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Olumide A. Mental health help-seeking by children and adolescents in Uganda's refugee settlements. THE LANCET. CHILD & ADOLESCENT HEALTH 2024; 8:546-547. [PMID: 39025555 DOI: 10.1016/s2352-4642(24)00166-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Accepted: 06/21/2024] [Indexed: 07/20/2024]
Affiliation(s)
- Adesola Olumide
- College of Medicine, University of Ibadan, Ibadan 200212, Nigeria.
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Bastoni S, van Lotringen CM, Kip H, Sanderman R, van Gemert-Pijnen LJEWC, van Dongen A. From theory to practice in implementation science: qualitative insights from the implementation model developed by a commercial eMental Health provider. Implement Sci Commun 2024; 5:72. [PMID: 38965581 PMCID: PMC11225237 DOI: 10.1186/s43058-024-00610-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 06/28/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND Although eMental health interventions are a viable solution to address disparities in access to mental healthcare and increase its efficiency, they still face challenges of implementation. Literature highlights numerous barriers such as diffusion of responsibility and unclear expectations of what implementation entails might hinder this process. While research mostly focuses on analyzing these barriers, there is an urgent need to increase uptake in practice. In turn, commercial companies focus mostly on increasing uptake, while overlooking research outputs. To bridge the gap between research and practice, attention to how implementation occurs in practice is required. This study investigates "Make it Happen" (MiH), the implementation model developed by the eMental Health company Minddistrict, aiming to gain more insight into operationalizing implementation frameworks by 1) describing MiH and its conceptual underpinnings, and 2) gaining lessons learned from the development of MiH. Ultimately, this work aims at improving existing scientific frameworks by extending them with knowledge from practice. METHODS First, individual interviews and focus groups with Minddistrict implementation managers were performed. Second, individual interviews with project leads in mental healthcare organizations that were involved in the implementation of Minddistrict were conducted. Within Minddistrict, 7 implementation managers and account managers were involved, in addition to 11 project leads from mental healthcare organizations. Data were elaborated with thematic analysis. RESULTS A comprehensive description of MiH and its 5 main phases was achieved. During the 1) Onboarding phase, implementing organizations are guided by Minddistrict to build a team responsible for implementation, which then 2) designs patient and client journeys, 3) builds, tailors and configures their offer, 4) trains key-users and, 5) evaluates the success of implementation. All participants had extensive and aligned definitions and articulated expectations on implementation. Points of improvement for the model such as role ambiguity and excessive workload were identified. As strengths, internal motivation and good relationships with the provider were valued. CONCLUSION The present study highlights the importance of clear role division and stakeholder engagement in implementation processes, and suggest that a strong collaboration between companies and academia could optimize implementation efforts and ensure a better fit between humans, context, and technologies.
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Affiliation(s)
- Sofia Bastoni
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands.
| | - Charlotte Marijne van Lotringen
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
| | - Hanneke Kip
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
- Department of Research, Transfore, Deventer, Netherlands
| | - Robbert Sanderman
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, 9712, Groningen, The Netherlands
| | - Lisette J E W C van Gemert-Pijnen
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
| | - Anne van Dongen
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
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Oladeji BD, Ayinde OO, Bello T, Kola L, Faregh N, Abdulmalik J, Zelkowitz P, Seedat S, Gureje O. Addressing the challenges of integrating care for perinatal depression in primary care in Nigeria. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-024-02611-7. [PMID: 38329495 DOI: 10.1007/s00127-024-02611-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 01/01/2024] [Indexed: 02/09/2024]
Abstract
PURPOSE This report provides the results of a task-shared approach for integrating care for perinatal depression (PND) within primary maternal and child healthcare (PMCH), including the factors that may facilitate or impede the process. METHODS This hybrid implementation-effectiveness study guided by the Replicating Effective Programmes framework was conducted in 27 PMCH clinics in Ibadan, Nigeria. The primary implementation outcome was change in the identification rates of PND by primary health care workers (PHCW) while the primary effectiveness outcome was the difference in symptom remission (EPDS score ≤ 5) 6 months postpartum. Outcome measures were compared between two cohorts of pregnant women, one recruited before and the other after training PHCW to identify and treat PND. Barriers and facilitators were explored in qualitative interviews. RESULTS Identification of PND improved from 1.4% before to 17.4% after training; post-training rate was significantly higher in clinics where PHCW routinely screened using the 2-item patient health questionnaire (24.8%) compared to non-screening clinics (5.6%). At 6-months postpartum, 60% of cohort one experienced remission from depression, compared to 56.5% cohort two [OR-0.9 (95%CI-0.6, 1.3) p = 0.58]. Identified facilitators for successful integration included existence of policy specifying mental health as a component of PHC, use of screening to aid identification and supportive supervision, while barriers included language and cultural attitudes towards mental health and human resource constraints. PHCW were able to make adaptations to address these barriers. CONCLUSIONS Successful implementation of task-shared care for perinatal depression requires addressing staff shortages and adopting strategies that can improve identification by non-specialist providers. TRIAL REGISTRATION This study was retrospectively registered 03 Dec 2019. https://doi.org/10.1186/ISRCTN94230307 .
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Affiliation(s)
- Bibilola D Oladeji
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria.
- WHO Collaborating Centre for Mental Health, Neurosciences and Drug and Alcohol Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria.
| | - Olatunde O Ayinde
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
- WHO Collaborating Centre for Mental Health, Neurosciences and Drug and Alcohol Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Toyin Bello
- WHO Collaborating Centre for Mental Health, Neurosciences and Drug and Alcohol Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Lola Kola
- WHO Collaborating Centre for Mental Health, Neurosciences and Drug and Alcohol Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Neda Faregh
- Department of Psychology, Carleton University, Ottawa, ON, Canada
| | - Jibril Abdulmalik
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Oye Gureje
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
- WHO Collaborating Centre for Mental Health, Neurosciences and Drug and Alcohol Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Al-Uzri M, Al-Taiar H, Abdulghani EA, Abbas YA, Suleman M. Impact of mhGAP-IG training on primary care physicians' knowledge of mental, neurological and substance use disorders in Iraq. BJPsych Int 2024; 21:14-16. [PMID: 38304410 PMCID: PMC10803792 DOI: 10.1192/bji.2023.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 08/17/2023] [Accepted: 09/27/2023] [Indexed: 02/03/2024] Open
Abstract
To address the growing need for good-quality mental health service provision to patients in Iraq, mhGAP-IG 2.0 training in mental, neurological and substance use (MNS) disorders was delivered for primary care physicians in May-June 2022 by the Royal College of Psychiatrists (RCPsych) volunteers scheme. An innovative hybrid model was used to deliver this training to improve engagement compared with virtual training alone. Pre- and post-training assessment tools showed a significant improvement in participants knowledge of MNS disorders. Follow-up fortnightly supervision sessions by RCPsych volunteers were planned to help participants consolidate their learning in managing MNS disorders.
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Affiliation(s)
- Mohammed Al-Uzri
- Consultant Psychiatrist, Assertive Outreach Service, Leicestershire Partnership NHS Trust, OSL House, Leicester, UK
| | - Hasanen Al-Taiar
- Consultant Psychiatrist, Oxford Clinic, Littlemore Mental Health Centre, Oxford, UK
| | | | | | - Muhammad Suleman
- Specialty Trainee in Psychiatry, Bradgate Mental Health Unit, Leicestershire Partnership NHS Trust, Leicester, UK.
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Iheanacho T, Chu C, Aguocha CM, Nwefoh E, Dike C. Integrating mental health into primary care in Nigeria: Implementation outcomes and clinical impact of the HAPPINESS intervention. Glob Ment Health (Camb) 2024; 11:e9. [PMID: 38390244 PMCID: PMC10882178 DOI: 10.1017/gmh.2024.4] [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] [Received: 09/03/2023] [Revised: 12/18/2023] [Accepted: 12/28/2023] [Indexed: 02/24/2024] Open
Abstract
Background The Health Action for Psychiatric Problems In Nigeria including Epilepsy and SubstanceS (HAPPINESS) intervention is a multicomponent, community-based, mobile technology-supported intervention that integrates mental health into primary health care centers in Nigeria using the World Health Organization's Mental Health Gap Action Programme-Intervention Guide (mhGAP-IG). This study evaluates its implementation and patient-level clinical impact using a quasi-experimental design (single cohort with pre- and post-measures). Findings The HAPPINESS intervention implementation demonstrated high feasibility with 84% adoption rate (% of participating primary health centers that completed its roll out) and 81% fidelity (% of clinicians who completed required intervention components according to the protocol). Retention rate in care at 12 months was 86%. Among patients with complete clinical records analyzed (n = 178), there was a statistically significant reduction in 9-item Patient Health Questionnaire scores from baseline (Md = 9.5) to 6 months (Md = 3.0) post-intervention (z = 80.5, p < 0.001), with a large effect size (r = 0.8) and statistically significant reduction in Brief Psychiatric Rating Scale scores from baseline (Md = 36.0) to 6 months (Md = 17.0) post-intervention (z = 128.5, p < 0.001), with a large effect size (r = 0.9). Implications Mobile technology-enhanced, mhGAP-IG-based efforts to scale-up mental health services in Nigeria are feasible and effective.
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Affiliation(s)
| | - Casey Chu
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
| | | | - Emeka Nwefoh
- Department of Medicine, Imo State University, Owerri, Nigeria
- CBM International, Abuja, Nigeria
| | - Charles Dike
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
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Omosigho PO, John OO, Musa MB, Aboelhassan YMEI, Olabode ON, Bouaddi O, Mengesha DT, Micheal AS, Modber MAKA, Sow AU, Kheir SGM, Shomuyiwa DO, Adebimpe OT, Manirambona E, Lucero-Prisno DE. Stigma and infectious diseases in Africa: examining impact and strategies for reduction. Ann Med Surg (Lond) 2023; 85:6078-6082. [PMID: 38098545 PMCID: PMC10718398 DOI: 10.1097/ms9.0000000000001470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/24/2023] [Indexed: 12/17/2023] Open
Abstract
Stigma poses a significant barrier to accessing care, managing, and preventing infectious diseases in Africa. The authors conducted an extensive search across Scopus, PubMed, ScienceDirect, and Google Scholar to identify relevant English-language articles, with no constraints on publication dates, using the keywords "Stigma," and "Infectious Disease," in conjunction with "Africa." This article explores the multifaceted nature of stigma associated with infectious diseases, highlighting its impact on healthcare access and public health outcomes. It delves into the current situation of infectious disease-related stigma in Africa, emphasizing the various diseases and contexts affected. The article identifies drivers of stigma, including negative attitudes, misinformation, and institutional practices, and discusses their role in perpetuating discrimination. Importantly, it provides recommendations for addressing infectious disease stigma in Africa through comprehensive strategies encompassing health education, contact-based interventions, professionalized counselling and peer support services, and community engagement. The article calls for collaboration among governments, healthcare organizations, NGOs, and community leaders to implement holistic strategies that prioritize inclusivity and stigma reduction. Ultimately, it underscores the urgent need to combat stigma to improve healthcare access and outcomes for individuals affected by infectious diseases in Africa.
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Affiliation(s)
| | - Okesanya Olalekan John
- Department of Medical Laboratory Science, Neuropsychiatric Hospital, Aro, Abeokuta
- Global Health Focus Africa, Abuja
| | | | | | | | - Oumnia Bouaddi
- International School of Public Health, Mohammed VI University of Health Sciences, Casablanca
- Mohammed VI Center For Research and Innovation, Rabat, Morocco
| | | | - Abioye Sunday Micheal
- Faculty of Basic Medical Sciences, Department of Public Health, Adeleke University, Ede, Osun State
| | | | - Alhaji Umar Sow
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown
| | | | | | | | - Emery Manirambona
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- Research Unit, Global Health Focus, Bujumbura, Burundi
| | - Don Eliseo Lucero-Prisno
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Oladeji BD, Ayinde OO, Bello T, Kola L, Faregh N, Abdulmalik J, Zelkowitz P, Seedat S, Gureje O. Cascade training for scaling up care for perinatal depression in primary care in Nigeria. Int J Ment Health Syst 2023; 17:41. [PMID: 37986025 PMCID: PMC10658820 DOI: 10.1186/s13033-023-00607-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 10/06/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Task-shared care is a demonstrated approach for integrating mental health into maternal and child healthcare (MCH) services. Training and continued support for frontline providers is key to the success of task sharing initiatives. In most settings this is provided by mental health specialists. However, in resource constrained settings where specialists are in short supply, there is a need to explore alternative models for providing training and supportive supervision to frontline maternal care providers. This paper reports on the impact of a cascade training (train-the-trainers) approach in improving the knowledge and attitudes of primary healthcare workers (PHCW) to perinatal depression. METHODS Senior primary health care providers selected from across participating local government areas were trained to provide training to other PHCWs. The training sessions facilitated by these trainers were observed and rated for fidelity by specialist trainers, while the trainees provided their impression of and satisfaction with the training sessions using predesigned assessment forms. Training outcomes assessed included knowledge of depression (using mhGAP training questions and knowledge of depression questionnaire) and attitude towards providing care for depression (revised depression attitude questionnaire (R-DAQ)) measured pre and post training as well as six months after training. RESULTS Trainees were 198 PHCWs (94.4% female), who routinely provide MCH services in 28 selected primary care clinics and had between 6- and 34-years' experience. Training was provided by 11 trained trainers who were general physicians or senior nurses. Training sessions were rated high in fidelity and on training style. Sessions were rated excellent by 77.8% of the trainees with the trainers described as knowledgeable, effective and engaging. Knowledge of depression mean score improved from a pre-training level of 12.3 ± 3.5 to 15.4 ± 3.7, immediately post-training and 14.7 ± 3.2, six months post-training (both comparisons: p < 0.001). The proportion of PHCW workers endorsing statements indicative of positive attitudes on the professional confidence and the generalist perspective modules of the R-DAQ also increased with training. CONCLUSION Our findings suggest that cascade training can be an effective model for rapidly providing training and upskilling frontline PHCWs to deliver care for women with perinatal depression in resource limited settings. TRIAL REGISTRATION This study was retrospectively registered 03 December 2019. https://doi.org/10.1186/ISRCTN 94,230,307.
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Affiliation(s)
- Bibilola D Oladeji
- Department of Psychiatry of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria.
| | - Olatunde O Ayinde
- Department of Psychiatry of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Toyin Bello
- WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Drug and Alcohol Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Lola Kola
- WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Drug and Alcohol Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Neda Faregh
- Department of Psychology, Carleton University, Ottawa, ON, Canada
| | - Jibril Abdulmalik
- Department of Psychiatry of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Oye Gureje
- Department of Psychiatry of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
- WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Drug and Alcohol Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Ogunwale A. Implementation of the Nigerian Mental Health Act 2021. Lancet Psychiatry 2023; 10:826-828. [PMID: 37567202 DOI: 10.1016/s2215-0366(23)00261-4] [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: 07/18/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 08/13/2023]
Affiliation(s)
- Adegboyega Ogunwale
- Forensic Unit, Department of Clinical Services, Neuropsychiatric Hospital, Aro, Abeokuta, Nigeria; Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, SE5 8AF, UK.
