis of the data from this study. It was found that 260 (5.8%) of the 4451 patients enrolled in the study had consulted a traditional healer during the last three months because of HIV. In multivariable analysis, patients with fewer HIV symptoms, those who had been on ART for >5.3 years and those from Tanzania were more likely to have consulted a traditional healer. However, at the time of the study, there was a famous healer in Manyara district, Loliondo village of Tanzania who claimed his herbal remedy was able to cure all chronic diseases including HIV. HIV treatment programs should be aware that patients with fewer HIV symptoms, those who have been on ART for five or more years, and patients attending ART centers near famous traditional healers are likely to consult traditional healers. Such patients may need more support or counseling about the risks of both stopping ART and poor adherence. Considering the realities of inadequate human resources for health and the burden of disease caused by HIV in sub-Saharan Africa, facilitating a collaboration between allopathic and traditional health practitioners is recommended.
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Affiliation(s)
- Jane N Wanyama
- 1 Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Sharon Tsui
- 2 FHI 360, Social and Behavioral Health Sciences, Durham, NC, USA
| | - Cynthia Kwok
- 2 FHI 360, Social and Behavioral Health Sciences, Durham, NC, USA
| | - Rhoda K Wanyenze
- 3 School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Julie A Denison
- 4 Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, MD, USA
| | - Olivier Koole
- 5 Institute of Tropical Medicine, Clinical Sciences Department, Antwerp, Belgium
| | | | - Barbara Castelnuovo
- 1 Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Fred Wabwire-Mangen
- 3 School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Gideon P Kwesigabo
- 7 Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Robert Colebunders
- 5 Institute of Tropical Medicine, Clinical Sciences Department, Antwerp, Belgium.,8 Global Health Institute, University of Antwerp, Belgium
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Di Lorenzo R, Cabri G, Carretti E, Galli G, Giambalvo N, Rioli G, Saraceni S, Spiga G, Del Giovane C, Ferri P. A preliminary study of Patient Dignity Inventory validation among patients hospitalized in an acute psychiatric ward. Neuropsychiatr Dis Treat 2017; 13:177-190. [PMID: 28182110 PMCID: PMC5279815 DOI: 10.2147/ndt.s122423] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To investigate the perception of dignity among patients hospitalized in a psychiatric setting using the Patient Dignity Inventory (PDI), which had been first validated in oncologic field among terminally ill patients. PATIENTS AND METHODS After having modified two items, we administered the Italian version of PDI to all patients hospitalized in a public psychiatric ward (Service of Psychiatric Diagnosis and Treatment of a northern Italian town), who provided their consent and completed it at discharge, from October 21, 2015 to May 31, 2016. We excluded minors and patients with moderate/severe dementia, with poor knowledge of Italian language, who completed PDI in previous hospitalizations and/or were hospitalized for <72 hours. We collected the demographic and clinical variables of our sample (n=135). We statistically analyzed PDI scores, performing Cronbach's alpha coefficient and principal factor analysis, followed by orthogonal and oblique rotation. We concomitantly administered to our sample other scales (Hamilton Rating Scales for Depression and Anxiety, Global Assessment of Functioning and Health of the Nation Outcome Scales) to analyze the PDI concurrent validity. RESULTS With a response rate of 93%, we obtained a mean PDI score of 48.27 (±19.59 SD) with excellent internal consistency (Cronbach's alpha coefficient =0.93). The factorial analysis showed the following three factors with eigenvalue >1 (Kaiser's criterion), which explained >80% of total variance with good internal consistency: 1) "Loss of self-identity and social role", 2) "Anxiety and uncertainty for future" and 3) "Loss of personal autonomy". The PDI and the three-factor scores were statistically significantly positively correlated with the Hamilton Scales for Depression and Anxiety but not with other scale scores. CONCLUSION Our preliminary research suggests that PDI can be a reliable tool to assess patients' dignity perception in a psychiatric setting, until now little investigated, helping professionals to improve quality of care and patients to accept treatments.
