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Banerjee SC, Asuzu C, Mapayi B, Olunloyo B, Odiaka E, Daramola OB, Gilliland J, Owoade IA, Kingham P, Alatise OI, Fitzgerald G, Kahn R, Olcese C, Ostroff JS. Feasibility, acceptability, and initial efficacy of empathic communication skills training to reduce lung cancer stigma in Nigeria: a pilot study. J Natl Cancer Inst Monogr 2024; 2024:30-37. [PMID: 38836528 DOI: 10.1093/jncimonographs/lgae006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/19/2024] [Accepted: 02/02/2024] [Indexed: 06/06/2024] Open
Abstract
Effective communication about cancer diagnosis and prognosis in sub-Saharan African oncology settings is often challenged by the cancer-related shame and stigma patients and families experience. Enhancing empathic communication between health care providers, including physicians and nurses, and oncology patients and their families can not only reduce cancer stigma but also improve patient engagement, treatment satisfaction, and quality of life. To reduce lung cancer stigma, we adapted an evidence-based empathic communication skills training intervention to reduce patients' experience of stigma in Nigeria and conducted a pilot study examining the feasibility and acceptability of the empathic communication skills training. Thirty health care providers, recruited from University College Hospital, Ibadan, and Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, participated in a 2.25-hour didactic and experiential training session. Participant surveys were completed before and after the training. Overall, participants reported highly favorable training evaluations, with at least 85% of health care providers agreeing or strongly agreeing to survey items assessing training relevance, novelty, clarity, and facilitator effectiveness. Self-efficacy to communicate empathically with patients increased significantly from before-training (Mean [SD] = 3.93 [0.28]) to after-training (Mean [SD] = 4.55 [0.15]; t29 = 3.51, P < .05). Significant improvements were observed in health care provider reports of empathy toward lung cancer survivors and attitude toward lung cancer care as well as significant reductions in lung cancer blame were noted. The empathic communication skills training was feasible, well received by oncology clinicians in Nigeria, and demonstrated improvements in health care provider-reported outcomes from before- to after-training.
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Affiliation(s)
- Smita C Banerjee
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Chioma Asuzu
- Psycho-oncology Unit, Department of Radiotherapy, University College Hospital, Ibadan, Nigeria
| | - Boladale Mapayi
- Department of Mental Health, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Blessing Olunloyo
- Psycho-oncology Unit, Department of Radiotherapy, University College Hospital, Ibadan, Nigeria
| | - Emeka Odiaka
- Psycho-oncology Unit, Department of Radiotherapy, University College Hospital, Ibadan, Nigeria
| | - Oluwafemi B Daramola
- African Research Group for Oncology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Jaime Gilliland
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Israel Adeyemi Owoade
- African Research Group for Oncology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Peter Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Olusegun I Alatise
- African Research Group for Oncology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Grace Fitzgerald
- Global Cancer Disparities Initiatives, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Rivka Kahn
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Cristina Olcese
- Global Cancer Disparities Initiatives, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jamie S Ostroff
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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van den Broek M, Gandhi Y, Sureshkumar DS, Prina M, Bhatia U, Patel V, Singla DR, Velleman R, Weiss HA, Garg A, Sequeira M, Pusdekar V, Jordans MJD, Nadkarni A. Interventions to increase help-seeking for mental health care in low- and middle-income countries: A systematic review. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002302. [PMID: 37703225 PMCID: PMC10499262 DOI: 10.1371/journal.pgph.0002302] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 07/24/2023] [Indexed: 09/15/2023]
Abstract
Mental health problems are a significant and growing cause of morbidity worldwide. Despite the availability of evidence-based interventions, most people experiencing mental health problems remain untreated. This treatment gap is particularly large in low- and middle-income countries (LMIC) and is due to both supply-side and demand-side barriers. The aim of this systematic review is to identify and synthesise the evidence on interventions to improve help-seeking for mental health problems in LMICs. The protocol was registered a priori (Registration number: CRD42021255635). We searched eight databases using terms based on three concepts: 'mental health/illness' AND 'help-seeking' AND 'LMICs'; and included all age groups and mental health problems. Forty-two papers were eligible and included in this review. Intervention components were grouped into three categories following the steps in the help-seeking process: (1) raising mental health awareness among the general population (e.g., distribution of printed or audio-visual materials), (2) identification of individuals experiencing mental health problems (e.g., community-level screening or detection), and (3) promoting help-seeking among people in need of mental health care (e.g., sending reminders). The majority of interventions (80%) included components in a combination of the aforementioned categories. Most studies report positive outcomes, yet results on the effectiveness is mixed, with a clear trend in favour of interventions with components from more than one category. Ten out of 42 studies (24%) yielded a statistically significant effect of the intervention on help-seeking; and all targeted a combination of the aforementioned categories (i.e., raising awareness, identification and help-seeking promotion). Only six studies (14%) focused on children and adolescents. Due to the limited number of robust studies done in LMICs and the heterogeneity of study designs, outcomes and components used, no definite conclusions can be drawn with regards to the effects of individual strategies or content of the interventions.