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Kwobah EK, Turissini M, Barasa J, Kimaiyo M, Okeyo L, Araka J, Njiriri F, Matundura R, Jaguga F. Mental healthcare services in Kenyan counties: a descriptive survey of four counties in Western Kenya. BMC Health Serv Res 2023; 23:543. [PMID: 37231439 DOI: 10.1186/s12913-023-09481-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 04/29/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND The government of Kenya has made progressive efforts towards improving mental health services in the country. However there is little documentation of mental health services in the counties that would support actualization of the legislative frameworks in the context of a devolved healthcare system. This study sought to document existing mental health services within 4 counties in Western Kenya. METHODS We conducted a cross sectional descriptive survey of four counties using the World Health Organization, Assessment Instrument for Mental Health Systems (WHO-AIMS). Data was collected in 2021, with 2020 being the year of reference. We collected data from the facilities offering mental healthcare within the counties as well as from County health policy makers and leaders. RESULTS Mental healthcare was provided at higher level facilities within the counties, with minimal structures at primary care facilities. No county had a stand-alone policy on mental health services or dedicated budget for mental healthcare. The national referral hospital, within Uasin-Gishu county, had a clear mental health budget for mental health. The national facility in the region had a dedicated inpatient unit while the other three counties admitted patients in general medical wards but had mental health outpatient clinics. The national hospital had a variety of medication for mental health care while the rest of the counties had very few options with antipsychotics being the most available. All the four counties reported submitting data on mental health to Kenya health information system (KHIS). There were no clearly defined mental healthcare structures in the primary care level except for funded projects under the National referral hospital and the referral mechanism was not well defined. There was no established mental health research in the counties except that which was affiliated to the national referral hospital. CONCLUSION In the four counties in Western Kenya, the mental health systems are limited and not well structured, are faced with limited human and financial resources and there is lack of county specific legistrative frameworks to support mental healthcare. We recommend that counties invest in structures to support provision of quality mental healthcare to the people they serve.
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Affiliation(s)
| | - Matthew Turissini
- Department of Internal Medicine, Indiana University, Bloomington, USA
| | - Julius Barasa
- Academic Model Providing Access to Healthcare, PO BOX 4606, Eldoret, Kenya
| | - Mercy Kimaiyo
- Academic Model Providing Access to Healthcare, PO BOX 4606, Eldoret, Kenya
| | - Lily Okeyo
- Academic Model Providing Access to Healthcare, PO BOX 4606, Eldoret, Kenya
| | - Joash Araka
- Academic Model Providing Access to Healthcare, PO BOX 4606, Eldoret, Kenya
| | - Faith Njiriri
- Academic Model Providing Access to Healthcare, PO BOX 4606, Eldoret, Kenya
| | - Richard Matundura
- Academic Model Providing Access to Healthcare, PO BOX 4606, Eldoret, Kenya
| | - Florence Jaguga
- Moi Teaching and Referral Hospital, P.O BOX 3-30100, Eldoret, Kenya
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10
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Mushi D, Hanlon C, Francis JM, Candida M, Demissie M, Teferra S. Adaptation of a model for integration of interventions for alcohol use disorders in primary health care in Tanzania. BMC PRIMARY CARE 2023; 24:106. [PMID: 37085751 PMCID: PMC10120272 DOI: 10.1186/s12875-023-02061-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 04/13/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND Integrating evidence-based interventions for people with alcohol use disorder (AUD) into primary healthcare (PHC) can increase access to care and reduce morbidity, mortality, and population burden. However, for the integration to be feasible, acceptable, and sustainable, there is a need to contextualize the approach and involve stakeholders. Therefore, this study aimed to use participatory methods to adapt a model for integrating AUD interventions in Tanzania's PHC system at the community, facility, and organizational levels. METHODS A mixed-methods study was used. Participants include key mental health stakeholders, experts, and PHC providers. We conducted a situational analysis to investigate opportunities and constraints in the existing systems of care, utilizing data available from the routine collection and/or in the public domain, individual semi-structured interviews (n = 11), and focus group discussions (3 groups; total n = 26 participants) and a series of theory of change (ToC) workshops (n = 32). Data from the three methods were triangulated to develop the adapted model for integrating interventions for AUD in PHC. RESULTS A situational appraisal revealed limited community, facility, and organizational resources and infrastructures for supporting services delivery of integrated AUD interventions. Also, shortage of health workforce, inadequate health management information systems, and limited medical supply and financing. Nevertheless, the theory of change proposed integrated AUD intervention packages and strategies to facilitate integrated care for people with AUD. Additionally, the barriers and facilitators for implementing these integrated AUD interventions and how to overcome them were explored. CONCLUSIONS The adapted model for the integrated AUD intervention in Tanzanian PHC revealed limited resources and system functioning for facilitating integrated AUD services. Nevertheless, it proposes the needed integrated AUD interventions and its barriers, facilitators, and strategies for overcoming them. There is a need to pilot the adapted model to inform plans for more comprehensive implementation or scaling up.
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Affiliation(s)
- Dorothy Mushi
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Science, P.O Box 65001, United Nations Road, Dar Es Salaam, Tanzania.
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Charlotte Hanlon
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Joel M Francis
- Department of Family Medicine and Primary Care, Witwatersrand University, Faculty of Health Sciences, Johannesburg, South Africa
| | - Moshiro Candida
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Mekdes Demissie
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
- Psychiatric Nursing Department, School of Nursing and Midwifery, College of Health and medical Sciences, Haramaya University, Ethiopia, Dire Dawa , Ethiopia
| | - Solomon Teferra
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Aluh DO, Onu JU, de Almeida JMC. A new era for mental health care in Nigeria. Lancet Psychiatry 2023; 10:310-311. [PMID: 36921611 DOI: 10.1016/s2215-0366(23)00071-8] [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: 01/23/2023] [Revised: 02/12/2023] [Accepted: 02/14/2023] [Indexed: 03/14/2023]
Affiliation(s)
- Deborah Oyine Aluh
- Lisbon Institute of Global Mental Health, Comprehensive Health Research Centre, Nova Medical School, Nova University of Lisbon, Lisbon 1150-082, Portugal; Department of Clinical Pharmacy and Pharmacy Management, University of Nigeria, Nsukka, Nigeria.
| | - Justus Uchenna Onu
- Department of Mental Health, Faculty of Medicine, Nnamdi Azikiwe University, Awka, Nigeria
| | - José Miguel Caldas de Almeida
- Lisbon Institute of Global Mental Health, Comprehensive Health Research Centre, Nova Medical School, Nova University of Lisbon, Lisbon 1150-082, Portugal
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12
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Primary health care nurses' mental health knowledge and attitudes towards patients and mental health care in a South African metropolitan municipality. BMC Nurs 2023; 22:25. [PMID: 36707801 PMCID: PMC9883930 DOI: 10.1186/s12912-023-01188-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 01/23/2023] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND In South Africa, there are on-going calls to integrate mental health services into existing primary health care (PHC) programmes such as Tuberculosis (TB). Successful service integration and quality service delivery partially depend on healthcare providers' mental health-related knowledge and attitudes. The aim of this study was to assess PHC nurses' mental health knowledge and attitudes towards mental health patients and mental health care. METHODS This was a cross-sectional survey involving the distribution of self-administered questionnaires among PHC nurses across 47 clinics. Data on socio-demographics, stigma-related mental health knowledge, and nurses' attitudes towards people with mental health problems and mental health care were subjected to descriptive and multiple regression analyses. RESULTS Out of 205 respondents, the majority were female (n = 178, 86.8%). The nurses' median age was 50 (interquartile range: 39-56). Their mean mental health knowledge score was 23.0 (standard deviation [sd]: 3.07) out of 30. Nurses were less knowledgeable about the employment (n = 95, 46.3%), recovery (n = 112, 54.6%), and help-seeking behaviour (n = 119, 58.0%) of people with mental health problems. Professional nurses had a significantly higher mean mental health knowledge score than enrolled/assistant nurses (22.8 vs. 21.1, t203 = 4.775, p < 0.001). Regarding attitudes, the nurses' mean attitude score was 40.68 (sd: 9.70) out of 96. Two in every five nurses (n = 91, 44.4%) scored above the mean attitude score, implying that they were inclined to have negative (stigmatising) attitudes towards people with mental problems and mental health care. Age (p = 0.048), job category (p < 0.001), and prior in-service mental health training (p = 0.029) made a unique contribution to predicting nurses' attitudes. CONCLUSION Gaps were established in PHC nurses' stigma-related mental health knowledge. A significant proportion of nurses had a propensity for negative (stigmatising) attitudes towards mental health patients and mental health care. Efforts towards integration of mental health into TB services in this metropolitan and similar settings should address mental health knowledge deficits and factors influencing nurses' negative attitudes. In-service training on mental health should be optimised, with attention to older nurses and enrolled/nursing assistants.
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Oseni TIA, Mensah-Bonsu M, Damagun FM, Salam TO, Sonny KJ, Opare-Lokko EBA, Namisango E, Ephraim OC. Ability and Preparedness of Family Physicians to Recognise and Treat Adolescent Mental Health Disorders in Nigeria and Ghana. Health Serv Insights 2023; 16:11786329231166366. [PMID: 37034312 PMCID: PMC10080409 DOI: 10.1177/11786329231166366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 03/12/2023] [Indexed: 04/11/2023] Open
Abstract
Background Management of mental health disorders has not been fully integrated into primary care despite been advocated by the World Health Organisation (WHO) and the World Organisation of Family Doctors (WONCA). This study therefore seeks to assess the ability and preparedness of Family Physicians to recognise and treat mental health disorders in adolescents. Methodology A descriptive cross-sectional study of 233 randomly selected Physicians Practicing in Family Medicine Clinics in Nigeria and Ghana was conducted using a semi structured self-administered questionnaire that was developed by the researchers and validated with a Cronbach's alpha coefficient of .85. Data analysis was done with the Statistical Package for Social Sciences™ (IBM Corp, Armonk, NY, USA) version 22.0. Results Respondents had a mean age of 43 ± 8 years, were mostly males 130 (55.79%), practised in Nigeria 168 (72.10%) and have been in practice for over 10 years 149 (63.95%). Majority of respondents 153 (65.67%) received at least one Medical Education sessions in mental health in the preceding 12 months of the study. Out of these, 146 (95.42%) said the sessions enhanced their knowledge of mental health, and 121 (79.08%) said the sessions enhanced their abilities and preparedness to attend to patients with mental disorders. Barriers included stigmatisation 156 (66.95%), poor facilities 136 (58.37%), non-conducive environment 135 (57.94%) and non-cooperation from patients 133 (57.08%). Conclusion This study showed that a lot of family physicians in Ghana and Nigeria are able and prepared to manage adolescent mental health disorders. They however cited stigmatisation, poor facilities and non-conducive environment as barriers to management of adolescent mental health disorders in primary care. Considering the severity of the disorder, there is a need to increase the training of Family Physicians in the management of adolescent mental health.
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Affiliation(s)
- Tijani Idris Ahmad Oseni
- Department of Family Medicine, Ambrose Alli University, Ekpoma, Nigeria
- Lifestyle and Behavioural Medicine Unit, Department of Family Medicine, Irrua Specialist Teaching Hospital, Irrua, Nigeria
- Tijani Idris Ahmad Oseni, Department of Family Medicine, Ambrose Alli University, KM 13, Benin/Auchi Road, Ekpoma, Edo 320001, Nigeria.
| | | | | | | | - Kumbert John Sonny
- Department of Family Medicine, Geriatric Medicine Subdivision, Federal Medical Centre, Keffi, Nigeria
| | - Edwina Beryl Addo Opare-Lokko
- Department of Family Medicine, Greater Accra Regional Hospital, Accra/Faculty of Family Medicine, Ghana College of Physicians and Surgeons, Accra, Ghana
| | - Eve Namisango
- African Palliative Care Association, Kampala, Uganda
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Onyenwe Chibuike Ephraim
- Department of Family Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
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14
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von Gaudecker JR, Agbapuonwu N, Kyololo O, Sathyaseelan M, Oruche U. Barriers and facilitators to treatment seeking behaviors for depression, epilepsy, and schizophrenia in low- and middle-income countries: A systematic review. Arch Psychiatr Nurs 2022; 41:11-19. [PMID: 36428038 DOI: 10.1016/j.apnu.2022.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 05/13/2022] [Accepted: 07/03/2022] [Indexed: 12/22/2022]
Abstract
Despite the severe consequences, the treatment gap for depression, epilepsy, and schizophrenia continues to be a major concern in low and middle-income countries (LMICs). We conducted a systematic review of literature on barriers and facilitators of treatment-seeking behaviors from the perspective of individuals living with depression, epilepsy, and schizophrenia and stakeholders in LMICs. Knowledge deficits, beliefs, and stigma were barriers to treatment-seeking across disorders. The most cited facilitators were demographics, socioeconomic status, and collaboration with traditional healers. Culturally sensitive interventions in collaboration with stakeholders within the community can facilitate treatment-seeking behaviors among people living with depression, epilepsy, and schizophrenia.
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Affiliation(s)
- Jane R von Gaudecker
- Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN 46202, USA.
| | - Noreen Agbapuonwu
- Department of Nursing, Nnamdi Azikiwe University, Nnewi Campus, Anambra State, Nigeria..
| | | | | | - Ukamaka Oruche
- Indiana University School of Nursing, Indianapolis, IN 46202, USA.
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15
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Kaiser BN, Ticao C, Anoje C, Boglosa J, Gafaar T, Minto J, Kohrt BA. Challenges in simultaneous validation of mental health screening tools in multiple languages: Adolescent assessments in Hausa and Pidgin in Nigeria. SSM - MENTAL HEALTH 2022; 2:100168. [PMID: 36712479 PMCID: PMC9878994 DOI: 10.1016/j.ssmmh.2022.100168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background With growing global recognition of the need to address mental health, a key challenge is determining who needs mental health services. Most self-report screening tools were developed in English-speaking high-income settings, and this cultural milieu influences the types and content of items, the manner in which items are asked, and the options for responding to items. Approaches have been developed for transcultural translation and validation. However, these approaches are typically applied in one language at a time, which is of limited utility in linguistically diverse settings. Methods To address challenges in cross-cultural validation, we undertook a unique process of simultaneously validating tools in two languages in Nigeria. Through this dual-language validation, we explored how cultural and contextual differences may influence what is considered valid for a mental health tool. We validated the Depression Self Rating Scale, Child PTSD Symptom Scale (CPSS), and Disruptive Behavior Disorders Rating Scale with a community sample of 330 adolescents aged 12-17. Validity was assessed in Hausa and Pidgin, two languages commonly spoken in Nigeria. Clinical psychologists used the Kiddie-Schedule for Affective Disorders and Schizophrenia to establish caseness. Results Most items had good discriminant validity, except on the CPSS, on which only 8 of 17 items discriminated by caseness. Findings indicate the influence of culture (e.g., linguistic differences in translatability of items) and context (e.g., items that reflect experiences of hunger or foodborne illness; different PTSD caseness by language might reflect differential trauma exposure between populations). We also identified items that operated differently between languages. Conclusion We identified shortcomings in cross-cultural validation procedures with regard to determining whether language, context, or or other differences influence performance of items. For future validation efforts, we recommend systematically collecting information on context and stressful/traumatic exposures as a way to contextualize interpretation of the validity findings. Acronyms Depression Self Rating Scale (DSRS), Child PTSD Symptom Scale (CPSS), Disruptive Behavior Disorders Rating Scale (DBDRS), Oppositional Defiant Disorder (ODD), Conduct Disorder (CD), Area Under the Curve (AUC), Diagnostic Odds Ratio (DOR), Low- and Middle-Income Countries (LMICs), Posttraumatic Stress Disorder (PTSD).
