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Alarcón Garavito GA, Burgess R, Dedios Sanguinetti MC, Peters LER, Vera San Juan N. Mental health services implementation in Colombia-A systematic review. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001565. [PMID: 38055705 DOI: 10.1371/journal.pgph.0001565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 10/02/2023] [Indexed: 12/08/2023]
Abstract
Colombia's mental health services have a complex history shaped by 60 years of armed conflict, a predominantly clinical approach to mental health, and social factors such as inequities and stigma. The 1990 Caracas declaration proposed a shift towards decentralised community mental health services and interventions based on the recovery approach and emphasis on social determinants of mental health in the Americas. Colombia has adopted these approaches in its legal and practical framework in recent years, but implementation has been uneven. This systematic review aims to contribute to mental health services understanding in Colombia by examining the barriers and facilitators to the implementation of mental health services in Colombia. A search was conducted to explore available peer-reviewed studies on Colombian mental health services across five databases (Medline, PubMed, Scopus, Scielo and BVS) on quantitative and qualitative research papers published in the last ten years and without language restrictions. The Consolidated Framework for Implementation Research (CFIR) was used to structure the analysis and identify barriers and facilitators during the implementation of mental health services. We adapted the CFIR to attend to gender, race and age informed by the Socio-Political Economy of Global Mental Health framework, given the importance of these factors to the Colombian health landscape. Finally, narrative synthesis was used to summarise the data. 1 530 records were identified, and 12 articles met all inclusion criteria and were included in the analysis. 8 papers described substance use disorders services, 11 involved multidisciplinary healthcare professionals, and 7 were implemented at a local scale. The primary barriers to implementation were the lack of coordination, high workloads, and low funding. Facilitators included the use of protocols, and the involvement of communities, stakeholders, users, and external champions. Findings suggest the continued importance of community and recovery approaches and efforts to improve coordination between multi-sector actors involved in the mental health spaces (e.g., public, and private organisations, users and their families).
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Affiliation(s)
- Germán Andrés Alarcón Garavito
- Institute for Global Health-University College London, London, United Kingdom
- School of Government-Universidad de los Andes, Bogotá, Colombia
| | - Rochelle Burgess
- Institute for Global Health-University College London, London, United Kingdom
| | | | - Laura E R Peters
- Institute for Risk and Disaster Reduction, University College London, London, United Kingdom
- College of Earth, Ocean, and Atmospheric Sciences, Oregon State University, Corvallis, OR, United States of America
| | - Norha Vera San Juan
- Institute for Global Health-University College London, London, United Kingdom
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2
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Integration of Common Elements Treatment Approach (CETA) into public sector HIV clinics for unhealthy alcohol use in urban Zambia: Qualitative evaluation on acceptability and feasibility. SSM - MENTAL HEALTH 2023. [DOI: 10.1016/j.ssmmh.2023.100195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
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3
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Arthur YA, Boardman GH, Morgan AJ, McCann TV. Cluster randomised controlled trial of a problem-solving, Story-bridge mental health literacy programme for improving Ghanaian community leaders' knowledge of depression. J Ment Health 2022; 31:748-756. [PMID: 32755441 DOI: 10.1080/09638237.2020.1793122] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Low levels of mental health literacy about depression in the community impact negatively on attitudes towards people with the disorder and their help-seeking. AIMS The aim of this study was to assess the effectiveness of a problem-solving, Story-bridge mental health literacy programme, in improving community leaders' knowledge about helpful interventions for, and recognition of, depression. METHODS A cluster randomised controlled trial involving 140 assembly members, intervention (n = 70) and control (n = 70) groups. The intervention group received a three-hour mental health literacy programme. The control group received a plain language basic brochure about mental health issues. Data were collected at baseline and 12-week follow-up. RESULTS The intervention group demonstrated greater improvement in knowledge about helpful interventions for, and recognition of, depression compared to the control group at follow-up; however, the differences in both measures were small and not statistically significant. CONCLUSION The programme has the potential to improve participants' knowledge about helpful interventions for, and recognition of, depression. Positive outcomes have public mental health implications as they might enhance early help-seeking and contribute to better outcomes for individuals with mental health problems. TRIAL REGISTRATION ACTRN12617000033347. Date of registration - 9 January 2017.
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Affiliation(s)
- Yaw Amankwa Arthur
- Discipline of Nursing and Midwifery, Institute for Health and Sport, Victoria University, Melbourne, Australia
| | - Gayelene H Boardman
- Discipline of Nursing and Midwifery, Institute for Health and Sport, Victoria University, Melbourne, Australia
| | - Amy J Morgan
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
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Hamdani SU, Huma ZE, Tamizuddin-Nizami A, Baneen UU, Suleman N, Javed H, Malik A, Wang D, Mazhar S, Khan SA, Minhas FA, Rahman A. Feasibility and acceptability of a multicomponent, group psychological intervention for adolescents with psychosocial distress in public schools of Pakistan: a feasibility cluster randomized controlled trial (cRCT). Child Adolesc Psychiatry Ment Health 2022; 16:47. [PMID: 35729589 PMCID: PMC9210054 DOI: 10.1186/s13034-022-00480-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 06/02/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Child and adolescent mental health problems are a global public mental health priority. However, there is a lack of evidence-based scalable psychological interventions for adolescents living in low resource settings. This trial was designed to evaluate the feasibility and acceptability of delivering the World Health Organization's Early Adolescent Skills for Emotions (EASE) intervention at public schools in a rural sub-district in Rawalpindi, Pakistan. METHODS A two arm, single blinded, feasibility cluster randomized controlled trial with mixed-methods evaluation was conducted with 59 adolescents and their caregivers from 8 public schools. In the 4 intervention arm schools, 6 non-specialist facilitators delivered the culturally-adapted EASE group sessions to the adolescents (n = 29) and their caregivers with desired fidelity under the supervision of in-country supervisors. RESULTS The participation rate of adolescents in the intervention sessions was 83%. The intervention strategies were implemented by the adolescents. However, attending biweekly sessions at schools was challenging for caregivers with only 50% caregivers attending the sessions. CONCLUSIONS The results of this study support the feasibility and acceptability of delivering this culturally adapted intervention through non-specialist facilitators in school settings in Pakistan and pave the way to conduct a fully powered cluster randomized controlled trial to test the effectiveness of intervention to improve psychological outcomes in adolescents. Trial registration Trial registered with Clinicaltrials.gov prospectively; NCT04254393.
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Affiliation(s)
- Syed Usman Hamdani
- Human Development Research Foundation (HDRF), Islamabad, Pakistan. .,Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK. .,Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan. .,Benazir Bhutto Hospital, Institute of Psychiatry, Rawalpindi Medical University, Rawalpindi, Pakistan.