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Affiliation(s)
- Myrthe van den Broek
- Research and Development, War Child, Amsterdam, The Netherlands
- Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, The Netherlands
| | - Yashi Gandhi
- Addictions and related-Research Group, Sangath, Goa, India
| | - Diliniya Stanislaus Sureshkumar
- Unit for Social and Community Psychiatry, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | - Matthew Prina
- Social Epidemiology Research Group, Kings College London, London, United Kingdom
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Urvita Bhatia
- Addictions and related-Research Group, Sangath, Goa, India
- Department of Psychology, Health and Professional Development at Oxford Brookes University, Oxford, United Kingdom
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, Massachusetts, United States of America
| | - Daisy R. Singla
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Canada
| | - Richard Velleman
- Addictions and related-Research Group, Sangath, Goa, India
- Department of Psychology, University of Bath, Bath, United Kingdom
| | - Helen A. Weiss
- MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Ankur Garg
- Addictions and related-Research Group, Sangath, Goa, India
| | | | - Veera Pusdekar
- Addictions and related-Research Group, Sangath, Goa, India
| | - Mark J. D. Jordans
- Research and Development, War Child, Amsterdam, The Netherlands
- Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, The Netherlands
| | - Abhijit Nadkarni
- Addictions and related-Research Group, Sangath, Goa, India
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Aluh DO, Onu JU, Ayilara O, Pedrosa B, Silva M, Grigaitė U, Dias M, Cardoso G, Caldas-de-Almeida JM. A qualitative integrative analysis of service users' and service providers' perspectives on ways to reduce coercion in mental health care. Soc Psychiatry Psychiatr Epidemiol 2023; 58:1353-1363. [PMID: 36781485 DOI: 10.1007/s00127-023-02435-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 02/02/2023] [Indexed: 02/15/2023]
Abstract
PURPOSE The movement to develop and implement non-coercive alternatives in the provision of mental health care is gaining momentum globally. To strengthen the basis of potential interventions that will be contextually relevant, and to complement the body of literature which is largely from high-income settings, the current study sought to explore the suggestions of service users and providers in Nigeria on how to reduce the use of coercive measures in mental health settings. METHODS Semi-structured interviews with 30 mental health professionals and four focus group discussions among 30 service users from two psychiatric hospitals in Nigeria were conducted. The data were analyzed thematically with the aid of MAXQDA. RESULTS The suggestions proposed by service users and mental health professionals were within the broad themes of communication, policies and legislation, and increased resources. Service users felt that improved communication, home consultations, non-legal advocates and clear rules and legislation would reduce the use of coercion, while service providers suggested increased public mental health literacy, better interpersonal relationships with patients, increased resources for mental health care, more research on the topic and regulation of coercive measures. CONCLUSION Many of the suggestions from this study reinforce strategies already in place to decrease coercion in other settings. However, additional recommendations that are relevant to the study setting, such as enhancing public mental health literacy, mental health legislation reform and increasing access to mental health services, deserve further consideration.
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Affiliation(s)
- Deborah Oyine Aluh
- Lisbon Institute of Global Mental Health, Lisbon, Portugal.
- NOVA Medical School, Comprehensive Health Research Centre (chrc), NOVA University of Lisbon, Lisbon, Portugal.
- Department of Clinical Pharmacy and Pharmacy Management, University of Nigeria, Nsukka, Nigeria.