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Affiliation(s)
- Bonnie N. Kaiser
- University of California San Diego, United States,Duke Global Health Institute, United States,Corresponding author. 9500 Gilman Road #0532, La Jolla, CA, 92093, United States. (B.N. Kaiser)
| | | | | | | | | | | | - Brandon A. Kohrt
- Duke Global Health Institute, United States,George Washington University, United States
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16
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Maba AP. Youth Help-Seeking Intention During the Covid-19 Pandemic: Comparison of Infection Rate in Living Area. BULLETIN OF COUNSELING AND PSYCHOTHERAPY 2022. [DOI: 10.51214/bocp.v5i1.340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
The aim of this study was to compare help-seeking intentions among youth living in areas with different Covid-19 infection rates during the pandemic. Data was collected using demographical questions and the General Help-seeking Questionnaire from a sample of 1,340 adolescents (971 females, 369 males) between August 11th and 21st, 2020. Of these participants, 423 (122 females, 301 males) were eligible for analysis. The data were analyzed using descriptive analysis and ANOVA. The results showed that youth living in areas with low Covid-19 infection rates had higher help-seeking intentions than those living in areas with high infection rates or no Covid-19 cases. These findings suggest that the rate of Covid-19 infection in an individual's living area may impact their help-seeking intentions during the pandemic. Further research is needed to fully understand the factors that contribute to help-seeking intentions during times of crisis and to develop interventions to support individuals in need of help. It is also important to consider the potential impact of other factors, such as access to resources and support systems, on help-seeking intentions among youth.
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17
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Ojagbemi A, Daley S, Kola L, Taylor Salisbury T, Feeney Y, Makhmud A, Lempp H, Thornicroft G, Gureje O. Perception of providers on use of the WHO mental health Gap Action Programme-Intervention Guide (mhGAP-IG) electronic version and smartphone-based clinical guidance in Nigerian primary care settings. BMC PRIMARY CARE 2022; 23:264. [PMID: 36243682 PMCID: PMC9571457 DOI: 10.1186/s12875-022-01869-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 09/23/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Taking advantage of the rapidly increasing access to digital technology in low- and middle-income countries, the World Health Organization has launched an electronic version of the mental health Gap Action Programme intervention guide (emhGAP-IG). This is suitable for use on smartphones or tablets by non-specialist primary healthcare providers (PHCWs) to deliver evidence-based intervention for priority mental, neurological and substance use disorders. We assessed the perceptions of PHCWs on the feasibility, acceptability, and benefits of using smartphone-based clinical guidance and the emhGAP-IG in the management of people with mental health conditions in Nigeria. METHODS: Exploration of the views of PHCWs from 12 rural and urban primary health clinics (PHCs) in South-Western Nigeria were carried out using 34 in-depth key informant qualitative interviews with nurses (n = 10), community health officers (n = 13) and community health extension workers (n = 11). An additional two focus group discussions, each comprising eight participants drawn from across the range of characteristics of PHCWs, were also conducted. Thematic analysis was conducted using a three-staged constant comparison technique to refine and categorise the data. RESULTS Three overall themes were identified around the use of clinical guidance and mobile applications (apps) in PHCs. Apps were deployed for purposes other than clinical consultation and decision making. Although paper-based guidance was the expected practice, its utilization is not fully embedded in routine care. An app-based decision-making tool was preferred to paper by PHCWs. Future usage of the emhGAP-IG would be facilitated by training and supporting of staff, helpful design features, and obtaining patients' buy-in. CONCLUSION Our findings suggest that the emhGAP-IG could be a viable way to embed clinical guidance and decision-making tools in the management of people with mental health conditions in Nigerian PHCs.
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Affiliation(s)
- Akin Ojagbemi
- World Health Organization Collaborating Centre For Research And Training In Mental Health, Neuroscience, And Substance Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, UK
| | - Stephanie Daley
- Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, UK
| | - Lola Kola
- World Health Organization Collaborating Centre For Research And Training In Mental Health, Neuroscience, And Substance Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Tatiana Taylor Salisbury
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychology, Psychiatry and Neuroscience, King’s College London, London, UK
| | - Yvonne Feeney
- Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, UK
| | - Akerke Makhmud
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychology, Psychiatry and Neuroscience, King’s College London, London, UK
| | - Heidi Lempp
- Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Graham Thornicroft
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychology, Psychiatry and Neuroscience, King’s College London, London, UK
| | - Oye Gureje
- World Health Organization Collaborating Centre For Research And Training In Mental Health, Neuroscience, And Substance Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
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18
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Giebel C, Shrestha N, Reilly S, White RG, Zuluaga MI, Saldarriaga G, Liu G, Allen D, Gabbay M. Community-based mental health and well-being interventions for older adults in low- and middle-income countries: a systematic review and meta-analysis. BMC Geriatr 2022; 22:773. [PMID: 36175867 PMCID: PMC9520120 DOI: 10.1186/s12877-022-03453-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 09/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mental health support is often scarce in low- and middle-income countries (LMIC), with mental health stigmatised. Older adults are some of the most vulnerable members of society and may require specific types of mental health support. The aim of this mixed-methods systematic review and meta-analysis was to explore the types, components, and efficacy of psychosocial community-based mental health interventions for older adults (aged 60 + years) residing in LMIC. METHODS Six databases were searched in August 2021. Studies published since 2000 were included if they collected primary quantitative or qualitative data on community-based interventions for improving mental health for older adults residing in LMICs, focusing on improving mental health and well-being outcomes. Full texts were screened by two researchers. RESULTS From 24,378 citations identified, 40 studies met eligibility criteria. Across 12 countries, interventions were categorised into those focusing on (1) Established forms of psychological therapy; (2) Exercise; (3) Education; (4) Social engagement; (5) Multi-component. Most interventions were effective in reducing levels of depression, anxiety, and improving well-being, including reminiscence therapy, different types of socialising, and breathing and laughter exercises. Some interventions reported no benefits and those that did at times failed to report continued benefits at follow-up. Given the variations in intervention type and delivery, cultures, and outcome measures used, underpinning factors of intervention success or failure were difficult to establish. CONCLUSIONS Psychosocial interventions for older adults in LMIC need to be adapted to local contexts depending on culture and population needs. Existing interventions and their components can be used as a foundation to produce adapted and multi-component interventions, to tackle growing and inadequate mental health care provision in LMIC. TRIAL REGISTRATION The review protocol was registered on PROSPERO [CRD42021271404].
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Affiliation(s)
- Clarissa Giebel
- Department of Primary Care & Mental Health, University of Liverpool, Liverpool, UK. .,NIHR ARC NWC, Liverpool, UK.
| | - Nipun Shrestha
- NHMRC Clinical Trials Center, University of Sydney, Sydney, Australia
| | - Siobhan Reilly
- Centre for Applied Dementia Studies, Bradford University, Bradford, UK
| | - Ross G White
- School of Psychology, Queen's University Belfast, Belfast, UK
| | | | - Gabriel Saldarriaga
- National Faculty of Public Health, Universidad de Antioquia, Medellín, Colombia
| | | | | | - Mark Gabbay
- Department of Primary Care & Mental Health, University of Liverpool, Liverpool, UK.,NIHR ARC NWC, Liverpool, UK
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19
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Nicholas A, Joshua O. Accessing Mental Health Services in Africa: Current state, efforts, challenges and recommendation. Ann Med Surg (Lond) 2022; 81:104421. [PMID: 35996570 PMCID: PMC9387063 DOI: 10.1016/j.amsu.2022.104421] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/12/2022] [Accepted: 08/12/2022] [Indexed: 11/15/2022] Open
Abstract
The COVID-19 pandemic brought to the surface the dwindling state of mental health services in Africa. While most countries have policies targeted at mental health problems, these policies are often weak and outdated to combat the present challenges. Africa faces various challenges in mental health delivery, ranging from inadequate staffing to sociocultural stigma and lack of effort from the government in terms of policies and funding. Many countries do not have the budgetary allocation for mental health. while those with budgetary allocation spend less than 5% of government health expenditure on mental health. Considering the continent's socioeconomic difficulties, it is almost a given that mental health illnesses will be on the rise. The continent's growing population, which is majorly youth, means that mental health services will be in high demand in the coming years. Therefore, the relevant stakeholders must look into the challenges and respond with a sense of urgency.
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Affiliation(s)
- Aderinto Nicholas
- Corresponding author. Department of Medicine and Surgery, Ladoke Akintola University of Technology, Ogbomoso, Nigeria.
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20
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Gureje O, Oladeji BD, Kola L, Bello T, Ayinde O, Faregh N, Bennett I, Zelkowitz P. Effect of intervention delivered by frontline maternal care providers to improve outcome and parenting skills among adolescents with perinatal depression in Nigeria (the RAPiD study): A cluster randomized controlled trial. J Affect Disord 2022; 312:169-176. [PMID: 35752215 DOI: 10.1016/j.jad.2022.06.032] [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] [Received: 02/23/2022] [Revised: 06/12/2022] [Accepted: 06/17/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Perinatal depression is more common and is associated with greater negative consequences among adolescents than adults. Psychosocial interventions designed for adults may be inadequate at addressing the unique features of adolescent perinatal depression. METHODS In a two-arm parallel cluster randomized trial conducted in thirty primary maternal care clinics in Ibadan, Nigeria (15-intervention and 15-control) we compared age-appropriate intervention consisting of problem-solving therapy, behavioral activation, parenting skills training, and parenting support from a self-identified adult to care as usual. Pregnant adolescents (aged <20 years) at fetal gestational age16-36 weeks with moderate to severe depression were recruited. Primary outcomes were depression symptoms (Edinburgh Postnatal Depression Scale, EPDS) and parenting practices (Infant-Toddler version of the Home Inventory for Measurement of the Environment, HOME-IT) at six-months postnatal. RESULTS There were 242 participants (intervention arm: 141; Control arm: 101), with a mean age of 18∙0 (SD-1∙2). Baseline mean EPDS score was 14∙2 (SD-2.1); 80∙1 % completed the six-month postnatal follow-up. The intervention group had lower level of depressive symptoms than the control group, mean EPDS scores: 5∙5 (SD-3∙6) versus 7∙2 (SD-4∙0) (adjusted mean difference -1∙84 (95%CI- 3∙06 to -0∙62; p = 0∙003) and better parenting practices, mean total HOME-IT scores: 29∙8 (SD-4∙4) versus 26∙4 (SD-4∙2) (adjusted mean difference 3∙4 (95%Cl- 2∙12 to 4∙69, p = 0∙001). LIMITATIONS This study explored the effect of complex interventions making it difficult to know precisely what aspects produced the outcomes. CONCLUSIONS An age-appropriate psychosocial intervention package holds promise for scaling up care for adolescents with perinatal depression especially in resource-constrained settings. TRIAL REGISTRATION ISRCTN16775958. Registered on 30 April 2019.
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Affiliation(s)
- Oye Gureje
- WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Drug and Alcohol Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Nigeria.
| | - Bibilola D Oladeji
- WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Drug and Alcohol Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Nigeria
| | - Lola Kola
- WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Drug and Alcohol Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Nigeria
| | - Toyin Bello
- WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Drug and Alcohol Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Nigeria
| | - Olatunde Ayinde
- WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Drug and Alcohol Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Nigeria
| | - Neda Faregh
- Department of Psychology, Carleton University, Ottawa, Ontario, Canada
| | - Ian Bennett
- Department of Family Medicine, Psychiatry and Behavioral Sciences, and Global Health, University of Washington, Seattle, USA
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Aluh DO, Onu JU, Caldas-de-Almeida JM. Nigeria's mental health and substance abuse bill 2019: Analysis of its compliance with the United Nations convention on the rights of persons with disabilities. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2022; 83:101817. [PMID: 35772283 DOI: 10.1016/j.ijlp.2022.101817] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 06/16/2022] [Accepted: 06/17/2022] [Indexed: 06/15/2023]
Abstract
Countries are struggling with reconciling their national mental health legislation with the CRPD approach, which stresses equality as the focal point of legislation, policies, and practices that affect people with disabilities. Several failed attempts have been made over the last two decades to update Nigeria's obsolete mental health legislation. The most recent attempt is the Mental Health and Substance abuse Bill 2019, which aims to protect the rights of people with mental health needs. It addresses many areas neglected by previous bills, such as non-discrimination of people with mental and substance use problems in the exercise of their civil, political, economic, social, full employment, religious, educational, and cultural rights. It categorically prohibits the use of seclusion in the treatment of people with mental health problems, makes provision for service users to be members of the Mental health review tribunal and allows for the protection of privacy and confidentiality of information about people with mental health problems. While keeping to most of WHO's recommendations for mental health legislation, the bill diverges from the CRPD's recommendations by allowing forced admission and treatment based on mental capacity, substitute decision-making by legal representatives or closest relatives, and non-prohibition of coercive practices. The bill does not make provisions for advance directives and is silent on informed consent to participate in research. Despite the bill's deficiencies, it would be a significant step forward for the country, whose current mental health legislation is the Lunacy Act of 1958. Although the CRPD has left it unclear how countries, especially low resource countries, should go about creating a workable legal framework, it is clear that all countries are expected to join the current global effort to eliminate, or at least reduce to the barest minimum, the use of coercion in mental health care. We expect that future revisions of this bill will examine its limitations in light of Nigeria's socio-cultural context.