| | - Zill-e Huma
- grid.490844.5Human Development Research Foundation (HDRF), Islamabad, Pakistan ,grid.10025.360000 0004 1936 8470Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK ,grid.419158.00000 0004 4660 5224Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Asad Tamizuddin-Nizami
- grid.415712.40000 0004 0401 3757Benazir Bhutto Hospital, Institute of Psychiatry, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Um-ul Baneen
- grid.490844.5Human Development Research Foundation (HDRF), Islamabad, Pakistan ,grid.419158.00000 0004 4660 5224Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Nadia Suleman
- grid.490844.5Human Development Research Foundation (HDRF), Islamabad, Pakistan ,grid.419158.00000 0004 4660 5224Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Hashim Javed
- grid.490844.5Human Development Research Foundation (HDRF), Islamabad, Pakistan ,grid.419158.00000 0004 4660 5224Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | | | - Duolao Wang
- grid.48004.380000 0004 1936 9764Global Health Trials Unit, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Samra Mazhar
- Ministry of National Health Services, Regulations and Coordination, Islamabad, Pakistan
| | - Shahzad Alam Khan
- grid.475671.6World Health Organization (WHO), Pakistan Office, Islamabad, Pakistan
| | - Fareed Aslam Minhas
- grid.419158.00000 0004 4660 5224Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Atif Rahman
- grid.10025.360000 0004 1936 8470Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
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Khosravi F, Fereidooni-Moghadam M, Mehrabi T, Moosavizade SR. The Effect of a Spirituality-Based Program on Stress, Anxiety, and Depression of Caregivers of Patients with Mental Disorders in Iran. JOURNAL OF RELIGION AND HEALTH 2022; 61:93-108. [PMID: 34417681 DOI: 10.1007/s10943-021-01372-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/26/2021] [Indexed: 06/13/2023]
Abstract
One of the important issues regarding caring for patients with mental disorders is the high prevalence of stress, anxiety, and depression in their caregivers. This study aimed to investigate the effect of a spirituality-based program on stress, anxiety, and depression of caregivers of patients with mental disorders. This clinical-trial study involved 60 family caregivers of patients with mental disorders who were referred to the clinic of Shahid Ayatollah Modarres Psychiatric Hospital in Isfahan, Iran, during 2019-2020. Accordingly, the samples were selected using convenient sampling method and then divided into two groups of experimental and control by simple random allocation. Next, the spirituality-based intervention was performed for the intervention group, and the needed data were collected in both intervention and control groups before, immediately after, and one month after the intervention. The data collection tool used in this study was DASS-21 questionnaire. No significant differences were observed between the two groups in terms of the mean scores of stress, anxiety, and depression (p > 0.05) before the intervention. However, some significant differences were found in terms of the stress, anxiety, and depression scores between the two groups immediately (p < 0.001) and one month after the intervention (p < 0.001). The spirituality-based program seemed to affect stress, anxiety, and depression of caregivers of patients with mental disorders positively. So, it is suggested to perform this intervention as an inexpensive and available supportive method for family caregivers of patients with mental disorders.
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Affiliation(s)
- Fateme Khosravi
- Faculty of Nursing and Midwifery, Nursing and Midwifery Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Malek Fereidooni-Moghadam
- Faculty of Nursing and Midwifery, Nursing and Midwifery Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Tayebe Mehrabi
- Faculty of Nursing and Midwifery, Nursing and Midwifery Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Taslakian EN, Garber K, Shekherdimian S. Diaspora engagement: a scoping review of diaspora involvement with strengthening health systems of their origin country. Glob Health Action 2022; 15:2009165. [PMID: 34904934 PMCID: PMC8676662 DOI: 10.1080/16549716.2021.2009165] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Diaspora communities are a growing source of external aid and resources to address unmet needs of health systems of their homelands. Although numerous articles have been published, these endeavors as a whole have not been systematically assessed. OBJECTIVE Examine the available literature to assess activities through which diasporas engage with the health system in their origin country and what barriers they face in their interventions. METHODS This is a scoping review from 1990-2018 using the PRISMA-Scr framework to examine both peer-reviewed and gray literature on (1) specific activities through which diasporas contribute to the health system in their origin country; (2) major health needs diasporas have tried to address; and (3) barriers faced by diaspora healthcare efforts. RESULTS The initial search identified 119 articles, of which 45 were eligible after excluding non-relevant studies. These were case studies of diaspora contributions to health systems in their origin country (13), interviews (13), literature reviews (9), general articles on the topic (4), and correspondences or presentations (6). The healthcare needs diasporas have sought to address include health workforce emigration ('brain drain') (10), capacity building for research and training (10), inadequate infrastructure (5), and finances (4). Specific activities included short-term missions (11), establishing partnerships (9), emigration back to country of origin (8), specific research and training programs (8), and financial remittances (5). Specific barriers identified were most commonly financial need within the origin country (8), lack of sustainability (6), communication issues (6), lack of intention to return to the origin country (5), infrastructure (4), and political concerns (3). CONCLUSION Further research on how to expand the scope of and reduce barriers to diaspora engagement is needed to optimize the effectiveness of diaspora contributions to their origin countries. Metrics and standards should be developed for assessing impact of diaspora engagement and interventions.
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Affiliation(s)
- Editt N. Taslakian
- Division of Plastic Surgery, Department of Surgery, University of Washington Medical Center, Seattle, WA, USA
| | - Kent Garber
- Department of Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Shant Shekherdimian
- Division of Pediatric Surgery, Department of Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA,CONTACT Shant Shekherdimian Division of Pediatric Surgery, Department of Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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Mustafa SE, Sarmiti NZ, Yusof ZYM, Nor NAM, Nor MM. WhatsApp and Health Communication. INTERNATIONAL JOURNAL OF E-HEALTH AND MEDICAL COMMUNICATIONS 2022. [DOI: 10.4018/ijehmc.315127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Little is known about the use of WhatsApp in promoting oral health among parents or caregivers. Therefore, the survey examined the impact of social media in disseminating health infographic messages in supporting children's oral health from the parent's perspective. The group of respondents read or saw posts or messages related to health education through Facebook (n=85, 31.9%), WhatsApp (n=68, 25.2%), and YouTube (n=61, 22.6%). There was a significant difference before and after the infographics were sent to the respondent, and it was found to be statistically significant (P-value <0.001). As a social media platform for oral health education purposes, WhatsApp appeared to improve parents' knowledge and behaviors towards their children's oral health. Most respondents perceived WhatsApp to be beneficial. Knowing how people use social media now could help health communication efforts be more effective and equitable.
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Davis NR, Alade KH. Twelve tips for point-of-care ultrasound teaching in low-resource settings. MEDICAL TEACHER 2021; 43:1134-1138. [PMID: 33203281 DOI: 10.1080/0142159x.2020.1845307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Point-of-care ultrasound (POCUS) has become the standard of care for many emergency department evaluations. Low-resource settings are ideal for POCUS to help improve access to imaging for a number of indications that are obstetric, disease or trauma related. The following twelve specific tips are aimed toward organizations and individuals who aspire to initiate POCUS training in a low-resource setting.
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Affiliation(s)
- Nichole R Davis
- Pediatric Emergency Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Kiyetta H Alade
- Pediatric Emergency Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
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Rimal P, Choudhury N, Agrawal P, Basnet M, Bohara B, Citrin D, Dhungana SK, Gauchan B, Gupta P, Gupta TK, Halliday S, Kadayat B, Mahar R, Maru D, Nguyen V, Poudel S, Raut A, Rawal J, Sapkota S, Schwarz D, Schwarz R, Shrestha S, Swar S, Thapa A, Thapa P, White R, Acharya B. Collaborative care model for depression in rural Nepal: a mixed-methods implementation research study. BMJ Open 2021; 11:e048481. [PMID: 34400456 PMCID: PMC8370561 DOI: 10.1136/bmjopen-2020-048481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Despite carrying a disproportionately high burden of depression, patients in low-income countries lack access to effective care. The collaborative care model (CoCM) has robust evidence for clinical effectiveness in improving mental health outcomes. However, evidence from real-world implementation of CoCM is necessary to inform its expansion in low-resource settings. METHODS We conducted a 2-year mixed-methods study to assess the implementation and clinical impact of CoCM using the WHO Mental Health Gap Action Programme protocols in a primary care clinic in rural Nepal. We used the Capability Opportunity Motivation-Behaviour (COM-B) implementation research framework to adapt and study the intervention. To assess implementation factors, we qualitatively studied the impact on providers' behaviour to screen, diagnose and treat mental illness. To assess clinical impact, we followed a cohort of 201 patients with moderate to severe depression and determined the proportion of patients who had a substantial clinical response (defined as ≥50% decrease from baseline scores of Patient Health Questionnaire (PHQ) to measure depression) by the end of the study period. RESULTS Providers experienced improved capability (enhanced self-efficacy and knowledge), greater opportunity (via access to counsellors, psychiatrist, medications and diagnostic tests) and increased motivation (developing positive attitudes towards people with mental illness and seeing patients improve) to provide mental healthcare. We observed substantial clinical response in 99 (49%; 95% CI: 42% to 56%) of the 201 cohort patients, with a median seven point (Q1:-9, Q3:-2) decrease in PHQ-9 scores (p<0.0001). CONCLUSION Using the COM-B framework, we successfully adapted and implemented CoCM in rural Nepal, and found that it enhanced providers' positive perceptions of and engagement in delivering mental healthcare. We observed clinical improvement of depression comparable to controlled trials in high-resource settings. We recommend using implementation research to adapt and evaluate CoCM in other resource-constrained settings to help expand access to high-quality mental healthcare.