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Affiliation(s)
- Rosaria Di Lorenzo
- Mental Health Department, Service of Psychiatric Diagnosis and Treatment in NOCSAE General Hospital
| | - Giulio Cabri
- Private Accredited Psychiatric Hospital villa Igea, Modena
| | | | - Giacomo Galli
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia
| | - Nina Giambalvo
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia
| | - Giulia Rioli
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia
| | - Serena Saraceni
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia
| | - Giulia Spiga
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia
| | - Cinzia Del Giovane
- PhD Statistics Unit, Department of Diagnostic, Clinical and Public Health Medicine
| | - Paola Ferri
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
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Vally Z, Abrahams L. The Effectiveness of Peer-Delivered Services in the Management of Mental Health Conditions: a Meta-Analysis of Studies from Low- and Middle-Income Countries. INTERNATIONAL JOURNAL FOR THE ADVANCEMENT OF COUNSELLING 2016. [DOI: 10.1007/s10447-016-9275-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Zheng Q, Tian Q, Hao C, Gu J, Tao J, Liang Z, Chen X, Fang J, Ruan J, Ai Q, Hao Y. Comparison of attitudes toward disability and people with disability among caregivers, the public, and people with disability: findings from a cross-sectional survey. BMC Public Health 2016; 16:1024. [PMID: 27686163 PMCID: PMC5043610 DOI: 10.1186/s12889-016-3670-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 08/15/2016] [Indexed: 12/13/2022] Open
Abstract
Background A negative attitude toward disability is one of the potential barriers for people with disability (PWD) to achieve social equality. Although numerous studies have investigated attitudes toward disability, few have evaluated personal attitudes toward disability among PWD, and made comparisons with attitudes of healthy respondents. This study was to investigate and compare the attitudes of PWD, caregivers, and the public toward disability and PWD in China, to identify discrepancies in attitude among the three groupsand to examine potential influencing factors of attitude within each group. Methods A cross-sectional study was conducted among 2912 PWD, 507 caregivers, and 354 members of the public in Guangzhou, China. Data were collected on participants’ socio-demographic information and personal attitudes toward disability using the Attitude to Disability Scale (ADS). ANOVA and ANCOVA were applied to compare the level of attitude among the three groups. Simple and multiple linear regression analyses were used to investigate the relationship between each background factor and attitude within each group. Results Over 90 % of caregivers were PWD’s family members. After controlling the socio-demographic characteristics, caregivers had the lowest total scores of ADS (caregivers: 47.7; PWD: 52.3; the public: 50.5). Caregivers who had taken care of PWD for longer durations of time had a more negative attitude toward disability. In contrast, PWD who had been disabled for longer times had a more positive attitude toward disability. Conclusions The current national social security system of China does not adequately support PWD’s family-member caregivers who may need assistance coping with their life with PWDs. More research is needed, and the development of a new health-care model for PWD is warranted.
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Affiliation(s)
- Qiaolan Zheng
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Qi Tian
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Chun Hao
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China.
| | - Jing Gu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Jianting Tao
- Guangzhou Service Center of Assistive Devices, Guangzhou, Guangdong, People's Republic of China
| | - Zuoyi Liang
- Guangzhou Disabled Person's Federation, Guangzhou, Guangdong, People's Republic of China
| | - Xinlin Chen
- Department of Preventive Medicine and Health Statistics, College of Fundamental Medical Science, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, People's Republic of China
| | - Jiqian Fang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Jianhua Ruan
- Guangzhou Service Center of Assistive Devices, Guangzhou, Guangdong, People's Republic of China
| | - Qiuxiang Ai
- Guangzhou Service Center of Assistive Devices, Guangzhou, Guangdong, People's Republic of China
| | - Yuantao Hao
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China.
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Hann K, Pearson H, Campbell D, Sesay D, Eaton J. Factors for success in mental health advocacy. Glob Health Action 2015; 8:28791. [PMID: 26689456 PMCID: PMC4685298 DOI: 10.3402/gha.v8.28791] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 11/09/2015] [Accepted: 11/10/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Mental health advocacy groups are an effective way of pushing the mental health agenda and putting pressure on national governments to observe the right to health; however, there is limited research that highlights best practices for such groups in low-resource settings. In an effort to improve the scaling up of mental health in Sierra Leone, stakeholders came together to form the country's first mental health advocacy group: the Mental Health Coalition - Sierra Leone. Since its inception, the group has worked towards raising the profile of mental health in Sierra Leone and developing as an advocacy organisation. DESIGN The study's aim was to investigate views on enabling factors and barriers associated with mental health advocacy in a low-income country using a community-based participatory approach and qualitative methodology. Focus groups (N=9) were held with mental health stakeholders, and key informant interviews (N=15) were conducted with advocacy targets. Investigators analysed the data collaboratively using coding techniques informed by grounded theory. RESULTS Investigators reveal viewpoints on key factors in networking, interacting with government actors, and awareness raising that enabled mental health advocacy aims of supporting policy, service delivery, service user rights, training for service delivery, and awareness raising. The investigators outline viewpoints on barriers for advocacy aims in framing the issue of mental health, networking, interacting with government actors, resource mobilization, and awareness raising. CONCLUSIONS The findings outline enabling factors, such as networking with key stakeholders, and barriers, such as lack of political will, for achieving mental health advocacy aims within a low-resource setting, Sierra Leone. Stakeholder coalitions can further key policy development aims that are essential to strengthen mental health systems in low-resource settings.