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Affiliation(s)
- Deborah Oyine Aluh
- Comprehensive Health Research Centre (CHRC), Nova Medical School, Nova University of Lisbon, Lisbon, Portugal; Lisbon Institute of Global Mental Health, Lisbon, Portugal; Department of Clinical Pharmacy and Pharmacy Management, University of Nigeria Nsukka, Nigeria.
| | - Justus Uchenna Onu
- Department of Mental Health, Faculty of Medicine, Nnamdi Azikiwe University, Awka, Nnewi Campus, Anambra State, Nigeria
| | - José Miguel Caldas-de-Almeida
- Comprehensive Health Research Centre (CHRC), Nova Medical School, Nova University of Lisbon, Lisbon, Portugal; Lisbon Institute of Global Mental Health, Lisbon, Portugal
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22
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Karkou V, Omylinska‐Thurston J, Parsons A, Nair K, Starkey J, Haslam S, Thurston S, Marshall LD. Bringing creative psychotherapies to primary
NHS
Mental Health Services in the
UK
: A feasibility study on patient and staff experiences of arts for the blues workshops delivered at Improving Access to Psychological Therapies (
IAPT
) services. COUNSELLING & PSYCHOTHERAPY RESEARCH 2022. [DOI: 10.1002/capr.12544] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Vicky Karkou
- Research Centre for Arts and Wellbeing Edge Hill University Ormskirk UK
| | | | - Ailsa Parsons
- Department of Psychology University of Salford Salford UK
| | - Kerry Nair
- Greater Manchester Mental Health NHS Foundation Trust Manchester UK
| | - Jennifer Starkey
- Research Centre for Arts and Wellbeing Edge Hill University Ormskirk UK
| | | | - Scott Thurston
- School of Arts and Media University of Salford Salford UK
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23
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An evaluation of mental health capacity building among Community Rehabilitation Officers in Malawi: A mixed-methods case study. SSM - MENTAL HEALTH 2022. [DOI: 10.1016/j.ssmmh.2022.100108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Chu C, Roxas N, Aguocha CM, Nwefoh E, Wang K, Dike C, Iheanacho T. Integrating mental health into primary care: evaluation of the Health Action for Psychiatric Problems In Nigeria including Epilepsy and SubstanceS (HAPPINESS) pilot project. BMC Health Serv Res 2022; 22:333. [PMID: 35279154 PMCID: PMC8917687 DOI: 10.1186/s12913-022-07703-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 02/28/2022] [Indexed: 11/29/2022] Open
Abstract
Background The Health Action for Psychiatric Problems In Nigeria including Epilepsy and SubstanceS (HAPPINESS) project trains non-specialist and primary health care workers in Imo State, Nigeria. This project adapted the World Health Organization’s Mental Health Gap Action Programme-Intervention Guide (mhGAP-IG), emphasizing stigma reduction among trainees. This convergent mixed-methods proof-of-concept study evaluates the HAPPINESS pilot project mhGAP-IG training’s impact on mental illness stigma among trainees and barriers, facilitators, and opportunities to consider for project improvement. Methods Trainees (n = 13) completed a 43-item questionnaire before and after their 5-day training to assess perceptions of mental disorders and attitudes towards people with mental illness. These responses were analyzed using paired-sample t-tests for four subscales of the questionnaire: acceptance of socializing with people with mental illness, normalizing activities and relationships with people with mental illness, supernatural causation of mental illness, and endorsement of a biopsychosocial approach to mental illness. Semi-structured key informant interviews (n = 11) with trainees, trainers, and local health officials who participated in or supported the HAPPINESS project were thematically analyzed to understand their experiences and perspectives of the project’s barriers, facilitators, and opportunities. Results Trainees showed significant improvements on socializing, normalizing, and supernatural causation subscales of the stigma questionnaire (p < 0.05). No significant effect was seen on the biopsychosocial subscale; however, evidence of biopsychosocial beliefs was found in interview responses. Key informant interviews revealed that the HAPPINESS project enhanced trainees’ diagnostic and treatment abilities, mental health awareness, and empathy towards patients. Misinformation, stigma, inadequate funding, and lack of road access to clinics were identified as barriers to mental health care integration into general care in Imo State. Respondents also suggested ways that the HAPPINESS project could be improved and expanded in the future. Conclusions This study adds to the limited evidence on the implementation of mhGAP-IG in Nigeria. Using mixed methods, it evaluates how mhGAP-IG can impact perceptions and knowledge of stigma among primary care trainees. It also highlights barriers, facilitators, and opportunities to consider for project growth. Future efforts should focus on clinical support, supervision, health outcomes, as well as scaling up and assessing the cost-effectiveness of the HAPPINESS project intervention. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07703-1.
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Le PD, Eschliman EL, Grivel MM, Tang J, Cho YG, Yang X, Tay C, Li T, Bass J, Yang LH. Barriers and facilitators to implementation of evidence-based task-sharing mental health interventions in low- and middle-income countries: a systematic review using implementation science frameworks. Implement Sci 2022; 17:4. [PMID: 35022081 PMCID: PMC8756725 DOI: 10.1186/s13012-021-01179-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 12/05/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Task-sharing is a promising strategy to expand mental healthcare in low-resource settings, especially in low- and middle-income countries (LMICs). Research on how to best implement task-sharing mental health interventions, however, is hampered by an incomplete understanding of the barriers and facilitators to their implementation. This review aims to systematically identify implementation barriers and facilitators in evidence-based task-sharing mental health interventions using an implementation science lens, organizing factors across a novel, integrated implementation science framework. METHODS PubMed, PsychINFO, CINAHL, and Embase were used to identify English-language, peer-reviewed studies using search terms for three categories: "mental health," "task-sharing," and "LMIC." Articles were included if they: focused on mental disorders as the main outcome(s); included a task-sharing intervention using or based on an evidence-based practice; were implemented in an LMIC setting; and included assessment or data-supported analysis of barriers and facilitators. An initial conceptual model and coding framework derived from the Consolidated Framework for Implementation Research and the Theoretical Domains Framework was developed and iteratively refined to create an integrated conceptual framework, the Barriers and Facilitators in Implementation of Task-Sharing Mental Health Interventions (BeFITS-MH), which specifies 37 constructs across eight domains: (I) client characteristics, (II) provider characteristics, (III) family and community factors, (IV) organizational characteristics, (V) societal factors, (VI) mental health system factors, (VII) intervention characteristics, and (VIII) stigma. RESULTS Of the 26,935 articles screened (title and abstract), 192 articles underwent full-text review, yielding 37 articles representing 28 unique intervention studies that met the inclusion criteria. The most prevalent facilitators occur in domains that are more amenable to adaptation (i.e., the intervention and provider characteristics domains), while salient barriers occur in domains that are more challenging to modulate or intervene on-these include constructs in the client characteristics as well as the broader societal and structural levels of influence (i.e., the organizational, mental health system domains). Other notable trends include constructs in the family and community domains occurring as barriers and as facilitators roughly equally, and stigma constructs acting exclusively as barriers. CONCLUSIONS Using the BeFITS-MH model we developed based on implementation science frameworks, this systematic review provides a comprehensive identification and organization of barriers and facilitators to evidence-based task-sharing mental health interventions in LMICs. These findings have important implications for ongoing and future implementation of this critically needed intervention strategy, including the promise of leveraging task-sharing intervention characteristics as sites of continued innovation, the importance of but relative lack of engagement with constructs in macro-level domains (e.g., organizational characteristics, stigma), and the need for more delineation of strategies for task-sharing mental health interventions that researchers and implementers can employ to enhance implementation in and across levels. TRIAL REGISTRATION PROSPERO CRD42020161357.
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Affiliation(s)
- PhuongThao D. Le
- grid.137628.90000 0004 1936 8753Department of Social and Behavioral Sciences, New York University School of Global Public Health, 708 Broadway, NY 10012 New York, USA
| | - Evan L. Eschliman
- grid.21107.350000 0001 2171 9311Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, 615 North Wolfe St., Baltimore, MD 21205 USA
| | - Margaux M. Grivel
- grid.137628.90000 0004 1936 8753Department of Social and Behavioral Sciences, New York University School of Global Public Health, 708 Broadway, NY 10012 New York, USA
| | - Jeffrey Tang
- grid.137628.90000 0004 1936 8753Department of Psychology, New York University Graduate School of Arts and Science, One-Half Fifth Avenue, New York, NY 10003 USA
| | - Young G. Cho
- grid.21729.3f0000000419368729New York State Psychiatric Institute, Columbia University, 1051 Riverside Dr., New York, NY 10032 USA
| | - Xinyu Yang
- grid.21729.3f0000000419368729Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th St., New York, NY 10032 USA
| | - Charisse Tay
- grid.21729.3f0000000419368729Columbia University Teachers College, 525 West 120th Street, New York, NY 10027 USA
| | - Tingyu Li
- grid.21729.3f0000000419368729Columbia University Teachers College, 525 West 120th Street, New York, NY 10027 USA
| | - Judith Bass
- grid.21107.350000 0001 2171 9311Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Hampton House, 8th Floor, 624 N. Broadway, Baltimore, MD 21205 USA
| | - Lawrence H. Yang
- grid.137628.90000 0004 1936 8753Department of Social and Behavioral Sciences, New York University School of Global Public Health, 708 Broadway, NY 10012 New York, USA ,grid.21729.3f0000000419368729Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th St., New York, NY 10032 USA
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Alabi AA. Self-confidence and knowledge of suicide assessment and prevention amongst first-line health professionals in Nelson Mandela Bay, South Africa. S Afr Fam Pract (2004) 2022; 64:e1-e6. [PMID: 35144471 PMCID: PMC8831997 DOI: 10.4102/safp.v64i1.5377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 10/14/2021] [Accepted: 10/16/2021] [Indexed: 11/01/2022] Open
Abstract
Background: First-line health professionals are uniquely positioned to recognise suicidal behaviours in patients. However, the opportunities are often missed or poorly managed. Self-confidence and knowledge of suicide prevention and assessment by health professionals can lead to prompt recognition and management of at-risk individuals. This study evaluates the first-line health professionals’ self-confidence and knowledge of suicide assessment in Nelson Mandela Bay Municipality (NMBM), South Africa.Methods: A cross-sectional study was conducted in six healthcare facilities across NMBM between January 2020 and March 2020. Five hundred first-line healthcare professionals were recruited to respond to a validated self-administered questionnaire to collect demographic characteristics, self-confidence levels and knowledge of suicide assessment and associated factors.Results: A total of 344 first-line health professionals completed the questionnaire (68.8% response rate); 40% of the respondents work in emergency units and 77.3% reported frequent encounters with patients who attempted suicide. Most participants had not received suicide assessment training during their undergraduate or postgraduate years (59.6% and 81.1%, respectively). They also lacked adequate knowledge and self-confidence in suicide assessment. Younger age, minimal work experience and attendance of two or more hours of suicide prevention training were associated with higher knowledge of suicide assessment.Conclusion: Findings revealed gaps in self-confidence and knowledge of suicide management, attributed to lack of training in suicide management. Health authorities should prioritise upskilling of front-line workers in suicide prevention and assessment, specifically targeting older nurses in the region.
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Affiliation(s)
- Adeyinka A Alabi
- Department of Family Medicine and Rural Health, Dora Nginza Regional Hospital, Gqeberha, South Africa; and, Department of Family Medicine and Rural Health, Faculty of Health Sciences, Walter Sisulu University, Mthatha.
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Adedeji IA, Ogunniyi A, Henderson DC, Sam-Agudu NA. Experiences and practices of caregiving for older persons living with dementia in African countries: A qualitative scoping review. DEMENTIA 2022; 21:995-1011. [PMID: 34978956 DOI: 10.1177/14713012211065398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The increasing awareness and diagnosis of dementia in Africa necessitate documentation of caregiving practices to understand local patterns and improve the quality of care. Caregiving in African communities is rooted in informal-communal social organization. This scoping review analyses caregiver characteristics and experiences, and practices of caregiving for persons living with dementia in Africa. METHODS A total of 152 references were retrieved, with 64 references obtained from PubMed, 85 from AJOL, and three from Scopus. Based on the relevance of titles, 83 references were further retained from PubMed (64), AJOL (16), and Scopus (3). A rapid review of abstracts was done in Distiller SR, and finally, six relevant articles were content-analyzed using Atlas ti 8.4 qualitative analysis software. RESULTS All six included studies were published between 2003 and 2018. Four themes were identified: article characteristics, caregiver characteristics, caregiver in context, and caregiver potentialities (challenges and opportunities). Studies reported findings from research conducted in four African countries: three from Nigeria, and one each from South Africa, Egypt, and Tanzania. Caregivers of persons living with dementia typically had eight years or less of formal education, were unpaid, and spent a daily average of 13 hours in caregiving. Cultural thresholds and individual caregiver differences underlie the interpretation of stressors across cultures. Caregivers lack the right training and information as well as support systems to improve their role performance and reduce accumulated stress. CONCLUSION In African countries, informational and educational platforms are essential for improved individual dementia caregiving, vis-à-vis strengthened roles of governments, and religious/traditional leaders and organizations.
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Affiliation(s)
- Isaac A Adedeji
- Department of Sociology, 107991Olabisi Onabanjo University, Ago-Iwoye, Nigeria
| | - Adesola Ogunniyi
- Department of Medicine, 58987University College Hospital, Ibadan, Nigeria
| | - David C Henderson
- Department of Psychiatry, 1846Boston University School of Medicine, USA
| | - Nadia A Sam-Agudu
- International Research Center of Excellence, 12264Institute of Human Virology Nigeria, Abuja, Nigeria.,Department of Paediatrics and Child Health, University of Cape Coast School of Medical Sciences, Cape Coast, Ghana.,Division of Epidemiology and Prevention, Institute of Human Virology, 12264University of Maryland School of Medicine, Baltimore, USA
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28
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Adekeye A. Bridging the gap by strengthening the MHGAP: Integrating mental health care into primary health care in Nigeria. ARCHIVES OF MENTAL HEALTH 2022. [DOI: 10.4103/amh.amh_34_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Mushi D, Francis JM, Moshiro C, Hanlon C, Teferra S. Integration of Alcohol Use Disorder Interventions in General Health Care Settings in Sub-Saharan Africa: A Scoping Review. Front Psychiatry 2022; 13:822791. [PMID: 35370845 PMCID: PMC8964495 DOI: 10.3389/fpsyt.2022.822791] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 02/07/2022] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Alcohol use disorder (AUD) is among the leading cause of morbidity and mortality in sub-Saharan Africa. Despite this, AUD is often not detected in health care settings, which contributes to a wide treatment gap. Integrating services for mental, neurological, and substance use disorders in general health care settings is among the recommended strategies to narrow this treatment gap. This scoping review aimed to map the available evidence on integration of AUD interventions in general health care settings in sub-Saharan Africa. METHODS We searched four databases (PubMed, PsycINFO, CINAHL, and Africa Wide Information) for publications up to December 2020. The search strategy focused on terms for alcohol use, alcohol interventions, and sub-Saharan African countries. Studies that reported AUD interventions in general health care settings in sub-Saharan Africa were eligible for inclusion. Over 3,817 potentially eligible articles were identified. After the removal of duplicates and screening of abstracts, 56 articles were included for full article review. Of these, 24 papers reporting on 22 studies were eligible and included in a narrative review. RESULTS Of the 24 eligible articles, 19 (80%) described AUD interventions that were being delivered in general health care settings, 3 (12%) described plans or programs for integrating AUD interventions at different levels of care, including in health facilities, and 2 (8%) studies reported on AUD interventions integrated into general health care settings. CONCLUSIONS This review shows that there is limited evidence on the integration of AUD interventions in health care settings in sub-Saharan Africa. There is an urgent need for studies that report systematically on the development, adaptation, implementation, and evaluation of integrated AUD interventions in health care settings in sub-Saharan Africa.