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Affiliation(s)
- Pragya Rimal
- Nyaya Health Nepal, Kathmandu, Nepal
- Possible, Kathmandu, Nepal
| | - Nandini Choudhury
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Possible, New York, New York, USA
| | | | - Madhur Basnet
- Nyaya Health Nepal, Kathmandu, Nepal
- Department of Psychiatry, BP Koirala Institute of Health Sciences, Dharan, Kathmandu, Nepal
| | | | - David Citrin
- Possible, New York, New York, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | | | | | | | | | - Scott Halliday
- Possible, New York, New York, USA
- Global Health, University of Washington, Seattle, Washington, USA
| | | | | | - Duncan Maru
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Possible, New York, New York, USA
| | - Viet Nguyen
- Health Services, Los Angeles County Department of Health Services, Los Angeles, California, USA
- University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | | | - Anant Raut
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Possible, New York, New York, USA
| | | | - Sabitri Sapkota
- Possible, Kathmandu, Nepal
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Dan Schwarz
- Possible, New York, New York, USA
- Division of Global Health Equity, Brigham and Women's Hospital Department of Medicine, Boston, Massachusetts, USA
| | - Ryan Schwarz
- Possible, New York, New York, USA
- Division of Global Health Equity, Brigham and Women's Hospital Department of Medicine, Boston, Massachusetts, USA
| | - Srijana Shrestha
- Possible, New York, New York, USA
- Department of Psychology, Wheaton College, Wheaton, Illinois, USA
| | | | | | - Poshan Thapa
- University of New South Wales School of Public Health and Community Medicine, Sydney, New South Wales, Australia
| | | | - Bibhav Acharya
- Possible, New York, New York, USA
- Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, California, USA
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Jacobs Y, Myers B, van der Westhuizen C, Brooke-Sumner C, Sorsdahl K. Task Sharing or Task Dumping: Counsellors Experiences of Delivering a Psychosocial Intervention for Mental Health Problems in South Africa. Community Ment Health J 2021; 57:1082-1093. [PMID: 33161458 PMCID: PMC8217044 DOI: 10.1007/s10597-020-00734-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 10/22/2020] [Indexed: 12/12/2022]
Abstract
Given task-sharing mental health counselling to non-specialist providers is a recognised strategy to increase service capacity, ensuring that their training, supervision, and support needs are met is necessary to facilitate the sustainable delivery of a high-quality service. Using in-depth interviews, we qualitatively explored the experiences of 18 facility-based counsellors (FBCs) tasked with delivering a counselling intervention within chronic disease services offered within primary care facilities participating in the project MIND cluster randomised controlled trial. Findings show that project MIND training with a strong emphasis on role playing and skills rehearsal improved FBCs' confidence and competence, complemented by highly structured supervision and debriefing provided by a registered counsellor, were key strategies for supporting the implementation of task-shared mental health counselling. FBCs perceived many benefits to providing mental health counselling in primary healthcare but systemic interventions are needed for sustained implementation.
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Affiliation(s)
- Y Jacobs
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa.,Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - B Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa.,Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - C van der Westhuizen
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - C Brooke-Sumner
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa.,Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - K Sorsdahl
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
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Ghaffari R, Taghizadieh A, Behshid M, Somi MH, Mirzazadeh A, Baradaran HR, Huntington M, Emami Razavi SH, Baghban Rezvan F, Salek Ranjbarzadeh F. Accountability in medical education from theory to practice Tabriz 2018 statement: A step towards the implementation of this social necessity. Med J Islam Repub Iran 2020; 34:93. [PMID: 33315967 PMCID: PMC7722974 DOI: 10.34171/mjiri.34.93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Indexed: 11/18/2022] Open
Abstract
Background: To implement the education reform package on accountability in medical education, the Education Development Center (EDC) of Tabriz University of Medical Sciences has held the first national conference on accountability in medical education, and the present statement is the result of scientific interactions and exchanges in the conference.
Methods: For implementation of the accountability in medical education, there was a need to inform faculty members and other stakeholders about their responsibility in education and health care needs. The provision of such platform was provided by holding a specialized conference on accountability in medical education by Tabriz University of Medical Sciences. Steps of preparing the draft version of the Tabriz 2018 Statement were as follow: Formation the scientific committee; Division of the responsibility for drafting the statement between various workgroups; and Preparation and primary approval of the draft of Tabriz 2018 Statement.
Results: Steps of preparing the draft version of the Tabriz 2018 Statement were: Formation of the scientific committee, Division of the responsibility for drafting the statement between the various workgroups and Preparation and primary approval of the draft of Tabriz 2018 Statement.
Conclusion: Establishing an educational accreditation model and reviewing accreditation standards based on social accountability can be an effective step to strengthen accountability towards community needs.
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Affiliation(s)
- Reza Ghaffari
- Medical Education Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Taghizadieh
- Tuberculosis and Lung Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mozhgan Behshid
- Medical Education Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran.,Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Husein Somi
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Azim Mirzazadeh
- Department of Medical Education, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Reza Baradaran
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Mark Huntington
- Department of Family Medicine, School of Medicine, University of South Dakota Sanford, 414 E. Clark Street, Vermillion, SD 57069, United States
| | - Seyed Hasan Emami Razavi
- Neuroscience Institute, Brain and Spinal Cord Injury Research Center (BASIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Flora Baghban Rezvan
- Medical Education Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fariba Salek Ranjbarzadeh
- Medical Education Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
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12
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Agyapong VIO, Shalaby R, Agyapong-Opoku G, Osei A, Ulzen T. The Impact of Diaspora-Based Psychiatrists' Participation in Clinical Teaching in a Lower Middle-Income Country on Interest in Psychiatry Among Medical Students and the Choice of Psychiatry as a Career. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2020; 44:756-760. [PMID: 32734385 DOI: 10.1007/s40596-020-01289-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 07/15/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The authors assess the impact of Ghanaian diaspora-based psychiatrists' participation in clinical teaching in Ghana on the attitudes of medical students toward careers in psychiatry. METHODS This quantitative cross-sectional study involved fifth- and sixth-year medical students of the four public medical schools in Ghana. Data were analyzed with descriptive and inferential statistics. RESULTS About half (49.7%) of clinical year medical students in Ghana reported that diaspora-based Ghanaian psychiatrists participated in their teaching during their clinical psychiatry rotation. A significantly higher proportion of medical students who had diaspora-based psychiatrists participate in their clinical training expressed that the depth of clinical teaching (54.4% vs. 45.6%, p = 0.003) and the extent of experience gained during their psychiatric rotations (54.7% vs. 45.3%, p = 0.001) were adequate or somewhat adequate when compared with medical students who did not have diaspora psychiatrists participate in their clinical training. Medical students who had diaspora-based Ghanaian psychiatrists participate in their teaching were significantly more likely to consider careers in psychiatry after their clinical rotation (42.2% versus 25.6%, χ2 = 16.2, p = 0.00). CONCLUSIONS In a low-resource country with few psychiatrists, the involvement of diaspora-based psychiatrists in the teaching of clinical year medical students has the potential to improve the global experience and attitude of the medical students toward psychiatry.