| | - Justus Uchenna Onu
- Department of Mental Health, Faculty of Medicine, Nnamdi Azikiwe University, Nnewi Campus, Awka, Anambra State, Nigeria
| | - Olaniyi Ayilara
- Department of Clinical Services, Federal Neuropsychiatric Hospital, Uselu, Edo State, Nigeria
| | - Barbara Pedrosa
- Lisbon Institute of Global Mental Health, Lisbon, Portugal
- NOVA Medical School, Comprehensive Health Research Centre (chrc), NOVA University of Lisbon, Lisbon, Portugal
| | - Manuela Silva
- Lisbon Institute of Global Mental Health, Lisbon, Portugal
- NOVA Medical School, Comprehensive Health Research Centre (chrc), NOVA University of Lisbon, Lisbon, Portugal
| | - Ugnė Grigaitė
- Lisbon Institute of Global Mental Health, Lisbon, Portugal
- NOVA Medical School, Comprehensive Health Research Centre (chrc), NOVA University of Lisbon, Lisbon, Portugal
| | - Margarida Dias
- Lisbon Institute of Global Mental Health, Lisbon, Portugal
- NOVA Medical School, Comprehensive Health Research Centre (chrc), NOVA University of Lisbon, Lisbon, Portugal
| | - Graça Cardoso
- Lisbon Institute of Global Mental Health, Lisbon, Portugal
- NOVA Medical School, Comprehensive Health Research Centre (chrc), NOVA University of Lisbon, Lisbon, Portugal
| | - José Miguel Caldas-de-Almeida
- Lisbon Institute of Global Mental Health, Lisbon, Portugal
- NOVA Medical School, Comprehensive Health Research Centre (chrc), NOVA University of Lisbon, Lisbon, Portugal
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Nyassi S, Abdi YA, Minto J, Osman F. "Helping Mentally Ill, a Reward Both in this Life and After": A Qualitative Study Among Community Health Professionals in Somaliland. Community Ment Health J 2023; 59:1051-1063. [PMID: 36602699 PMCID: PMC10289922 DOI: 10.1007/s10597-022-01085-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 12/22/2022] [Indexed: 01/06/2023]
Abstract
This study aimed to describe the experiences of community mental health workers, predominantly female, nurses and doctors providing community-based mental health services in Borama, Somaliland. A qualitative explorative study using focus group discussions was conducted. Data were collected from three focus group discussions with 22 female community health workers, two medical doctors, and two registered nurses and analyzed using content analysis with an inductive approach. Three main categories were identified from the analysis: (1) bridging the mental health gap in the community; (2) working in a constrained situation; and (3) being altruistic. Overall, the community mental health workers felt that their role was to bridge the mental health gap in the community. They described their work as a rewarding and motivated them to continue despite challenges and improving community healthcare workers' work conditions and providing resources in mental health services will contribute to strengthening mental health services in Somaliland.
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Affiliation(s)
- Sungkutu Nyassi
- School of Health and Welfare, Dalarna University, 79188 Falun, Sweden
| | - Yakoub Aden Abdi
- College of Health Science, Amoud University, Amoud Valley, Borama, Somaliland Somalia
| | - John Minto
- University of the West of Scotland, Paisley, Scotland
| | - Fatumo Osman
- School of Health and Welfare, Dalarna University, 79188 Falun, Sweden
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von Gaudecker JR, Agbapuonwu N, Kyololo O, Sathyaseelan M, Oruche U. Barriers and facilitators to treatment seeking behaviors for depression, epilepsy, and schizophrenia in low- and middle-income countries: A systematic review. Arch Psychiatr Nurs 2022; 41:11-19. [PMID: 36428038 DOI: 10.1016/j.apnu.2022.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 05/13/2022] [Accepted: 07/03/2022] [Indexed: 12/22/2022]
Abstract
Despite the severe consequences, the treatment gap for depression, epilepsy, and schizophrenia continues to be a major concern in low and middle-income countries (LMICs). We conducted a systematic review of literature on barriers and facilitators of treatment-seeking behaviors from the perspective of individuals living with depression, epilepsy, and schizophrenia and stakeholders in LMICs. Knowledge deficits, beliefs, and stigma were barriers to treatment-seeking across disorders. The most cited facilitators were demographics, socioeconomic status, and collaboration with traditional healers. Culturally sensitive interventions in collaboration with stakeholders within the community can facilitate treatment-seeking behaviors among people living with depression, epilepsy, and schizophrenia.
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Affiliation(s)
- Jane R von Gaudecker
- Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN 46202, USA.
| | - Noreen Agbapuonwu
- Department of Nursing, Nnamdi Azikiwe University, Nnewi Campus, Anambra State, Nigeria..
| | | | | | - Ukamaka Oruche
- Indiana University School of Nursing, Indianapolis, IN 46202, USA.