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Affiliation(s)
- Dorothy Mushi
- Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,Centre for Innovative Drug Development and Therapeutics Trial for Africa, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Science, Dar es Salaam, Tanzania
| | - Joel M Francis
- Department of Family Medicine and Primary Care, Faculty of Health Sciences, Witwatersrand University, Johannesburg, South Africa.,Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Science, Dar es Salaam, Tanzania
| | - Candida Moshiro
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Science, Dar es Salaam, Tanzania
| | - Charlotte Hanlon
- Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,Centre for Innovative Drug Development and Therapeutics Trial for Africa, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,Centre for Global Mental Health, Health Service and Population Research Department and WHO Collaborating Centre for Mental Health and Training, Institute of Psychiatry, Psychology, and Neuroscience, King's College University, London, United Kingdom
| | - Solomon Teferra
- Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Diagnosing and Treating Depression and Anxiety in Patients with Cardiovascular Disorders and Diabetes Mellitus in Primary Healthcare: Is Training of Physicians Enough for Improvement? CONSORTIUM PSYCHIATRICUM 2021. [DOI: 10.17816/cp112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION: Common mental disorders anxiety and depression are prevalent among patients with cardiovascular disease (CVD) and diabetes mellitus type 2 (DM) and can negatively influence treatment outcomes and healthcare expenses. Despite the importance of management of depression and anxiety in primary care facilities, the diagnostics and treatment of these disorders remain insufficient in the Russian Federation.
AIM: To explore whether the rates of referrals to psychiatrists and indicated pharmacological treatment received due to depression or anxiety among patients with CVD and DM will significantly change in primary healthcare facilities after the training of primary care physicians (PCPhs) to deal with comorbid depression and anxiety (including the algorithm for referral to a psychiatrist).
METHODS: Patients in primary care outpatient settings with diagnoses of CVD and DM passed screening on anxiety and depression using the Hospital Anxiety and Depression Scale (HADS), and information about the indicated treatment for anxiety or depression was collected when present (Sample 1: n=400). The educational programme for PCPhs on the diagnostics of anxiety and depression was then performed, and PCPhs were instructed to refer patients with HADS 7 to a psychiatrist. After the training, the second sample was collected (Sample 2: n=178) using the same assessments as for Sample 1. The independent expert (psychiatrist) evaluated whether the patients had received the indicated pharmacological treatment according to the screening criteria used in the study for anxiety and depression for both samples.
RESULTS: The proportions of patients with borderline abnormal and abnormal HADS scores (7) were 365 (91.2%) and 164 (92.1%) in Sample 1 and Sample 2, respectively. In Sample 1, among patients with HADS 7, 119 (29.8%) received psychopharmacological treatment, but in only 46 (38.7%) cases was it indicated in compliance with the screening criteria. In Sample 2, among patients with HADS 7, 59 (33.1%) received psychopharmacological treatment, and in only 14 (23.7%) cases was it indicated in compliance with the screening criteria. The differences in the indicated pharmacological treatment were not statistically significant, and no one from Sample 2 with HADS 7 met a psychiatrist through PCPh referral.
CONCLUSIONS: Anxiety and depression are prevalent in patients with CVD and DM treated in primary care facilities, but these patients may not be receiving the indicated pharmacological treatment. Barriers to referral and the use of psychiatric consultation exist despite the focused training of PCPhs and the straightforward referral protocol provided.
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Okeke EN. Money and my mind: Maternal cash transfers and mental health. HEALTH ECONOMICS 2021; 30:2879-2904. [PMID: 34462990 PMCID: PMC9291569 DOI: 10.1002/hec.4398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 06/14/2021] [Accepted: 07/05/2021] [Indexed: 05/30/2023]
Abstract
This paper documents important mental health spillovers in the context of a program that offered pregnant women modest cash incentives to use pre- and perinatal health care services. Program participation was randomized and the payments were made after the birth of the child (and after the completion of an endline mental health assessment). I present causal evidence that the program led to improvements in mothers' mental health. The effect size ranges from a 1-3 percentage point reduction in postpartum depression measured using the Edinburgh Postnatal Depression Scale. I present suggestive evidence that these beneficial effects on mental health may be related to program-induced improvements in child health. These results provide novel evidence that programs designed to improve birth outcomes may generate unanticipated spillover effects on mental health.
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Affiliation(s)
- Edward N. Okeke
- Department of Economics, Sociology and StatisticsRANDSanta MonicaCaliforniaUSA
- Pardee RAND Graduate SchoolRANDSanta MonicaCaliforniaUSA
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Ogunbajo A, Iwuagwu S, Williams R, Biello K, Kahler CW, Sandfort TGM, Mimiaga MJ. Psychological Problems Mediate the Relationship Between Minority Stress and HIV Sexual Risk Among Nigerian Men Who Have Sex with Men: Testing the Minority Stress Model. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:3163-3174. [PMID: 34561795 DOI: 10.1007/s10508-021-01943-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 01/15/2021] [Accepted: 02/04/2021] [Indexed: 06/13/2023]
Abstract
Gay, bisexual, and other men who have sex with men (GBMSM) in Nigeria bear a disproportionately higher burden of HIV. Meyer's minority stress theory posits that social stress due to the discrimination, violence, and stigma experienced by lesbian, gay, and bisexual men and women (LGBs)-due to their sexual orientation-may contribute to psychological problems, including mental health problems, substance use, and HIV sexual risk-taking. Between March and June 2019, we recruited 406 GBMSM from four states in Nigeria (Abuja, Delta, Lagos, and Plateau) to complete a cross-sectional survey at local community-based organizations. We utilized structural equation modeling to test whether psychological problems and substance use mediated the relationship between minority stress and HIV sexual risk-taking (condomless anal sex and number of sexual partners) among GBMSM in Nigeria. Minority stress (β = 0.60, 95% CI: 0.44-0.72, p ≤ .001), substance use (β = 0.43, 95% CI: 0.27-0.59, p = .004), and psychological problems (β = 0.35, 95% CI: 0.28-0.45 p = .012) had moderate associations with HIV sexual risk-taking. We found that psychological problems mediated the relationship between minority stress and HIV sexual risk-taking. Interventions focused on addressing psychological problems may help mitigate the effects of minority stress on HIV sexual risk-taking among GBMSM in Nigeria.
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Affiliation(s)
- Adedotun Ogunbajo
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main St., Box G-S121-3, Providence, RI, 02912, USA.
- Center for Health Equity, Brown University School of Public Health, Providence, RI, USA.
| | | | - Rashidi Williams
- Equality Triangle for Health and Peoples' Development Initiative, Warri, Delta, Nigeria
| | - Katie Biello
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main St., Box G-S121-3, Providence, RI, 02912, USA
- Center for Health Equity, Brown University School of Public Health, Providence, RI, USA
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Christopher W Kahler
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main St., Box G-S121-3, Providence, RI, 02912, USA
| | - Theodorus G M Sandfort
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Matthew J Mimiaga
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main St., Box G-S121-3, Providence, RI, 02912, USA
- Center for Health Equity, Brown University School of Public Health, Providence, RI, USA
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, Providence, RI, USA
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Gureje O, Oladeji B, Ayinde OO, Kola L, Abdulmalik J, Abass WAL, Faregh N, Zelkowitz P. Scaling up care for perinatal depression for improved maternal and infant health (SPECTRA): protocol of a hybrid implementation study of the impact of a cascade training of primary maternal care providers in Nigeria. Int J Ment Health Syst 2021; 15:73. [PMID: 34544456 PMCID: PMC8450310 DOI: 10.1186/s13033-021-00496-6] [Citation(s) in RCA: 3] [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] [Received: 08/13/2020] [Accepted: 08/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The large treatment gap for mental disorders in low- and middle-income countries (LMIC) necessitates task-sharing approaches in scaling up care for mental disorders. Previous work have shown that primary health care workers (PHCW) can be trained to recognize and respond to common mental disorders but there are lingering questions around sustainable implementation and scale-up in real world settings. METHOD This project is a hybrid implementation-effectiveness study guided by the Replicating Effective Programmes Framework. It will be conducted in four overlapping phases in maternal care clinics (MCC) in 11 local government areas in and around Ibadan metropolis, Nigeria. In Phase I, engagement meetings with relevant stake holders will be held. In phase II, the organizational and clinical profiles of MCC to deliver chronic depression care will be assessed, using interviews and a standardized assessment tool administered to staff and managers of the clinics. To ascertain the current level of care, 167 consecutive women presenting for antenatal care for the first time and who screened positive for depression will be recruited and followed up till 12 months post-partum. In phase III, we will design and implement a cascade training programme for PHCW, to equip them to identify and treat perinatal depression. In phase IV, a second cohort of 334 antenatal women will be recruited and followed up as in Phase I, to ascertain post-training level of care. The primary implementation outcome is change in the identification and treatment of perinatal depression by the PHCW while the primary effectiveness outcome is recovery from depression among the women at 6 months post-partum. A range of mixed-method approaches will be used to explore secondary implementation outcomes, including fidelity and acceptability. Secondary effectiveness outcomes are measures of disability and of infant outcomes. DISCUSSION This study represents an attempt to systematically assess and document an implementation strategy that could inform the scaling up of evidence based interventions for perinatal depression using the WHO mhGAP-IG in LMIC. Trial registration This study was registered on 03 December, 2019. https://doi.org/10.1186/ISRCTN94230307 .
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Affiliation(s)
- Oye Gureje
- Department of Psychiatry, University of Ibadan, Ibadan, Nigeria.
| | | | | | - Lola Kola
- Department of Psychiatry, University of Ibadan, Ibadan, Nigeria
| | | | | | - Neda Faregh
- Department of Psychology, Carleton University, Ottawa, ON, Canada
| | - Phyllis Zelkowitz
- Division of Social and Transcultural Psychiatry, McGill University, Montreal, Canada.,Department of Psychiatry, Jewish General Hospital, Montreal, Canada
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Mukala Mayoyo E, van de Put W, Van Belle S, van Mierlo B, Criel B. Intégration de la santé mentale dans les services de soins de santé primaires en République démocratique du Congo. SANTE PUBLIQUE 2021; Vol. 33:77-87. [PMID: 34372645 DOI: 10.3917/spub.211.0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The study aims to document the experience of integrating a mental health care package into the general health care system of Lubero district in the Democratic Republic of Congo (DRC) between 2011 and 2015, and more specifically, the effects of this integration on the access to and use of health services offering mental health care. METHOD This is a retrospective study using a case study design. Data collected from different project documents and an analytic review of the official reports of the Ministry of Public Health were used for an analysis of the results of the integration. RESULTS The results indicate that 3,941 patients with mental health problems used the care offered at the health centers and the district hospital between 2012 and 2015. In 2015, the average utilization rate of curative care in health centers for mental health problems was 7 new cases/1,000 inhabitants/year. The majority of these patients were treated on an outpatient basis, at primary health care level. DISCUSSION Our study shows that it is possible to integrate mental health into existing general health services in the DRC. Nevertheless, the major problems in terms of access and use of basic care in the Lubero district indicate that the success of such an integration depends on the quality of the health system in place and the involvement of a wide range of both health and non-health actors, including key people within communities.
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Spagnolo J, Champagne F, Leduc N, Rivard M, Melki W, Piat M, Laporta M, Guesmi I, Bram N, Charfi F. Building capacity in mental health care in low- and middle-income countries by training primary care physicians using the mhGAP: a randomized controlled trial. Health Policy Plan 2020; 35:186-198. [PMID: 31794027 DOI: 10.1093/heapol/czz138] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2019] [Indexed: 12/15/2022] Open
Abstract
To address the rise in mental health conditions in Tunisia, a training based on the Mental Health Gap Action Programme (mhGAP) Intervention Guide (IG) was offered to primary care physicians (PCPs) working in the Greater Tunis area. Non-specialists (such as PCPs)' training is an internationally supported way to target untreated mental health symptoms. We aimed to evaluate the programme's impact on PCPs' mental health knowledge, attitudes, self-efficacy and self-reported practice, immediately following and 18 months after training. We conducted an exploratory trial with a combination of designs: a pretest-posttest control group design and a one-group pretest-posttest design were used to assess the training's short-term impact; and a repeated measures design was used to assess the training's long-term impact. The former relied on a delayed-intervention strategy: participants assigned to the control group (Group 2) received the training after the intervention group (Group 1). The intervention consisted of a weekly mhGAP-based training session (totalling 6 weeks), comprising lectures, discussions, role plays and a support session offered by trainers. Data were collected at baseline, following Group 1's training, following Group 2's training and 18 months after training. Descriptive, bivariate and ANOVA analyses were conducted. Overall, 112 PCPs were randomized to either Group 1 (n = 52) or Group 2 (n = 60). The training had a statistically significant short-term impact on mental health knowledge, attitudes and self-efficacy scores but not on self-reported practice. When comparing pre-training results and results 18 months after training, these changes were maintained. PCPs reported a decrease in referral rates to specialized services 18 months after training in comparison to pre-training. The mhGAP-based training might be useful to increase mental health knowledge and self-efficacy, and decrease reported referral rates and negative mental health attitudes among PCPs in Tunisia and other low- and middle-income countries. Future studies should examine relationships among these outcome variables.
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Affiliation(s)
- Jessica Spagnolo
- School of Public Health, IRSPUM, Université de Montréal, 7101 Park Avenue, Montréal, Québec H3N 1X9, Canada
| | - François Champagne
- School of Public Health, IRSPUM, Université de Montréal, 7101 Park Avenue, Montréal, Québec H3N 1X9, Canada
| | - Nicole Leduc
- School of Public Health, IRSPUM, Université de Montréal, 7101 Park Avenue, Montréal, Québec H3N 1X9, Canada
| | - Michèle Rivard
- School of Public Health, IRSPUM, Université de Montréal, 7101 Park Avenue, Montréal, Québec H3N 1X9, Canada
| | - Wahid Melki
- Hôpital Razi, Manouba, Tunisia.,Faculté de médecine, Université de Tunis El-Manar, Tunis, Tunisia
| | - Myra Piat
- Douglas Mental Health University Institute, 6875 Boulevard LaSalle, Verdun, QC H4H 1R3, Canada.,Department of Psychiatry, McGill University, 1033 Avenue des Pins, Montréal, QC H3A 1A1, Canada
| | - Marc Laporta
- Department of Psychiatry, McGill University, 1033 Avenue des Pins, Montréal, QC H3A 1A1, Canada.,The Montréal WHO-PAHO Collaborating Centre for Research and Training in Mental Health, 6875 Boulevard LaSalle, Verdun, QC H4H 1R3, Canada
| | - Imen Guesmi
- Centre médico-scolaire et universitaire de Manouba, Manouba, Tunisia
| | - Nesrine Bram
- Hôpital Razi, Manouba, Tunisia.,Faculté de médecine, Université de Tunis El-Manar, Tunis, Tunisia
| | - Fatma Charfi
- Faculté de médecine, Université de Tunis El-Manar, Tunis, Tunisia.,Hôpital Mongi-Slim, La Marsa, Tunisia
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Zani B, Fairall L, Petersen I, Folb N, Bhana A, Thornicroft G, Hanass-Hancock J, Lund C, Bachmann M. Predictors of receiving a diagnosis, referral and treatment of depression in people on antiretroviral therapy in South African primary care: a secondary analysis of data from a randomised trial. Trop Med Int Health 2020; 25:1450-1466. [PMID: 32985080 PMCID: PMC7756779 DOI: 10.1111/tmi.13495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objective To describe the receipt of a diagnosis, referral and treatment for depression in people receiving antiretroviral therapy (ART), with depressive symptoms and attending primary care clinics in South Africa, and investigate factors associated with receiving these components of care. Methods This is a secondary analysis of data from a randomised controlled trial of an intervention intended to improve detection and treatment of depression in primary care patients receiving ART. In this analysis, we combined cross‐sectional and longitudinal data from the intervention and control arms. Using regression models and adjusting for intra‐cluster correlation of outcomes, we investigated associations between socioeconomic characteristics, depressive symptoms, stress, disability and stigma, and receipt of a diagnosis, referral and treatment for depression. Results Of 2002 participants enrolled, 18% reported a previous diagnosis of depression by a healthcare worker and 10% reported having received counselling from a specialist mental health worker. Diagnosis, referral and counselling during the follow‐up period were appropriately targeted, being independently more frequent in participants with higher enrolment scores for depressive symptoms, stress or disability. Participants with higher stigma scores at enrolment were independently less likely to receive counselling. Severe socio‐economic deprivation was common but was not associated with treatment. Conclusion While the receipt of a diagnosis, referral and treatment for depression were uncommon, they seemed to be appropriately targeted. Socio‐economic deprivation was not associated with treatment.