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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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14
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Meza RD, Kiche S, Soi C, Khairuzzaman AN, Nales CJR, Whetten K, Wasonga AI, Amanya C, Dorsey S. Barriers and facilitators of child and guardian attendance in task-shifted mental health services in schools in western Kenya. Glob Ment Health (Camb) 2020; 7:e16. [PMID: 32742674 PMCID: PMC7379319 DOI: 10.1017/gmh.2020.9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 05/12/2020] [Accepted: 05/22/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Globally, nearly 140 million children have experienced the death of one or both parents, and as a result many experience higher rates of mental health problems. Trauma-focused cognitive behavioral therapy (TF-CBT) delivered by lay counselors has been shown to improve mental health outcomes for children experiencing traumatic grief due to parental loss; however, challenges with treatment attendance limit the public health impact of mental health services. This study used qualitative methods to assess barriers and facilitators of child and guardian attendance of school-based lay counselor delivered TF-CBT. METHODS Semi-structured interviews were conducted with 36 lay counselors (18 teachers; 18 community health volunteers) who delivered TF-CBT to explore their perceptions of barriers of facilitators of child and guardian attendance of group-based sessions delivered in schools. RESULTS Counselors identified attendance barriers and facilitators related to the delivery setting, resources, participant characteristics, intervention characteristics and counselor behaviors. The findings revealed a greater number of facilitators than barriers. Common facilitators included participant and counselor resources, counselor commitment behaviors and communication efforts to encourage attendance. Barriers were less frequently endorsed, with participant resources, child or guardian illness and communication challenges most commonly mentioned. CONCLUSIONS Attention to barriers and facilitators of attendance in the context in which mental health interventions are delivered allows for identification of ways to improve attendance and treatment engagement and achieve the potential promise of providing accessible mental health services.
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Affiliation(s)
- Rosemary D. Meza
- Department of Psychology, University of Washington, Guthrie Hall 119A, Box 351525, Seattle, WA98195, USA
| | - Sharon Kiche
- SMART Center, Psychiatry and Behavioral Sciences, University of Washington, 6200 NE 74th Street, Suite 110, Seattle, WA98115, USA
| | - Caroline Soi
- Department of Global Health, Harris Hydraulics Laboratory, University of Washington, 1510 San Juan Road, Seattle, WA98195, USA
| | - Alya N. Khairuzzaman
- Department of Psychology, University of Washington, Guthrie Hall 119A, Box 351525, Seattle, WA98195, USA
| | - Cristian J. Rivera Nales
- Department of Psychology, University of Washington, Guthrie Hall 119A, Box 351525, Seattle, WA98195, USA
| | - Kathryn Whetten
- Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Box 90519, Durham, NC27708, USA
- Terry Sanford Institute of Public Policy, Duke Global Health Institute, Duke University, Box 90239, Durham, NC27708, USA
| | | | - Cyrilla Amanya
- Research Department, Ace Africa Kenya, P.O. Box 1185, 50200 Bungoma, Kenya
| | - Shannon Dorsey
- Department of Psychology, University of Washington, Guthrie Hall 119A, Box 351525, Seattle, WA98195, USA
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15
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Prevalence of mental disorders in South Asia: An umbrella review of systematic reviews and meta-analyses. Asian J Psychiatr 2020; 51:102041. [PMID: 32315966 DOI: 10.1016/j.ajp.2020.102041] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/21/2020] [Accepted: 03/25/2020] [Indexed: 01/08/2023]
Abstract
Mental disorders are highly prevalent in eight South Asian countries, yet there is a gap of a synthesized overview of the prevalence of mental disorders in this region. This umbrella review aims to summarize the prevalence of mental disorders from systematic reviews and meta-analyses of South Asian studies. A systematic search of 11 major databases and additional sources was conducted until December 11, 2019. Articles were included if they were systematic reviews or meta-analyses, reported the prevalence of mental disorders, and reported primary studies conducted in South Asian countries only. Among 2591 citations, a total of 23 reviews met all the criteria of this umbrella review. The synthesized findings from those reviews suggest high prevalence rates for mental disorders, including depressive disorders, anxiety disorders, mood disorders, suicidal behavior and self-harm, schizophrenia, substance use disorders, neurodevelopmental disorders, dementia, and other mental health problems. Also, findings suggest a high burden of maternal depression, psychiatric comorbidities in chronic physical illnesses, and various mental disorders among children, elderly adults, refugees, and other vulnerable populations. Most studies were from India whereas evidence from Afghanistan, Bhutan, and Maldives was limited. The findings of this review are constrained with heterogeneity in prevalence estimations, methodologies, sampling issues, and limitations in the existing literature, which should be addressed in future research. The evidence synthesized in this review provides national and regional overview of the prevalence of mental disorders, which may inform better policymaking and practice advancing mental health in South Asia.
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16
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Abstract
As the world undergoes rapid ageing, informal support from friends and relatives is becoming especially important among older adults in middle and low income countries, where formalized social protections may be limited. We use new data from a cohort of adults ages 40 and older in rural South Africa to explore how receipt of emotional support differs by gender and marital status. Our findings suggest that women are more likely to get emotional support than men and have more sources of support. Moreover, women are more likely to get emotional support from relatives, whereas men are more likely to get support from friends. In regard to marital status, married people are more likely to get emotional support and have more sources of support than people who are not married. However, separated/divorced and widowed people are more likely to get emotional support from relatives and have more sources of non-spousal support than married people. These findings point toward gaps in informal systems of support, and the particular importance of considering men and unmarried (especially never married) people when designing policies to offer social protections to older populations.
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17
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Padmakar A, de Wit EE, Mary S, Regeer E, Bunders-Aelen J, Regeer B. Supported Housing as a recovery option for long-stay patients with severe mental illness in a psychiatric hospital in South India: Learning from an innovative de-hospitalization process. PLoS One 2020; 15:e0230074. [PMID: 32271784 PMCID: PMC7144972 DOI: 10.1371/journal.pone.0230074] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 02/20/2020] [Indexed: 12/16/2022] Open
Abstract
Individuals with severe mental illness have long been segregated from living in communities and participating in socio- cultural life. In recent years, owing to progressive legislations and declarations (in India and globally), there has been a growing movement towards promoting social inclusion and community participation, with emphasis on the need to develop alternative and inclusive care paradigms for persons with severe mental illness. However, transitions from inpatient care to community settings is a complex process involving implications at multiple levels involving diverse stakeholders such as mental health service users, care providers, local communities and policy makers. This article studies how the transition from a hospital setting to a community-based recovery model for personals with severe mental illness can be facilitated. It reflects on the innovative process of creating a Supported Housing model in South India, where 11 MH Service users transitioned from a psychiatric ECRC to independent living facilities. Experiences in various phases of the project development, including care provider- and community level responses and feedback were scrutinised to understand the strategies that were employed in enabling the transition. Qualitative methods (including in-depth interviews and naturalistic observations) were used with residents and staff members to explore the challenges they encountered in stabilizing the model, as well as the psychosocial benefits experienced by residents in the last phase. These were complemented with a Brief Psychiatric Rating Scale (BPRS) and WHO Quality of Life scale to compare baseline and post-assessment results and an increase of quality of life. Results display a significant reduction of psychiatric symptoms in patients (p< 0.5). It also describes the challenges encountered in the current context, and strategies that were used to respond and adapt the model to address these concerns effectively. Positive behavioural and psycho-emotional changes were observed amongst the residents, significant amongst those being enhanced in their mobility and participation. The article concludes by discussing the implications of this study for the development of innovative community-based models in wider contexts.