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Affiliation(s)
- Katrina Hann
- Mental Health Coalition - Sierra Leone, Freetown, Sierra Leone;
| | | | - Doris Campbell
- Mental Health Coalition - Sierra Leone, Freetown, Sierra Leone
| | - Daniel Sesay
- Mental Health Coalition - Sierra Leone, Freetown, Sierra Leone
| | - Julian Eaton
- CBM International, Lomé, Togo
- Centre for Global Mental Health, LSHTM, London School of Hygiene and Tropical Medicine, London, UK
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Jahiel RI. A Structural and Conceptual Modification of the International Classification of Function, Disability and Health (ICF). Rehabil Process Outcome 2015. [DOI: 10.4137/rpo.s13340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Current criticisms of the International Classification of Function, Disability and Health (ICF) are focused on its activity/participation component and on its conceptual basis. I propose structural and conceptual changes. (1) The components would be body structure, body function, intent, actual environment, and participation. (2) Intent would be linked to the concept of self-agency, and its codes would have two qualifiers associating it with capability and strength of willed activity. (3) All activity/participation codes of the original ICF would be moved to the modified ICF's participation component. This component is based on interaction between intent and environment, and it is linked to the concept of joint agency. (4) A new entity, scene setting, represents the sum total of all components' codes involved in a given act of participation. (5) Additional constructs are suggested to elucidate the relations between intent and environment that allow enactment of a given act of participation. The modified ICF is consistent with current concepts of disability and unambiguous in distinctions between body function, activity, and participation. There are no significant alterations in the original ICF codes.
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Affiliation(s)
- Rene I. Jahiel
- École Libre des Hautes Études, New York, NY, USA
- Department of Medicine, New York University, New York, NY, USA
- University of Connecticut Health Center, Farmington, CT, USA
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Brooke-Sumner C, Lund C, Petersen I. Perceptions of psychosocial disability amongst psychiatric service users and caregivers in South Africa. Afr J Disabil 2014; 3:146. [PMID: 28730007 PMCID: PMC5443050 DOI: 10.4102/ajod.v3i1.146] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 09/19/2014] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND In many parts of South Africa there is little support for people with psychosocial disability caused by schizophrenia, beyond provision of psychotropic medications. Appropriate community-based psychosocial rehabilitation interventions are a crucial element of mental health service development. OBJECTIVES This study aimed to use an explanatory model of illness framework to document experiences of illness, disability and recovery amongst service users with schizophrenia and their caregivers in a poorly resourced area in the North West Province. Data were used to provide recommendations for a contextually appropriate non-specialist facilitated group psychosocial rehabilitation intervention. METHOD Eighteen in-depth individual interviews were conducted: nine with schizophrenia service users and nine with caregivers. Interviews were conducted by two trained field researchers; both clinical psychologists fluent in the first language of participants. All interviews were recorded, translated and transcribed. Data were thematically analysed using NVivo 9. RESULTS Participants linked the illness to witchcraft, poverty and stress. Family conflict was recognised in the course of the illness, causing stress and challenges for emotional well-being. Knowledge of diagnosis and biomedical treatment was minimal. Key factors recognised by service users as promoting recovery were the ability to work, and the support of traditional healers and religious structures. CONCLUSION Based on the findings of this study, a group psychosocial rehabilitation intervention emerged as a recommendation, with the incorporation of psycho-education, adherence support, coping skills, and opportunities for income generation and productive activity. The importance of also enlisting the support of religious leaders and traditional healers in supporting recovery is emphasised.
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Affiliation(s)
- Carrie Brooke-Sumner
- School of Applied Human Sciences, Discipline of Psychology, University of KwaZulu-Natal, South Africa
| | - Crick Lund
- Alan J. Flisher Centre for Public Mental Health Department of Psychiatry and Mental Health, University of Cape Town, South Africa
| | - Inge Petersen
- School of Applied Human Sciences, Discipline of Psychology, University of KwaZulu-Natal, South Africa
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