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Affiliation(s)
- B Zani
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - L Fairall
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa.,King's Global Health Institute, King's College London, London, UK.,Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - I Petersen
- Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa
| | - N Folb
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - A Bhana
- Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa.,Health Systems Research Unit, South African Medical Research Council, Durban, South Africa
| | - G Thornicroft
- Centre for Global Mental Health, King's College London, London, UK
| | - J Hanass-Hancock
- HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa.,School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - C Lund
- Centre for Global Mental Health, King's College London, London, UK.,Alan J Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, South Africa
| | - M Bachmann
- Norwich Medical School, University of East Anglia, Norwich, UK
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Ezeanolue EE, Iheanacho T, Adedeji IA, Itanyi IU, Olakunde B, Patel D, Dakum P, Okonkwo P, Akinmurele T, Obiefune M, Khamofu H, Oyeledun B, Aina M, Eyo A, Oleribe O, Oko J, Olutola A, Gobir I, Aliyu MH, Aliyu G, Woelk G, Aarons G, Siberry G, Sturke R. Opportunities and challenges to integrating mental health into HIV programs in a low- and middle-income country: insights from the Nigeria implementation science Alliance. BMC Health Serv Res 2020; 20:904. [PMID: 32993621 PMCID: PMC7526407 DOI: 10.1186/s12913-020-05750-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 09/21/2020] [Indexed: 11/10/2022] Open
Abstract
Background In Nigeria, there is an estimated 1.9 million people living with HIV (PLHIV), 53% of whom utilize HIV care and services. With decreasing HIV-related deaths and increasing new infections, HIV with its associated comorbidities continue to be a key public health challenge in Nigeria. Untreated, comorbid mental disorders are a critical but potentially modifiable determinant of optimal HIV treatment outcomes. This study aimed to identify the challenges and opportunities related to integrating mental health care into existing HIV programs in Nigeria. Method Attendees at the Nigeria Implementation Science Alliance (NISA)‘s 2019 conference participated in nominal group technique (NGT) exercise informed by the “Exploration, Preparation, Implementation, and Sustainment (EPIS)” framework. The NGT process was conducted among the nominal groups in two major sessions of 30-min phases followed by a 30-min plenary session. Data analysis proceeded in four steps: transcription, collation, theming and content analysis. Results The two major theoretical themes from the study were – opportunities and challenges of integrating mental health treatment into HIV services. Three sub-themes emerged on opportunities: building on health care facilities for HIV services (screening, counseling, task-sharing monitoring and evaluation frameworks), utilizing existing human resources or workforce in HIV programs (in-service training and including mental health in education curriculum) and the role of social and cultural structures (leveraging existing community, traditional and faith-based infrastructures). Four sub-themes emerged for challenges: double burden of stigma and the problems of early detection (HIV and mental health stigma, lack of awareness), existing policy gaps and structural challenges (fragmented health system), limited human resources for mental health care in Nigeria (knowledge gap and burnout) and dearth of data/evidence for planning and action (research gaps). Conclusions Potential for integrating treatments for mental disorders into HIV programs and services exist in Nigeria. These include opportunities for clinicians’ training and capacity building as well as community partnerships. Multiple barriers and challenges such as stigma, policy and research gaps would need to be addressed to leverage these opportunities. Our findings serve as a useful guide for government agencies, policy makers and research organizations to address co-morbid mental disorders among PLHIV in Nigeria.
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Affiliation(s)
- Echezona E Ezeanolue
- Center for Translation and Implementation Research, Institute of Maternal and Child health, University of Nigeria Nsukka, Enugu Campus, Enugu, Nigeria.,Healthy Sunrise Foundation, Las Vegas, NV, USA
| | - Theddeus Iheanacho
- Department of Psychiatry, Yale University School of Medicine, Yale University, 300 George Street, New Haven, CT, 06511, USA.
| | | | - Ijeoma Uchenna Itanyi
- Center for Translation and Implementation Research, Institute of Maternal and Child health, University of Nigeria Nsukka, Enugu Campus, Enugu, Nigeria.,Department of Community Medicine, University of Nigeria, Enugu, Nigeria
| | - Babayemi Olakunde
- Center for Translation and Implementation Research, Institute of Maternal and Child health, University of Nigeria Nsukka, Enugu Campus, Enugu, Nigeria.,National Agency for Control of AIDS, Abuja, Nigeria
| | - Dina Patel
- Healthy Sunrise Foundation, Las Vegas, NV, USA
| | - Patrick Dakum
- Institute of Human Virology, University of Maryland, Baltimore, MD, USA.,Institute of Human Virology, Abuja, Nigeria
| | | | | | | | | | | | | | - Andy Eyo
- Excellence Community Education Welfare Scheme, Abuja, Nigeria
| | - Obinna Oleribe
- Excellence and Friends Management Consult, Abuja, Nigeria
| | - John Oko
- Catholic Caritas Foundation Nigeria, Abuja, Nigeria
| | | | - Ibrahim Gobir
- Center for Global Health Practice and Impact, Georgetown University, Washington, USA
| | - Muktar H Aliyu
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Gambo Aliyu
- National Agency for Control of AIDS, Abuja, Nigeria
| | - Godfrey Woelk
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, USA
| | | | - George Siberry
- United States Agency for International Development, Washington, USA
| | - Rachel Sturke
- Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
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Luitel NP, Breuer E, Adhikari A, Kohrt BA, Lund C, Komproe IH, Jordans MJD. Process evaluation of a district mental healthcare plan in Nepal: a mixed-methods case study. BJPsych Open 2020; 6:e77. [PMID: 32718381 PMCID: PMC7443901 DOI: 10.1192/bjo.2020.60] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The PRogramme for Improving Mental Health carE (PRIME) evaluated the process and outcomes of the implementation of a mental healthcare plan (MHCP) in Chitwan, Nepal. AIMS To describe the process of implementation, the barriers and facilitating factors, and to evaluate the process indicators of the MHCP. METHOD A case study design that combined qualitative and quantitative methods based on a programme theory of change (ToC) was used and included: (a) district-, community- and health-facility profiles; (b) monthly implementation logs; (c) pre- and post-training evaluation; (d) out-patient clinical data and (e) qualitative interviews with patients and caregivers. RESULTS The MHCP was able to achieve most of the indicators outlined by the ToC. Of the total 32 indicators, 21 (66%) were fully achieved, 10 (31%) partially achieved and 1 (3%) were not achieved at all. The proportion of primary care patients that received mental health services increased by 1200% over the 3-year implementation period. Major barriers included frequent transfer of trained health workers, lack of confidential space for consultation, no mental health supervision in the existing system, and stigma. Involvement of Ministry of Health, procurement of new psychotropic medicines through PRIME, motivation of health workers and the development of a new supervision system were key facilitating factors. CONCLUSIONS Effective implementation of mental health services in primary care settings require interventions to increase demand for services and to ensure there is clinical supervision for health workers, private rooms for consultations, a separate cadre of psychosocial workers and a regular supply of psychotropic medicines.
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Affiliation(s)
| | - Erica Breuer
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, South Africa; and Department of Medicine and Public Health, University of Newcastle, Australia
| | - Anup Adhikari
- Transcultural Psychosocial Organization (TPO), Nepal
| | - Brandon A Kohrt
- Department of Psychiatry, George Washington University, USA; and Transcultural Psychosocial Organization (TPO), Nepal
| | - Crick Lund
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, South Africa; and Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Ivan H Komproe
- Faculty of Social and Behavioural Sciences, Utrecht University; and Research and Development Department, HealthNet TPO, Amsterdam, the Netherlands
| | - Mark J D Jordans
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Faculty of Social and Behavioural Sciences, Department of Anthropology, University of Amsterdam, the Netherlands; and Transcultural Psychosocial Organization (TPO), Nepal
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Michael S, Chowdhary N, Rawstorne P, Dua T. Developing competencies for the WHO mhGAP Intervention Guide Version 2.0 training package. World Psychiatry 2020; 19:248-249. [PMID: 32394545 PMCID: PMC7215064 DOI: 10.1002/wps.20762] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
| | - Neerja Chowdhary
- Brain Health Unit, Department of Mental Health and Substance UseWorld Health OrganizationGenevaSwitzerland
| | | | - Tarun Dua
- Brain Health Unit, Department of Mental Health and Substance UseWorld Health OrganizationGenevaSwitzerland
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Wagenaar BH, Hammett WH, Jackson C, Atkins DL, Belus JM, Kemp CG. Implementation outcomes and strategies for depression interventions in low- and middle-income countries: a systematic review. Glob Ment Health (Camb) 2020; 7:e7. [PMID: 32346482 PMCID: PMC7176918 DOI: 10.1017/gmh.2020.1] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 01/07/2020] [Accepted: 01/22/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND We systematically reviewed implementation research targeting depression interventions in low- and middle-income countries (LMICs) to assess gaps in methodological coverage. METHODS PubMed, CINAHL, PsycINFO, and EMBASE were searched for evaluations of depression interventions in LMICs reporting at least one implementation outcome published through March 2019. RESULTS A total of 8714 studies were screened, 759 were assessed for eligibility, and 79 studies met inclusion criteria. Common implementation outcomes reported were acceptability (n = 50; 63.3%), feasibility (n = 28; 35.4%), and fidelity (n = 18; 22.8%). Only four studies (5.1%) reported adoption or penetration, and three (3.8%) reported sustainability. The Sub-Saharan Africa region (n = 29; 36.7%) had the most studies. The majority of studies (n = 59; 74.7%) reported outcomes for a depression intervention implemented in pilot researcher-controlled settings. Studies commonly focused on Hybrid Type-1 effectiveness-implementation designs (n = 53; 67.1), followed by Hybrid Type-3 (n = 16; 20.3%). Only 21 studies (26.6%) tested an implementation strategy, with the most common being revising professional roles (n = 10; 47.6%). The most common intervention modality was individual psychotherapy (n = 30; 38.0%). Common study designs were mixed methods (n = 27; 34.2%), quasi-experimental uncontrolled pre-post (n = 17; 21.5%), and individual randomized trials (n = 16; 20.3). CONCLUSIONS Existing research has focused on early-stage implementation outcomes. Most studies have utilized Hybrid Type-1 designs, with the primary aim to test intervention effectiveness delivered in researcher-controlled settings. Future research should focus on testing and optimizing implementation strategies to promote scale-up of evidence-based depression interventions in routine care. These studies should use high-quality pragmatic designs and focus on later-stage implementation outcomes such as cost, penetration, and sustainability.
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Affiliation(s)
- Bradley H. Wagenaar
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Wilson H. Hammett
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Courtney Jackson
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Dana L. Atkins
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Jennifer M. Belus
- Department of Psychology, University of Maryland, College Park, MD, USA
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Ahrens J, Kokota D, Mafuta C, Konyani M, Chasweka D, Mwale O, Stewart RC, Osborn M, Chikasema B, Mcheka M, Blackwood D, Gilfillan S. Implementing an mhGAP-based training and supervision package to improve healthcare workers' competencies and access to mental health care in Malawi. Int J Ment Health Syst 2020; 14:11. [PMID: 32127914 PMCID: PMC7045435 DOI: 10.1186/s13033-020-00345-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 02/20/2020] [Indexed: 01/19/2023] Open
Abstract
Background It is now well established that the integration of mental health care into primary care is one of the most effective ways of reducing the substantial treatment gap for mental disorders which exists in most low- and middle-income countries. This study set out to determine whether a Mental Health Gap Action Programme (mhGAP) training and supervision package could be contextualised and implemented within the existing health care system in five districts in Southern Malawi. In addition, the study assessed the feasibility of holding community awareness events and establishing peer support groups in each district to further improve the access of the population to evidence-based mental health care. Methods A lead training team of experienced Malawian mental health professionals was appointed and mhGAP training materials were contextualised for use in Malawi. The lead team delivered a 4-day training package to district mental health teams in five districts covering three core conditions: psychosis, moderate-severe depression, and alcohol and substance use disorders. District mental health teams then delivered a 2-day training package and provided monthly supervision for 3 months to 500 non-specialist healthcare workers. Paired sample t-tests were used to compare knowledge, confidence and attitude scores before and immediately after training, and after 6 months in two districts. Case detection rates measured pre- and post-training in the pilot district were compared using Wilcoxon Rank Sum Test. Community awareness events were held and peer support groups were established in each of the five districts. The acceptability of the package was assessed through focus group discussions involving specialist and non-specialist healthcare workers, users and carers. Results Non-specialist healthcare workers’ knowledge and confidence scores significantly increased immediately after training in comparison to pre-training. These scores were maintained at 6 months. However, no statistically significant change in attitude scores was detected. Case detection rates increased immediately after the training in comparison to pre-training. Responses from focus group discussion participants illustrated the programme’s acceptability. Conclusions This study demonstrated that, with minimal additional funding and working within existing structures, an mhGAP based training at primary and secondary health care levels is feasible in Southern Malawi.