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Affiliation(s)
- Archana Padmakar
- The Banyan Academy of Leadership in Mental Health (BALM), Chennai, India
| | - Emma Emily de Wit
- Athena Institute, Faculty of Science, Vrije University, Amsterdam, Netherlands
- * E-mail:
| | - Sagaya Mary
- The Banyan Academy of Leadership in Mental Health (BALM), Chennai, India
| | - Eline Regeer
- Altrecht, Mental Health Care, Utrecht, Netherlands
| | - Joske Bunders-Aelen
- Athena Institute, Faculty of Science, Vrije University, Amsterdam, Netherlands
| | - Barbara Regeer
- Athena Institute, Faculty of Science, Vrije University, Amsterdam, Netherlands
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18
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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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19
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Kwobah E, Jaguga F, Robert K, Ndolo E, Kariuki J. Efforts and Challenges to Ensure Continuity of Mental Healthcare Service Delivery in a Low Resource Settings During COVID-19 Pandemic-A Case of a Kenyan Referral Hospital. Front Psychiatry 2020; 11:588216. [PMID: 33519544 PMCID: PMC7840829 DOI: 10.3389/fpsyt.2020.588216] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 12/14/2020] [Indexed: 12/21/2022] Open
Abstract
The rising number of patients with Covid-19 as well as the infection control measures have affected healthcare service delivery, including mental healthcare. Mental healthcare delivery in low and middle income countries where resources were already limited are likely to be affected more during this pandemic. This paper describes the efforts of ensuring mental healthcare delivery is continued in a referral hospital in Kenya, Moi Teaching and Referral hospital, as well as the challenges faced. These efforts are guided by the interim guidelines developed by the Kenyan ministry of health. Some of the adjustments described includes reducing number of patients admitted, shortening the stay in the inpatient setting, using outdoors for therapy to promote physical distancing, utilization of electronic platforms for family therapy sessions, strengthening outpatient services, and supporting primary care workers to deliver mental health care services. Some of the challenges include limited ability to move about, declining ability for patients to pay out of pocket due to the economic challenges brought about by measures to control Covid-19, limited drug supplies in primary care facilities, inability to fully implement telehealth due to connectivity issues and stigma for mental health which results in poor social support for the mentally ill patients. It is clear that current pandemic has jeopardized the continuity of usual mental healthcare in many settings. This has brought to sharp focus the need to decentralize mental health care and promote community based services. Meanwhile, there is need to explore feasible alternatives to ensure continuity of care.
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Affiliation(s)
- Edith Kwobah
- Department of Mental Health, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Florence Jaguga
- Department of Mental Health, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Kiptoo Robert
- Department of Mental Health, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Elias Ndolo
- Department of Mental Health, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Jane Kariuki
- Mental Health and Rehabilitative Services, Moi Teaching and Referral Hospital, Eldoret, Kenya
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20
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Campbell A, Ridout B, Amon K, Navarro P, Collyer B, Dalgleish J. A Customized Social Network Platform (Kids Helpline Circles) for Delivering Group Counseling to Young People Experiencing Family Discord That Impacts Their Well-Being: Exploratory Study. J Med Internet Res 2019; 21:e16176. [PMID: 31859671 PMCID: PMC6942185 DOI: 10.2196/16176] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 11/07/2019] [Accepted: 11/13/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND It has often been reported that young people are at high risk of mental health concerns, more so than at any other time in development over their life span. The situational factors that young people report as impacting their well-being are not addressed as often: specifically, family discord. Kids Helpline, a national service in Australia that provides free counseling online and by telephone to young people in distress, report that family discord and well-being issues are one of the major concerns reported by clients. In order to meet the preferences that young people seek when accessing counseling support, Kids Helpline has designed and trialed a custom-built social network platform for group counseling of young people experiencing family discord that impacts their well-being. OBJECTIVE In this exploratory study, we communicate the findings of Phase 1 of an innovative study in user and online counselor experience. This will lead to an iterative design for a world-first, purpose-built social network that will do the following: (1) increase reach and quality of service by utilizing a digital tool of preference for youth to receive peer-to-peer and counselor-to-peer support in a safe online environment and (2) provide the evidence base to document the best practice for online group counseling in a social network environment. METHODS The study utilized a participatory action research design. Young people aged 13-25 years (N=105) with mild-to-moderate depression or anxiety (not high risk) who contacted Kids Helpline were asked if they would like to trial the social networking site (SNS) for peer-to-peer and counselor-to-peer group support. Subjects were grouped into age cohorts of no more than one year above or below their reported age and assigned to groups of no more than 36 participants, in order to create a community of familiarity around age and problems experienced. Each group entered into an 8-week group counseling support program guided by counselors making regular posts and providing topic-specific content for psychoeducation and discussion. Counselors provided a weekly log of events to researchers; at 2-week intervals, subjects provided qualitative and quantitative feedback through open-ended questions and specific psychometric measures. RESULTS Qualitative results provided evidence of user support and benefits of the online group counseling environment. Counselors also reported benefits of the modality of therapy delivery. Psychometric scales did not report significance in changes of mood or affect. Counselors and users suggested improvements to the platform to increase user engagement. CONCLUSIONS Phase 1 provided proof of concept for this mode of online counseling delivery. Users and counselors saw value in the model and innovation of the service. Phase 2 will address platform issues with changes to a new social network platform. Phase 2 will focus more broadly on mental health concerns raised by users and permit inclusion of a clinical population of young people experiencing depression and anxiety. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12616000518460; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370381.
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Affiliation(s)
- Andrew Campbell
- Cyberpsychology Research Group, Faculty of Medicine & Health, The University of Sydney, Camperdown, Australia
| | - Brad Ridout
- Cyberpsychology Research Group, Faculty of Medicine & Health, The University of Sydney, Camperdown, Australia
| | - Krestina Amon
- Cyberpsychology Research Group, Faculty of Medicine & Health, The University of Sydney, Camperdown, Australia
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21
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Ahulu LD, Gyasi-Gyamerah AA, Anum A. Predicting risk and protective factors of generalized anxiety disorder: a comparative study among adolescents in Ghana. INTERNATIONAL JOURNAL OF ADOLESCENCE AND YOUTH 2019. [DOI: 10.1080/02673843.2019.1698440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Lynda Dede Ahulu
- Clinical Psychology Unit, Accra Psychiatric Hospital , Accra, Ghana
| | | | - Adote Anum
- Department of Psychology, University of Ghana , Legon, Ghana
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22
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Kohrt BA, Mistry AS, Anand N, Beecroft B, Nuwayhid I. Health research in humanitarian crises: an urgent global imperative. BMJ Glob Health 2019; 4:e001870. [PMID: 31798999 PMCID: PMC6861060 DOI: 10.1136/bmjgh-2019-001870] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/04/2019] [Accepted: 09/12/2019] [Indexed: 01/30/2023] Open
Abstract
Globally, humanitarian crises-such as armed conflict, forced displacement, natural disasters and major disease outbreaks-affect more people today than at any point in recorded history. These crises have immense acute and long-term health impacts on hundreds of millions of people, predominantly in low and middle-income countries (LMIC), yet the evidence base that informs how humanitarian organisations respond to them is weak. Humanitarian crises are often treated as an outlier in global health. However, they are an increasingly common and widespread driver of health that should be integrated into comprehensive approaches and strategies, especially if we hope to achieve ambitious global health targets such as the Sustainable Development Goals. The academic research community can play an important role in addressing the evidence gap in humanitarian health. There are important scientific questions of high public health relevance that can only be addressed by conducting research in humanitarian settings. While working in these settings is uniquely challenging, there are effective strategies that can be employed, such as using flexible and adaptive research methodologies, partnering with non-governmental organisations and other humanitarian actors, and devoting greater attention to issues of research ethics, community engagement, local LMIC-based partners, building humanitarian research capacity and collaborating across disciplines.
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Affiliation(s)
- Brandon A Kohrt
- Department of Psychiatry and Behavioral Sciences and Department of Global Health, George Washington University, Washington, DC, USA
| | - Amit S Mistry
- Fogarty International Center, NIH, Bethesda, Maryland, USA
| | - Nalini Anand
- Fogarty International Center, NIH, Bethesda, Maryland, USA
| | | | - Iman Nuwayhid
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
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23
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Zhao Y, Fitzpatrick T, Wan B, Day S, Mathews A, Tucker JD. Forming and implementing community advisory boards in low- and middle-income countries: a scoping review. BMC Med Ethics 2019; 20:73. [PMID: 31623624 PMCID: PMC6796331 DOI: 10.1186/s12910-019-0409-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 09/16/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Community advisory boards (CABs) have expanded beyond high-income countries (HICs) and play an increasing role in low- and middle-income country (LMIC) research. Much research has examined CABs in HICs, but less is known about CABs in LMICs. The purposes of this scoping review are to examine the creation and implementation of CABs in LMICs, including identifying frequently reported challenges, and to discuss implications for research ethics. METHODS We searched five databases (PubMed, Embase, Global Health, Scopus, and Google Scholar) for publications describing or evaluating CABs in LMICs. Two researchers independently reviewed articles for inclusion. Data related to the following aspects of CABs were extracted from included publications: time, country, financial support, research focus, responsibilities, and challenges. Thematic analyses were used to summarize textual data describing challenges. RESULTS Our search yielded 2005 citations, 83 of which were deemed eligible for inclusion. Most studies (65) were published between 2010 and 2017. Upper-middle-income countries were more likely to have studies describing CABs, with South Africa (17), China (8), and Thailand (7) having the greatest numbers. The United States National Institutes of Health was the main source of financial support for CABs. Many CABs (53/88, 60%) focused on HIV research. Thirty-four studies reported how CABs influenced the informed consent process for clinical trials or other aspects of research ethics. CAB responsibilities were related to clinical trials, including reviewing study protocols, educating local communities about research activities, and promoting the ethical conduct of research. Challenges faced by CABs included the following: incomplete ethical regulations and guidance; limited knowledge of science among members of communities and CABs; unstable and unbalanced power relationships between researchers and local communities; poor CAB management, including lack of formal participation structures and absence of CAB leadership; competing demands for time that limited participation in CAB activities; and language barriers between research staff and community members. Several challenges reflected shortcomings within the research team. CONCLUSIONS Our findings examine the formation and implementation of CABs in LMICs and identify several ethical challenges. These findings suggest the need for further ethics training among CAB members and researchers in LMICs.
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Affiliation(s)
- Yang Zhao
- University of North Carolina at Chapel Hill - Project China, No.2 Lujing Road, Guangzhou, 510095 China
| | - Thomas Fitzpatrick
- University of North Carolina at Chapel Hill - Project China, No.2 Lujing Road, Guangzhou, 510095 China
- University of Washington School of Medicine, Seattle, USA
| | - Bin Wan
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Suzanne Day
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Allison Mathews
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Joseph D. Tucker
- University of North Carolina at Chapel Hill - Project China, No.2 Lujing Road, Guangzhou, 510095 China
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, USA
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
- Faculty of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK
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Wamwayi MO, Cope V, Murray M. Service gaps related to culturally appropriate mental health care for African immigrants. Int J Ment Health Nurs 2019; 28:1110-1118. [PMID: 31207014 DOI: 10.1111/inm.12622] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/24/2019] [Indexed: 11/29/2022]
Abstract
The population of overseas-born Australians continues to grow including the recent increase of immigrants and refugees from African countries. Due to this increase, healthcare services need to assess if current available services are culturally appropriate for African immigrant inpatients. This qualitative study, with a quality improvement focus, examined current services to identify key service gaps and consider recommendation to improve care of African immigrant mental health inpatients in the hospital from the point of view of staff working within the organisation. What was revealed is that services currently offered to African mental health inpatients were culturally inappropriate. Emerging themes included inadequate interpreter services, lack of cultural awareness staff training, lack of organisation link with other services, unmet spiritual needs, use of staff/families as interpreters, culturally inappropriate information, and lack of or inadequate culturally appropriate policies and framework. Changes to current practices are recommended to provide culturally appropriate mental health care to African inpatients.
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Affiliation(s)
- Michael O Wamwayi
- Discipline of Nursing, College of Science, Health, Engineering and Education, Murdoch University, Murdoch, Western Australia, Australia
| | - Vicki Cope
- Discipline of Nursing, College of Science, Health, Engineering and Education, Murdoch University, Murdoch, Western Australia, Australia
| | - Melanie Murray
- Discipline of Nursing, College of Science, Health, Engineering and Education, Murdoch University, Murdoch, Western Australia, Australia
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25
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Kemp CG, Petersen I, Bhana A, Rao D. Supervision of Task-Shared Mental Health Care in Low-Resource Settings: A Commentary on Programmatic Experience. GLOBAL HEALTH: SCIENCE AND PRACTICE 2019; 7:150-159. [PMID: 31249017 PMCID: PMC6641815 DOI: 10.9745/ghsp-d-18-00337] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 04/02/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Christopher G Kemp
- Department of Global Health, University of Washington, Seattle, WA, USA.
| | - Inge Petersen
- School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Arvin Bhana
- School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa.,South African Medical Research Council, Health Systems Research Unit, Durban, South Africa
| | - Deepa Rao
- Department of Global Health, University of Washington, Seattle, WA, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
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26
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Bonsu AS, Salifu Yendork J. Community-Based Mental Health Care: Stigma and Coping Strategies Among Professionals and Family Caregivers in the Eastern Region of Ghana. Issues Ment Health Nurs 2019; 40:444-451. [PMID: 30943063 DOI: 10.1080/01612840.2018.1564158] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
To a large extent caregivers perceive stigma through their social and community interactions by virtue of their association with persons with mental health problems. Meanwhile, evidence on their strategies for coping with potentially undesirable experiences linked with stigma is limited. Using a descriptive qualitative approach, the present study explored affiliate stigma among mental health professionals and family caregivers of persons with mental illness. Data, collected through one-on-one interviews with 10 mental health professionals and 10 family caregivers, were examined with content analysis. Findings revealed that, although stigma attached to mental illness was largely directed at sufferers and family caregivers, professionals sometimes had their fair share. To manage the negative impact of stigma, caregivers adopted various strategies including the use of realisation, tactical or planned ignoring, self-motivation, acceptance and religion. Implications of the findings necessitate the intensification of mental health education among the general populace, which must be targeted at demystifying mental illness.