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Affiliation(s)
- Jen Ahrens
- 1Mile End Hospital, Bancroft Road, London, E1 4DG UK.,2Department of Mental Health, University of Malawi, College of Medicine, P/Bag 360, Chichiri, Blantyre 3, Malawi
| | - Demoubly Kokota
- 2Department of Mental Health, University of Malawi, College of Medicine, P/Bag 360, Chichiri, Blantyre 3, Malawi
| | | | - Mary Konyani
- Malawi College of Health Sciences, Zomba Campus, Zomba, Malawi
| | - Dennis Chasweka
- 5Department of Paediatrics, University of Malawi, College of Medicine, P/Bag 360, Chichiri, Blantyre 3, Malawi
| | - Owen Mwale
- 2Department of Mental Health, University of Malawi, College of Medicine, P/Bag 360, Chichiri, Blantyre 3, Malawi
| | - Robert C Stewart
- 2Department of Mental Health, University of Malawi, College of Medicine, P/Bag 360, Chichiri, Blantyre 3, Malawi.,6Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Morningside Park, Edinburgh, EH10 5HF UK
| | - Madeline Osborn
- 7Scotland Malawi Mental Health Education Project, Royal Edinburgh Hospital, Morningside Park, Edinburgh, EH10 5HF UK
| | | | | | - Douglas Blackwood
- 6Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Morningside Park, Edinburgh, EH10 5HF UK
| | - Sheila Gilfillan
- 2Department of Mental Health, University of Malawi, College of Medicine, P/Bag 360, Chichiri, Blantyre 3, Malawi.,8Royal Edinburgh Hospital, Morningside Park, Edinburgh, EH10 5HF UK
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Jegede A, Willey B, Hamade P, Oshiname F, Chandramohan D, Ajayi I, Falade C, Baba E, Webster J. Evaluation of a capacity building intervention on malaria treatment for under-fives in rural health facilities in Niger State, Nigeria. Malar J 2020; 19:90. [PMID: 32093679 PMCID: PMC7041190 DOI: 10.1186/s12936-020-03167-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 02/17/2020] [Indexed: 11/10/2022] Open
Abstract
Background Despite the uptake of parasitological testing into policy and practice, appropriate prescription of anti-malarials and artemisinin-based combination therapy (ACT) in accordance with test results is variable. This study describes a National Malaria Control Programme-led capacity building intervention which was implemented in 10 States of Nigeria. Using the experience of Niger State, this study assessed the effect on malaria diagnosis and prescription practices among febrile under-fives in rural health facilities. Methods The multicomponent capacity building intervention consisted of revised case management manuals; cascade training from national to state level carried out at the local government area (LGA) level; and on the job capacity development through supportive supervision. The evaluation was conducted in 28, principally government-owned, health facilities in two rural LGAs of Niger State, one in which the intervention case management of malaria was implemented and the other acted as a comparison area with no implementation of the intervention. Three outcomes were considered in the context of rapid diagnostic testing (RDT) for malaria which were: the prevalence of RDT testing in febrile children; appropriate treatment of RDT-positive children; and appropriate treatment of RDT-negative children. Outcomes were compared post-intervention between intervention and comparison areas using multivariate logistic regression. Results The intervention did not improve appropriate management of under-fives in intervention facilities above that seen for under-fives in comparison facilities. Appropriate treatment with artemisinin-based combinations of RDT-positive and RDT-negative under-fives was equally high in both areas. However, appropriate treatment of RDT-negative children, when defined as receipt of no ACT or any other anti-malarials, was better in comparison areas. In both areas, a small number of RDT-positives were not given ACT, but prescribed an alternative anti-malarial, including artesunate monotherapy. Among RDT-negatives, no under-fives were prescribed artesunate as monotherapy. Conclusion In a context of significant stock-outs of both ACT medicines and RDTs, under-fives were not more appropriately managed in intervention than comparison areas. The malaria case management intervention implemented through cascade training reached only approximately half of health workers managing febrile under-fives in this setting. Implementation studies on models of cascade training are needed to define what works in what context.
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Affiliation(s)
- Ayodele Jegede
- Department of Sociology, University of Ibadan, Ibadan, Nigeria.
| | - Barbara Willey
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Prudence Hamade
- Malaria Consortium, Development House, 56-64 Leonard Street, London, EC24 4LT, UK
| | - Fredrick Oshiname
- Department of Health Promotion and Education, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Daniel Chandramohan
- Disease Control Department, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - IkeOluwa Ajayi
- Department of Epidemiology and Biostatistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Catherine Falade
- Department of Pharmacology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Ebenezer Baba
- Malaria Consortium East and Southern Africa, Plot 2, Sturrock Road, P.O. Box 8045, Kampala, Uganda
| | - Jayne Webster
- Disease Control Department, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
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Robles R, Lopez-Garcia P, Miret M, Cabello M, Cisneros E, Rizo A, Ayuso-Mateos JL, Medina-Mora ME. WHO-mhGAP Training in Mexico: Increasing Knowledge and Readiness for the Identification and Management of Depression and Suicide Risk in Primary Care. Arch Med Res 2020; 50:558-566. [PMID: 32062428 DOI: 10.1016/j.arcmed.2019.12.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 12/05/2019] [Accepted: 12/12/2019] [Indexed: 11/25/2022]
Abstract
BACKGOUND In order to reduce the treatment gap of mental disorders, the World Health Organization (WHO) has proposed the mhGAP guidelines to be implemented globally. AIM OF THE STUDY To examine the effectivity of a training course based on the WHO-mhGAP guidelines to increase knowledge and readiness for identification and management of depression and suicide risk in primary care (PC) in Mexico. METHODS PC clinicians were invited to participate in a traning course; before and after it, all completed an evaluation of knowledge of mhGAP and depression (0-10 points), and self-efficacy in suicide risk management (0-40 points), and were classified according to Prochaska and Diclemente transtheorical model in their particular stage of readiness for identification and management of these conditions. RESULTS The sample included 60 health professionals. Before training, clinicians had adequate knowledge of depression and its treatment (8.1 ± 1.66), but not on the mhGAP model and/or suicide risk management, which increased by the end of training (mhGAPpre:7.91 ± 2.19 vs. mhGAPpost:8.77 ± 1.34, p = 0.01; SuicidePRE:29.16 ± 9.35 vs. SuicidePOST:39.24 ± 6.83, p = 0.0001). Before training, most clinicians were at the contemplation stage (42.6% vs. 37.7% at the action and 19.7% at the precontemplation stage). By the end of the training, a decrease in the number of clinicians at both the contemplation and precontemplation stages (to 36.1% and to zero, respectively) and a significant increase of clinicians at the action stage (to 63.9%) was observed. CONCLUSIONS A training course based on the WHO-mhGAP could be an effective tool for increasing PC clinicians' willingness to implement mental health services.
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Affiliation(s)
- Rebeca Robles
- Centro de Investigación en Salud Mental Global, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, México.
| | - Pilar Lopez-Garcia
- Departamento de Psiquiatría, Universidad Autónoma de Madrid, España; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, España
| | - Marta Miret
- Departamento de Psiquiatría, Universidad Autónoma de Madrid, España; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, España
| | - Maria Cabello
- Departamento de Psiquiatría, Universidad Autónoma de Madrid, España; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, España
| | | | - Alfredo Rizo
- Hospital Civil de Guadalajara Fray Antonio Alcalde, Jalisco, México
| | - Jose Luis Ayuso-Mateos
- Departamento de Psiquiatría, Universidad Autónoma de Madrid, España; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, España
| | - María Elena Medina-Mora
- Centro de Investigación en Salud Mental Global, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, México
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Godman B, Grobler C, Van-De-Lisle M, Wale J, Barbosa WB, Massele A, Opondo P, Petrova G, Tachkov K, Sefah I, Abdulsalim S, Alrasheedy AA, Unnikrishnan MK, Garuoliene K, Bamitale K, Kibuule D, Kalemeera F, Fadare J, Khan TA, Hussain S, Bochenek T, Kalungia AC, Mwanza J, Martin AP, Hill R, Barbui C. Pharmacotherapeutic interventions for bipolar disorder type II: addressing multiple symptoms and approaches with a particular emphasis on strategies in lower and middle-income countries. Expert Opin Pharmacother 2020; 20:2237-2255. [PMID: 31762343 DOI: 10.1080/14656566.2019.1684473] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Introduction: Appropriately managing mental disorders is a growing priority across countries in view of the impact on morbidity and mortality. This includes patients with bipolar disorders (BD). Management of BD is a concern as this is a complex disease with often misdiagnosis, which is a major issue in lower and middle-income countries (LMICs) with typically a limited number of trained personnel and resources. This needs to be addressed.Areas covered: Medicines are the cornerstone of managing patients with Bipolar II across countries including LMICs. The choice of medicines, especially antipsychotics, is important in LMICs with high rates of diabetes and HIV. However, care is currently compromised in LMICs by issues such as the stigma, cultural beliefs, a limited number of trained professionals and high patient co-payments.Expert opinion: Encouragingly, some LMICs have introduced guidelines for patients with BD; however, this is very variable. Strategies for the future include addressing the lack of national guidelines for patients with BD, improving resources for mental disorders including personnel, improving medicine availability and patients' rights, and monitoring prescribing against agreed guidelines. A number of strategies have been identified to improve the treatment of patients with Bipolar II in LMICs, and will be followed up.
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Affiliation(s)
- Brian Godman
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedicial Sciences, University of Strathclyde, Glasgow, UK.,Division of Clinical Pharmacology, Karolinska, Karolinska Institutet, Stockholm, Sweden.,Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, South Africa.,Health Economics Centre, University of Liverpool Management School, Liverpool, UK
| | - Christoffel Grobler
- Elizabeth Donkin Hospital, Port Elizabeth, South Africa.,Walter Sisulu University, East London, South Africa.,Nelson Mandela University, Port Elizabeth, South Africa
| | | | - Janney Wale
- Independent consumer advocate, Brunswick, Australia
| | - Wallace Breno Barbosa
- Department of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Amos Massele
- Department of Biomedical Sciences, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Philip Opondo
- Department of Psychiatry, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Guenka Petrova
- Faculty of Pharmacy, Department of Social Pharmacy and Pharmacoeconomics, Medical University of Sofia, Sofia, Bulgaria
| | - Konstantin Tachkov
- Faculty of Pharmacy, Department of Social Pharmacy and Pharmacoeconomics, Medical University of Sofia, Sofia, Bulgaria
| | - Israel Sefah
- Department of Pharmacy, Keta Municipal Hospital, Ghana Health Service, Keta, Ghana
| | - Suhaj Abdulsalim
- Unaizah College of Pharmacy, Qassim University, Buraidah Saudi Arabia
| | | | | | - Kristina Garuoliene
- Department of Pathology, Forensic Medicine and Pharmacology, Faculty of Medicine, Vilnius University, Lithuania and Ministry of Health, Vilnius, Lithuania
| | - Kayode Bamitale
- School of Pharmacy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Dan Kibuule
- School of Pharmacy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Francis Kalemeera
- School of Pharmacy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Joseph Fadare
- Department of Pharmacology and Therapeutics, College of Medicine, Ekiti State University, Ado-Ekiti, Nigeria
| | | | | | - Tomasz Bochenek
- Department of Drug Management, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | | | - James Mwanza
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Antony P Martin
- Health Economics Centre, University of Liverpool Management School, Liverpool, UK.,HCD Economics, The Innovation Centre, Daresbury, UK
| | - Ruaraidh Hill
- Liverpool Reviews and Implementation Group, Whelan Building, Liverpool University, Liverpool, UK
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona Italy
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Singh G, Sharma M, Krishnan A, Dua T, d'Aniello F, Manzoni S, Sander JW. Models of community-based primary care for epilepsy in low- and middle-income countries. Neurology 2020; 94:165-175. [PMID: 31919114 DOI: 10.1212/wnl.0000000000008839] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 11/07/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To review systematically community-based primary care interventions for epilepsy in low- and middle-income countries to rationalize approaches and outcome measures in relation to epilepsy care in these countries. METHODS A systematic search of PubMed, EMBASE, Global Index Medicus, CINAHL, and Web of Science was undertaken to identify trials and implementation of provision of antiseizure medications, adherence reinforcement, and/or health care provider or community education in community-based samples of epilepsy. Data on populations addressed, interventions, and outcomes were extracted from eligible articles. RESULTS The 24 reports identified comprise mostly care programs addressing active convulsive epilepsy. Phenobarbital has been used most frequently, although other conventional antiseizure medications (ASMs) have also been used, but none of the newer. Tolerability rates in these studies are high, but overall attrition is considerable. Other approaches include updating primary health care providers, reinforcing treatment adherence in clinics, and raising community awareness. In these programs, the coverage of existing treatment gap in the community, epilepsy-related mortality, and comorbidity burden are only fleetingly addressed. None, however, explicitly describe sustainability plans. CONCLUSIONS Cost-free provision, mostly of phenobarbital, has resulted in short-term seizure freedom in roughly half of the people with epilepsy in low- and middle-income countries. Future programs should include a range of ASMs. These should cover apart from seizure control and treatment adherence, primary health care provider education, community awareness, and referral protocols for specialist care. Programs should incorporate impact assessment at the local level. Sustainability in the long term as much as resilience and scalability should be addressed in future initiatives.