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27
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Spagnolo J, Champagne F, Leduc N, Melki W, Bram N, Guesmi I, Rivard M, Bannour S, Bouabid L, Ganzoui SBHH, Mongi BM, Riahi A, Saoud Z, Zine E, Piat M, Laporta M, Charfi F. A program to further integrate mental health into primary care: lessons learned from a pilot trial in Tunisia. JOURNAL OF GLOBAL HEALTH REPORTS 2019. [DOI: 10.29392/joghr.3.e2019022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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28
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Brockie T, Azar K, Wallen G, O'Hanlon Solis M, Adams K, Kub J. A conceptual model for establishing collaborative partnerships between universities and Native American communities. Nurse Res 2019; 27:27-32. [PMID: 31468833 DOI: 10.7748/nr.2019.e1613] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND Collaborative partnerships are increasingly recognised as valuable and essential tools for improving community health. AIM To present the process used to establish a collaboration between a university and a community, including a description of the conceptual model that provided guidance for one such project. DISCUSSION While numerous studies explore the potential benefits of such efforts, few have addressed how to initiate partnerships. The initiation phase and formative work required are arguably the most crucial step, as they become the foundation on which all future efforts are built and through which sustainability is achieved. CONCLUSION These formative steps are essential when working with Native American communities, which experience severe health disparities, but for which limited initiatives are available for community health interventions. IMPLICATIONS FOR PRACTICE The approach used in this project can guide the establishment of a university-community collaboration, from initiation to evaluation.
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Affiliation(s)
- Teresa Brockie
- Johns Hopkins School of Nursing, Community Public Health, Baltimore MD
| | | | - Gwenyth Wallen
- Nursing Research and Translational Science, National Institutes of Health Clinical Center, Bethesda MD
| | | | | | - Joan Kub
- University of Southern California, Los Angeles CA
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29
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An Embedded Systems Perspective in Conceptualizing Canada’s Healthcare Sustainability. SUSTAINABILITY 2019. [DOI: 10.3390/su11020531] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Healthcare sustainability has been dominated by a strong fiscal orientation. In an era of budget cuts and staff reductions, the financial challenges in Canadian healthcare are immediate and must be addressed. However, an independent focus on financial viability is too narrow a framing; too limited to allow for the kind of creative, novel, and even radical thinking that is required to fundamentally alter the current course of healthcare in Canada and internationally. Prospects for solving the current financial challenges are likely to be greatly enhanced if we simultaneously account for the broad and interrelated dimensions of sustainability. What would a healthcare system look like if sustainability were adopted as the focal and principal goal? And what might a “deep” sustainability orientation imply for how we think about and manage healthcare systems? This analysis is informed by the notion that healthcare systems are fully contained within the societal system, which is itself fully contained within the broader ecological system. This model, which foregrounds nature as the most fundamental and important system, has both greater ecological validity and particular relevance to the healthcare context given the interdependence between the health of natural systems and the health of humans. Our understanding of nature in relation to health may be key to solving or at least reducing the economic burden of healthcare. A multidimensional systems orientation thus has the potential to unveil new modes of thinking that highlight intersectoral relations, communications, collaboration, and cross-boundary learning for improved health and wellbeing, healthcare performance, and sustainability.
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30
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Berniyanti T, Bramantoro T, Rasuna G, Zamzam A, Kusumo A, Ramadhani A. WhatsApp platform as an dental and oral health online communication forum for dentist, nurse, and elementary teachers. J Int Oral Health 2019. [DOI: 10.4103/jioh.jioh_226_18] [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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31
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Citrin D, Mehanni S, Acharya B, Wong L, Nirola I, Sherchan R, Gauchan B, Karki KB, Singh DR, Shamasunder S, Le P, Schwarz D, Schwarz R, Dangal B, Dhungana SK, Maru S, Mahar R, Thapa P, Raut A, Adhikari M, Basnett I, Kaluanee SP, Deukmedjian G, Halliday S, Maru D. Power, potential, and pitfalls in global health academic partnerships: review and reflections on an approach in Nepal. Glob Health Action 2018; 10:1367161. [PMID: 28914185 PMCID: PMC5645653 DOI: 10.1080/16549716.2017.1367161] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Global health academic partnerships are centered around a core tension: they often mirror or reproduce the very cross-national inequities they seek to alleviate. On the one hand, they risk worsening power dynamics that perpetuate health disparities; on the other, they form an essential response to the need for healthcare resources to reach marginalized populations across the globe. Objectives: This study characterizes the broader landscape of global health academic partnerships, including challenges to developing ethical, equitable, and sustainable models. It then lays out guiding principles of the specific partnership approach, and considers how lessons learned might be applied in other resource-limited settings. Methods: The experience of a partnership between the Ministry of Health in Nepal, the non-profit healthcare provider Possible, and the Health Equity Action and Leadership Initiative at the University of California, San Francisco School of Medicine was reviewed. The quality and effectiveness of the partnership was assessed using the Tropical Health and Education Trust Principles of Partnership framework. Results: Various strategies can be taken by partnerships to better align the perspectives of patients and public sector providers with those of expatriate physicians. Actions can also be taken to bring greater equity to the wealth and power gaps inherent within global health academic partnerships. Conclusions: This study provides recommendations gleaned from the analysis, with an aim towards both future refinement of the partnership and broader applications of its lessons and principles. It specifically highlights the importance of targeted engagements with academic medical centers and the need for efficient organizational work-flow practices. It considers how to both prioritize national and host institution goals, and meet the career development needs of global health clinicians.
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Affiliation(s)
- David Citrin
- a Possible , Kathmandu , Nepal.,b Department of Anthropology , University of Washington , Seattle , WA , USA.,c Department of Global Health , University of Washington , Seattle , WA , USA.,d Henry M. Jackson School of International Studies , University of Washington , Seattle , WA , USA
| | - Stephen Mehanni
- a Possible , Kathmandu , Nepal.,e Health Equity Action Leadership Initiative , University of California, San Francisco , San Francisco , CA , USA.,f Division of Hospital Medicine , University of California, San Francisco , San Francisco , CA , USA.,g Gallup Indian Medical Center , Gallup , NM , USA
| | - Bibhav Acharya
- a Possible , Kathmandu , Nepal.,e Health Equity Action Leadership Initiative , University of California, San Francisco , San Francisco , CA , USA.,f Division of Hospital Medicine , University of California, San Francisco , San Francisco , CA , USA.,h Department of Psychiatry , University of California, San Francisco , San Francisco , CA , USA.,i Shared Minds , Boston , MA , USA
| | - Lena Wong
- a Possible , Kathmandu , Nepal.,e Health Equity Action Leadership Initiative , University of California, San Francisco , San Francisco , CA , USA.,f Division of Hospital Medicine , University of California, San Francisco , San Francisco , CA , USA.,j Tuba City Regional Health Care , Tuba City , AZ , USA
| | - Isha Nirola
- a Possible , Kathmandu , Nepal.,e Health Equity Action Leadership Initiative , University of California, San Francisco , San Francisco , CA , USA
| | - Rekha Sherchan
- a Possible , Kathmandu , Nepal.,e Health Equity Action Leadership Initiative , University of California, San Francisco , San Francisco , CA , USA
| | - Bikash Gauchan
- a Possible , Kathmandu , Nepal.,e Health Equity Action Leadership Initiative , University of California, San Francisco , San Francisco , CA , USA
| | - Khem Bahadur Karki
- k Nepal Health Research Council , Ministry of Health , Kathmandu , Nepal
| | - Dipendra Raman Singh
- l Public Health Monitoring & Evaluation Division , Ministry of Health , Kathmandu , Nepal
| | - Sriram Shamasunder
- e Health Equity Action Leadership Initiative , University of California, San Francisco , San Francisco , CA , USA.,f Division of Hospital Medicine , University of California, San Francisco , San Francisco , CA , USA
| | - Phuoc Le
- e Health Equity Action Leadership Initiative , University of California, San Francisco , San Francisco , CA , USA.,f Division of Hospital Medicine , University of California, San Francisco , San Francisco , CA , USA
| | - Dan Schwarz
- a Possible , Kathmandu , Nepal.,m Department of Medicine, Division of Global Health Equity , Brigham and Women's Hospital , Boston , MA , USA.,n Department of Medicine, Division of General Pediatrics , Boston Children's Hospital , Boston , MA , USA
| | - Ryan Schwarz
- a Possible , Kathmandu , Nepal.,m Department of Medicine, Division of Global Health Equity , Brigham and Women's Hospital , Boston , MA , USA.,o Department of Medicine, Division of General Internal Medicine , Massachusetts General Hospital , Boston , MA , USA.,p Department of Medicine , Harvard Medical School , Boston , MA , USA
| | | | | | - Sheela Maru
- a Possible , Kathmandu , Nepal.,q Department of Obstetrics and Gynecology , Boston Medical Center , Boston , MA , USA.,r Department of Obstetrics and Gynecology , Boston University School of Medicine , Boston , MA , USA.,s Department Medicine, Division of Women's Health , Brigham and Women's Hospital , Boston , MA , USA
| | | | | | | | - Mukesh Adhikari
- t District Health Office, Department of Health Services , Ministry of Health , Mangalsen , Achham , Nepal
| | | | - Shankar Prasad Kaluanee
- a Possible , Kathmandu , Nepal.,u School of Leadership and Development , Eastern University , St. Davids , PA , USA
| | - Grace Deukmedjian
- a Possible , Kathmandu , Nepal.,e Health Equity Action Leadership Initiative , University of California, San Francisco , San Francisco , CA , USA.,f Division of Hospital Medicine , University of California, San Francisco , San Francisco , CA , USA.,v Tséhootsooí Medical Center , Fort Defiance , AZ , USA
| | - Scott Halliday
- a Possible , Kathmandu , Nepal.,d Henry M. Jackson School of International Studies , University of Washington , Seattle , WA , USA
| | - Duncan Maru
- a Possible , Kathmandu , Nepal.,m Department of Medicine, Division of Global Health Equity , Brigham and Women's Hospital , Boston , MA , USA.,n Department of Medicine, Division of General Pediatrics , Boston Children's Hospital , Boston , MA , USA.,p Department of Medicine , Harvard Medical School , Boston , MA , USA.,w Department of Global Health and Social Medicine , Harvard Medical School , Boston , MA , USA
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Smythe T, Le G, Owen R, Ayana B, Hansen L, Lavy C. The development of a training course for clubfoot treatment in Africa: learning points for course development. BMC MEDICAL EDUCATION 2018; 18:163. [PMID: 30005662 PMCID: PMC6044045 DOI: 10.1186/s12909-018-1269-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 06/26/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Clubfoot is a common congenital musculoskeletal disorder that causes mobility impairment. There is a lack of trained mid-level personnel to provide clubfoot treatment in Africa and there is no standard training course. This prospective study describes the collaborative and participatory approach to the development of a training course for the treatment of clubfoot in children in resource constrained settings. METHODS We used a systems approach to evaluate the development of the training course. Inputs: The research strategy included a review of context and available training materials, and the collection of data on current training practices. Semi-structured interviews were conducted with seven expert clubfoot trainers. A survey of 32 international and regional trainers was undertaken to inform practical issues. The data were used to develop a framework for training with advice from two technical groups, consisting of regional and international stakeholders and experts. PROCESS A consensus approach was undertaken during workshops, meetings and the sharing of documents. The design process for the training materials took twenty-four months and was iterative. The training materials were piloted nine times between September 2015 and February 2017. Processes and materials were reviewed and adapted according to feedback after each pilot. RESULTS Fifty-one regional trainers from Africa (18 countries), 21 international experts (11 countries), 113 local providers of clubfoot treatment (Ethiopia, Rwanda and Kenya) and local organising teams were involved in developing the curriculum and pilot testing. The diversity of the two technical advisory groups allowed a wide range of contributions to the collaboration. Output: The resulting curriculum and content comprised a two day basic training and a two day advanced course. The basic course utilised adult learning techniques for training novice providers in the treatment of idiopathic clubfoot in children under two years old. The advanced course builds on these principles. CONCLUSION Formative research that included mixed methods (both qualitative and quantitative) was important in the development of an appropriate training course. The process documentation from this study provides useful information to assist planning of medical training programmes and may serve as a model for the development of other courses.
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Affiliation(s)
- Tracey Smythe
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E7HT UK
| | - Grace Le
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | | | | | - Linda Hansen
- CURE International, Beit CURE Hospital, Lusaka, Zambia
| | - Christopher Lavy
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Acharya B, Basnet M, Rimal P, Citrin D, Hirachan S, Swar S, Thapa P, Pandit J, Pokharel R, Kohrt B. Translating mental health diagnostic and symptom terminology to train health workers and engage patients in cross-cultural, non-English speaking populations. Int J Ment Health Syst 2017; 11:62. [PMID: 29026440 PMCID: PMC5627499 DOI: 10.1186/s13033-017-0170-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 09/26/2017] [Indexed: 11/10/2022] Open
Abstract
Although there are guidelines for transcultural adaptation and validation of psychometric tools, similar resources do not exist for translation of diagnostic and symptom terminology used by health professionals to communicate with one another, their patients, and the public. The issue of translation is particularly salient when working with underserved, non-English speaking populations in high-income countries and low- and middle-income countries. As clinicians, researchers, and educators working in cross-cultural settings, we present four recommendations to avoid common pitfalls in these settings. We demonstrate the need for: (1) harmonization of terminology among clinicians, educators of health professionals, and health policymakers; (2) distinction in terminology used among health professionals and that used for communication with patients, families, and the lay public; (3) linkage of symptom assessment with functional assessment; and (4) establishment of a culture of evaluating communication and terminology for continued improvement.
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Affiliation(s)
- Bibhav Acharya
- Possible, Bayalpata Hospital, Sanfebagar-10, Achham, Nepal
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA USA
- Shared Minds, Boston, MA USA
| | - Madhur Basnet
- Shared Minds, Boston, MA USA
- Faculty of Medicine, Department of Psychiatry, B.P. Koirala Institute of Health Sciences, Dharan, Sunsari Nepal
| | - Pragya Rimal
- Possible, Bayalpata Hospital, Sanfebagar-10, Achham, Nepal
| | - David Citrin
- Possible, Bayalpata Hospital, Sanfebagar-10, Achham, Nepal
- Department of Anthropology, University of Washington, Seattle, WA USA
- Department of Global Health, University of Washington, Seattle, WA USA
- Henry M. Jackson School of International Studies, University of Washington, Seattle, WA USA
| | - Soniya Hirachan
- Shared Minds, Boston, MA USA
- Department of Psychiatry, University of Minnesota, Minneapolis, MN USA
| | - Sikhar Swar
- Possible, Bayalpata Hospital, Sanfebagar-10, Achham, Nepal
- Psychiatric Department, Kathmandu Medical College, Kathmandu, Nepal
| | - Poshan Thapa
- Possible, Bayalpata Hospital, Sanfebagar-10, Achham, Nepal
| | | | - Rajeev Pokharel
- Ministry of Health, Policy Planning & International Cooperation Division, Kathmandu, Nepal
| | - Brandon Kohrt
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
- Department of Psychiatry, George Washington University, Washington D.C., USA
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34
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Isralowitz, Richard & Findley, Patricia A. (Eds.): Mental Health and Addiction Care in the Middle East. Int J Ment Health Addict 2017. [DOI: 10.1007/s11469-017-9805-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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