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Affiliation(s)
- Gagandeep Singh
- From the Department of Neurology (G.S.), Dayanand Medical College, Ludhiana, India; Division of Non-Communicable Diseases (M.S.), Indian Council of Medical Research; Department of Community Medicine (A.K.), All India Institute of Medical Sciences, New Delhi, India; Mental Health Division (T.D.), World Health Organization, Geneva, Switzerland; Department of Clinical Medicine and Surgery (F.d'.A.), University of Naples Federico II, ; University of Campania (S.M.), Luigi Vanvitelli, Naples, Italy; NIHR University College London Hospitals Biomedical Research Centre (G.S., J.W.S.), UCL Queen Square Institute of Neurology, London, Chalfont Centre for Epilepsy (G.S., J.W.S.), Chalfont St Peter, United Kingdom; and Stichting Epilepsie Instellingen Nederland (SEIN) (J.W.S.), Heemstede, Netherlands
| | - Meenakshi Sharma
- From the Department of Neurology (G.S.), Dayanand Medical College, Ludhiana, India; Division of Non-Communicable Diseases (M.S.), Indian Council of Medical Research; Department of Community Medicine (A.K.), All India Institute of Medical Sciences, New Delhi, India; Mental Health Division (T.D.), World Health Organization, Geneva, Switzerland; Department of Clinical Medicine and Surgery (F.d'.A.), University of Naples Federico II, ; University of Campania (S.M.), Luigi Vanvitelli, Naples, Italy; NIHR University College London Hospitals Biomedical Research Centre (G.S., J.W.S.), UCL Queen Square Institute of Neurology, London, Chalfont Centre for Epilepsy (G.S., J.W.S.), Chalfont St Peter, United Kingdom; and Stichting Epilepsie Instellingen Nederland (SEIN) (J.W.S.), Heemstede, Netherlands
| | - Anand Krishnan
- From the Department of Neurology (G.S.), Dayanand Medical College, Ludhiana, India; Division of Non-Communicable Diseases (M.S.), Indian Council of Medical Research; Department of Community Medicine (A.K.), All India Institute of Medical Sciences, New Delhi, India; Mental Health Division (T.D.), World Health Organization, Geneva, Switzerland; Department of Clinical Medicine and Surgery (F.d'.A.), University of Naples Federico II, ; University of Campania (S.M.), Luigi Vanvitelli, Naples, Italy; NIHR University College London Hospitals Biomedical Research Centre (G.S., J.W.S.), UCL Queen Square Institute of Neurology, London, Chalfont Centre for Epilepsy (G.S., J.W.S.), Chalfont St Peter, United Kingdom; and Stichting Epilepsie Instellingen Nederland (SEIN) (J.W.S.), Heemstede, Netherlands
| | - Tarun Dua
- From the Department of Neurology (G.S.), Dayanand Medical College, Ludhiana, India; Division of Non-Communicable Diseases (M.S.), Indian Council of Medical Research; Department of Community Medicine (A.K.), All India Institute of Medical Sciences, New Delhi, India; Mental Health Division (T.D.), World Health Organization, Geneva, Switzerland; Department of Clinical Medicine and Surgery (F.d'.A.), University of Naples Federico II, ; University of Campania (S.M.), Luigi Vanvitelli, Naples, Italy; NIHR University College London Hospitals Biomedical Research Centre (G.S., J.W.S.), UCL Queen Square Institute of Neurology, London, Chalfont Centre for Epilepsy (G.S., J.W.S.), Chalfont St Peter, United Kingdom; and Stichting Epilepsie Instellingen Nederland (SEIN) (J.W.S.), Heemstede, Netherlands
| | - Francesco d'Aniello
- From the Department of Neurology (G.S.), Dayanand Medical College, Ludhiana, India; Division of Non-Communicable Diseases (M.S.), Indian Council of Medical Research; Department of Community Medicine (A.K.), All India Institute of Medical Sciences, New Delhi, India; Mental Health Division (T.D.), World Health Organization, Geneva, Switzerland; Department of Clinical Medicine and Surgery (F.d'.A.), University of Naples Federico II, ; University of Campania (S.M.), Luigi Vanvitelli, Naples, Italy; NIHR University College London Hospitals Biomedical Research Centre (G.S., J.W.S.), UCL Queen Square Institute of Neurology, London, Chalfont Centre for Epilepsy (G.S., J.W.S.), Chalfont St Peter, United Kingdom; and Stichting Epilepsie Instellingen Nederland (SEIN) (J.W.S.), Heemstede, Netherlands
| | - Sara Manzoni
- From the Department of Neurology (G.S.), Dayanand Medical College, Ludhiana, India; Division of Non-Communicable Diseases (M.S.), Indian Council of Medical Research; Department of Community Medicine (A.K.), All India Institute of Medical Sciences, New Delhi, India; Mental Health Division (T.D.), World Health Organization, Geneva, Switzerland; Department of Clinical Medicine and Surgery (F.d'.A.), University of Naples Federico II, ; University of Campania (S.M.), Luigi Vanvitelli, Naples, Italy; NIHR University College London Hospitals Biomedical Research Centre (G.S., J.W.S.), UCL Queen Square Institute of Neurology, London, Chalfont Centre for Epilepsy (G.S., J.W.S.), Chalfont St Peter, United Kingdom; and Stichting Epilepsie Instellingen Nederland (SEIN) (J.W.S.), Heemstede, Netherlands
| | - Josemir W Sander
- From the Department of Neurology (G.S.), Dayanand Medical College, Ludhiana, India; Division of Non-Communicable Diseases (M.S.), Indian Council of Medical Research; Department of Community Medicine (A.K.), All India Institute of Medical Sciences, New Delhi, India; Mental Health Division (T.D.), World Health Organization, Geneva, Switzerland; Department of Clinical Medicine and Surgery (F.d'.A.), University of Naples Federico II, ; University of Campania (S.M.), Luigi Vanvitelli, Naples, Italy; NIHR University College London Hospitals Biomedical Research Centre (G.S., J.W.S.), UCL Queen Square Institute of Neurology, London, Chalfont Centre for Epilepsy (G.S., J.W.S.), Chalfont St Peter, United Kingdom; and Stichting Epilepsie Instellingen Nederland (SEIN) (J.W.S.), Heemstede, Netherlands.
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Zafra-Tanaka JH, Pacheco-Barrios K, Inga-Berrospi F, Taype-Rondan A. Self-perceived competencies in the diagnosis and treatment of mental health disorders among general practitioners in Lima, Peru. BMC MEDICAL EDUCATION 2019; 19:464. [PMID: 31842855 PMCID: PMC6916154 DOI: 10.1186/s12909-019-1900-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 12/05/2019] [Indexed: 06/10/2023]
Abstract
AIM To assess the self-perceived competencies in diagnosing and treating patients with mental health disorders, among recently graduated general practitioners (GPs) from Lima, Peru. METHODS A cross-sectional study was performed in April 2017 at a General Practitioner's meeting held for those who were going to perform the social service, by the Peruvian College of Physicians in Lima. Attendees were invited to answer a questionnaire that evaluated their self-perception of competence in diagnosing and treating four different mental health disorders; major depression, anxiety disorder, alcohol dependence, and schizophrenia. RESULTS Out of 434 evaluated GPs, the following percentages were self-perceived as competent in their adequate diagnosis of depression (70.5%), anxiety (73.3%), alcohol dependence (67.6%), and schizophrenia (62.0%). Concerning pharmacological treatment, these percentages were 46.6, 47.5, 39.0 and 37.6%, respectively. Referring to all the studied mental disorders, 41.6% of participants self-perceived competence in providing an adequate diagnosis, 36.1% in providing non-pharmacological treatment, and 20.1% in providing pharmacological treatment. CONCLUSION The rate of adequate self-perceived competences was higher for diagnosis than for treatment of patients with mental health disorders. These results highlight the importance of designing and implementing interventions to improve medical education so as to develop the skills necessary to confront mental health disorders.
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Affiliation(s)
| | - Kevin Pacheco-Barrios
- SYNAPSIS Mental Health and Neurology, Non-Profit organization, Lima, Peru
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
| | | | - Alvaro Taype-Rondan
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
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What Impedes General Practitioners' Identification of Mental Disorders at Outpatient Departments? A Qualitative Study in Shanghai, China. Ann Glob Health 2019; 85:134. [PMID: 31799127 PMCID: PMC6857524 DOI: 10.5334/aogh.2628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Mental disorders endanger people’s health and lives. General practitioners (GPs) play a valuable role in identifying and treating mental disorders in outpatient clinical settings. However, there are obstacles for GPs’ identification in developing countries. Objective: This study’s aim was to identify the related obstacles and to propose optimized strategies. Methods: We conducted qualitative interviews with 26 GPs from seven randomly sampled community healthcare centers in Shanghai, China. The interview guide was based primarily on the items from mental status evaluation. After transcribing, coding, condensing, and categorizing talking content, we summarized the theme structure and results. Findings: GPs lacked the confidence and skills to conduct psychiatric evaluation and seldom conducted it. Patients’ behaviors also influenced whether evaluations were conducted. The GPs expressed that they were short of strategies and wished to be well trained and have sufficient practice. We found that two major reasons impeded GPs’ identification. First, the GPs had difficulty making a diagnosis: they lacked diagnostic ability and confidence, they had misunderstandings about diagnoses, and they had unclear qualifications for making psychiatric diagnoses. Second, the GPs lacked skills for evaluation and reevaluation: their evaluation had inadequacies of contents and subjects; they lacked mental state examination evaluation, communication, and severity assessment skills and knowledge. Conclusions: This study found that it is difficult for GPs in developing countries to become competent in the diagnosis and systematic evaluation of mental disorders without external help. Unclear qualification also limited GPs’ diagnoses of mental disorders. We proposed that optimized strategies to overcome these challenges lie in support of changes in policy, programs, and utilizing effective tools, such as the mhGAP, GMHAT/PC, BVC, Grille’s assessment tool, and telemedicine.
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Nakku JEM, Rathod SD, Garman EC, Ssebunnya J, Kangere S, De Silva M, Patel V, Lund C, Kigozi FN. Evaluation of the impacts of a district-level mental health care plan on contact coverage, detection and individual outcomes in rural Uganda: a mixed methods approach. Int J Ment Health Syst 2019; 13:63. [PMID: 31583013 PMCID: PMC6767634 DOI: 10.1186/s13033-019-0319-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 09/17/2019] [Indexed: 11/24/2022] Open
Abstract
Background The burden of mental disorders in low- and middle-income countries is large. Yet there is a major treatment gap for these disorders which can be reduced by integrating the care of mental disorders in primary care. Aim We aimed to evaluate the impact of a district mental health care plan (MHCP) on contact coverage for and detection of mental disorders, as well as impact on mental health symptom severity and individual functioning in rural Uganda. Results For adults who attended primary care facilities, there was an immediate positive effect of the MHCP on clinical detection at 3 months although this was not sustained at 12 months. Those who were treated in primary care experienced significant reductions in symptom severity and functional impairment over 12 months. There was negligible change in population-level contact coverage for depression and alcohol use disorder. Conclusion The study found that it is possible to integrate mental health care into primary care in rural Uganda. Treatment by trained primary care workers improves clinical and functioning outcomes for depression, psychosis and epilepsy. Challenges remain in accessing the men for care, sustaining the improvement in detection over time, and creating demand for services among those with presumed need.
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Affiliation(s)
- J E M Nakku
- 1Makerere University College of Health Sciences/Butabika National Referral and Teaching Mental Hospital, Kampala, Uganda
| | - S D Rathod
- 2Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - E C Garman
- 3Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - J Ssebunnya
- 1Makerere University College of Health Sciences/Butabika National Referral and Teaching Mental Hospital, Kampala, Uganda
| | - S Kangere
- 4Makerere University/Butabika National Referral and Teaching Mental Hospital, Kampala, Uganda
| | | | - V Patel
- 6Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA USA.,7Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA USA
| | - C Lund
- 3Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.,8Centre for Global Mental Health, Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK
| | - F N Kigozi
- 1Makerere University College of Health Sciences/Butabika National Referral and Teaching Mental Hospital, Kampala, Uganda
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Faregh N, Lencucha R, Ventevogel P, Dubale BW, Kirmayer LJ. Considering culture, context and community in mhGAP implementation and training: challenges and recommendations from the field. Int J Ment Health Syst 2019; 13:58. [PMID: 31462908 PMCID: PMC6708207 DOI: 10.1186/s13033-019-0312-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 08/05/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Major efforts are underway to improve access to mental health care in low- and middle-income countries (LMIC) including systematic training of non-specialized health professionals and other care providers to identify and help individuals with mental disorders. In many LMIC, this effort is guided by the mental health Gap Action Programme (mhGAP) established by the World Health Organization, and commonly centres around one tool in this program: the mhGAP-Intervention Guide. OBJECTIVE To identify cultural and contextual challenges in mhGAP training and implementation and potential strategies for mitigation. METHOD An informal consultative approach was used to analyze the authors' combined field experience in the practice of mhGAP implementation and training. We employed iterative thematic analysis to consolidate and refine lessons, challenges and recommendations through multiple drafts. Findings were organized into categories according to specific challenges, lessons learned and recommendations for future practice. We aimed to identify cross-cutting and recurrent issues. RESULTS Based on intensive fieldwork experience with a focus on capacity building, we identify six major sets of challenges: (i) cultural differences in explanations of and attitudes toward mental disorder; (ii) the structure of the local health-care system; (iii) the level of supervision and support available post-training; (iv) the level of previous education, knowledge and skills of trainees; (v) the process of recruitment of trainees; and (vi) the larger socio-political context. Approaches to addressing these problems include: (1) cultural and contextual adaptation of training activities, (2) meaningful stakeholder and community engagement, and (3) processes that provide support to trainees, such as ongoing supervision and Communities of Practice. CONCLUSION Contextual and cultural factors present major barriers to mhGAP implementation and sustainability of improved services. To enable trainees to effectively apply their local cultural knowledge, mhGAP training needs to: (1) address assumptions, biases and stigma associated with mental health symptoms and problems; (2) provide an explicit framework to guide the integration of cultural knowledge into assessment, treatment negotiation, and delivery; and (3) address the specific kinds of problems, modes of clinical presentations and social predicaments seen in the local population. Continued research is needed to assess the effectiveness these strategies.
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Affiliation(s)
- Neda Faregh
- Department of Psychology, Carleton University, 1125 Colonel By Drive, Ottawa, ON K1S 5B6 Canada
- Global Mental Health Program, McGill University, Montreal, Canada
| | - Raphael Lencucha
- School of Physical & Occupational Therapy, McGill University, 3654 Prom Sir-William-Osler, Montreal, QC H3G 1Y5 Canada
- Global Mental Health Program, McGill University, Montreal, Canada
| | - Peter Ventevogel
- Public Health Section, Division of Programme Support and Management, United Nations High Commissioner for Refugees, 94 Rue de Montbrillant, 1202 Geneva, Switzerland
| | - Benyam Worku Dubale
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Laurence J. Kirmayer
- Division of Social and Transcultural Psychiatry, McGill University, 1033 Pine Ave, Montreal, QC H3A 1A1 Canada
- Global Mental Health Program, McGill University, Montreal, Canada
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Gask L, Coupe N, Green G. An evaluation of the implementation of cascade training for suicide prevention during the 'Choose Life' initiative in Scotland - utilizing Normalization Process Theory. BMC Health Serv Res 2019; 19:588. [PMID: 31429739 PMCID: PMC6701107 DOI: 10.1186/s12913-019-4398-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 08/01/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND 'Cascade training' or 'train-the-trainers' has been widely utilised in the dissemination of information and expertise in health and social care, but with little examination of the work required for optimal delivery. National suicide prevention strategies commonly include such training initiatives. METHODS A qualitative study to characterise the work, according to the concepts of Normalization Process Theory, required to disseminate STORM, a model of suicide prevention training across Scotland, and then implement it within organisations. This utilised a cascade style 'train-the trainers' intervention delivered as part of the Choose Life suicide prevention strategy in Scotland during 2008-11. Semi-structured interviews were carried out with 19 training facilitators, 30 of their group participants within organisations and 11 local managers within health boards in Scotland. RESULTS Crucial to the process of a cascade training approach to implementing suicide prevention within an organisation was the multi-layered activity of constructing coherence of the intervention at every level in order to prevent dilution of the training. This necessitated collaborative work within and between groups of actors- managers, facilitators and participants. Where facilitators were effectively engaged in their role, confident in their ability to train, supported by supervision and possessed the leadership skills to engage both with participants and their local context to deliver training, there was evidence of both successful delivery and embedding within the organisation. However, there was little systematic evidence of institutional level appraisal- crucial to truly implementing a novel intervention within the system - despite efforts at local managerial engagement. CONCLUSIONS Successful cascade or train-the-trainer implementation of an intervention requires extensive collaborative work to take place between and within groups of actors at all levels of an organization from those working at policy level to the 'coalface'. A priori application of Normalization Process Theory, to specify aims and goals for the necessary work to be carried out between different groups of actors, would assist in embedding a novel working practice at all levels. Future national training strategies for suicide prevention should address what is required to establish a flourishing culture of high-quality skills acquisition and development within healthcare organisations.
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Affiliation(s)
- Linda Gask
- Centre for Primary Care, University of Manchester, Manchester, UK
| | - Nia Coupe
- Manchester Centre for Health Psychology, University of Manchester, Manchester, UK
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