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Ekeke N, Ossai EN, Kreibich S, Onyima A, Chukwu J, Nwafor C, Meka A, Murphy-Okpala N, Henry P, Eze C. A cluster randomized trial for improving mental health and well-being of persons affected by leprosy or buruli ulcer in Nigeria: A study protocol. Int J Mycobacteriol 2022; 11:133-138. [PMID: 35775544 DOI: 10.4103/ijmy.ijmy_247_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
This protocol describes a study in which we would assess the effect of using community lay counselors, self-help groups (SHGs), and trained frontline health workers to reduce mental disorders and improve quality of life (QOL) of persons affected by leprosy or Buruli ulcer (BU). A cluster randomized controlled study design will be employed. The study will involve persons affected by leprosy or BU. Ten local government areas (clusters) with the highest number of notified leprosy or BU cases between 2014 and 2018 in Southern Nigeria will be purposively selected. The clusters will be randomized into intervention and control groups using a computer-generated list of random numbers. At baseline, data were collected using the following validated questionnaires, Patient Health Questionnaire, Generalized Anxiety Disorder questionnaire, Stigma Assessment and Reduction of Impact Scale, World Health Organization QOL BREF and Warwick-Edinburgh Mental Well-being scale among persons affected by leprosy or BU. The intervention will last for 2 years and will involve use of community lay counselors, SHGs, and appropriately trained frontline health workers in reducing mental disorders and improving QOL of persons affected by leprosy or BU. This project postulates that the reduction of burden of mental health problems and improved QOL among persons affected by leprosy or BU could be achieved through a holistic approach involving SHGs, appropriately trained community opinion leaders, and general health-care workers as well as a functional referral system. If successful, the model will be integrated into the activities of the National Tuberculosis and Leprosy Control Programme and scaled up nationwide. Trial registration: ISRCTN Registry: ISRCTN 83649248. https://trialsearch. who.int/Trial2.aspx? TrialID % ISRCTN83649248 Prospectively registered.
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Affiliation(s)
- Ngozi Ekeke
- German Leprosy and TB Relief Association, Enugu, Nigeria
| | - Edmund Ndudi Ossai
- Department of Community Medicine, College of Health Sciences, Ebonyi State University, Abakaliki, Nigeria
| | - Saskia Kreibich
- German Leprosy and TB Relief Association, Wuerzburg, Germany
| | - Amaka Onyima
- Tuberculosis, Leprosy and Buruli Ulcer Control Programme, Ogbaru Local Government Area, Anambra State, Nigeria
| | - Joseph Chukwu
- German Leprosy and TB Relief Association, Enugu, Nigeria
| | - Charles Nwafor
- German Leprosy and TB Relief Association, Enugu, Nigeria
| | - Anthony Meka
- German Leprosy and TB Relief Association, Enugu, Nigeria
| | | | - Precious Henry
- German Leprosy and TB Relief Association, Enugu, Nigeria
| | - Chinwe Eze
- German Leprosy and TB Relief Association, Enugu, Nigeria
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Qureshi O, Endale T, Ryan G, Miguel-Esponda G, Iyer SN, Eaton J, De Silva M, Murphy J. Barriers and drivers to service delivery in global mental health projects. Int J Ment Health Syst 2021; 15:14. [PMID: 33487170 PMCID: PMC7827991 DOI: 10.1186/s13033-020-00427-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 12/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research in global mental health (GMH) has previously documented how contextual factors like political instability, poverty and poorly-funded health infrastructure continue to compromise effective and equitable mental health service delivery. There is a need to develop more feasible and evidence-based solutions through implementation research. This paper, one in a series pertaining to implementation in GMH projects worldwide, focuses on implementation factors influencing mental health service delivery. METHODS This is a qualitative study carried out as part of a Theory of Change-driven evaluation of Grand Challenges Canada's (GCC's) Global Mental Health portfolio. Purposive sampling was used to recruit twenty-nine GCC grantees for interviews. A semi-structured interview schedule was used to guide the interviews which were recorded and subsequently transcribed. Transcripts were double-coded and analyzed in NVivo 11 using framework analysis. This paper reports results related to detection and treatment of mental illness, mental health promotion and prevention of mental illness. RESULTS Key barriers included: lack of appropriate human resources and expertise for service delivery; lack of culturally appropriate screening tools and interventions; and difficulties integrating services with the existing mental health system. Formative research was a key driver facilitating the cultural adaptation of mental health detection, treatment, promotion and preventative approaches. Recruiting local providers and utilizing mHealth for improving screening, monitoring and data management were also found to be successful approaches in reducing workforce burden, improving sustainability, mental health literacy, participant engagement and uptake. CONCLUSIONS The study identifies a number of key barriers to and drivers of successful service delivery from the perspective of grantees implementing GMH projects. Findings highlight several opportunities to mitigate common challenges, providing recommendations for strengthening systems- and project-level approaches for delivering mental health services. Further, more inclusive research is required to inform guidance around service delivery for successful implementation, better utilization of funding and improving mental health outcomes among vulnerable populations in low-resource settings.
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Affiliation(s)
- Onaiza Qureshi
- Global Mental Health, London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT UK
| | - Tarik Endale
- Department of Counseling and Clinical Psychology, Teachers College, Colombia University, 525 W 120th St, New York, NY 10027 USA
| | - Grace Ryan
- Centre for Global Mental Health, Department of Population Health, London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT UK
| | - Georgina Miguel-Esponda
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 16 De Crespigny Park, London, SE5 8AF UK
| | - Srividya N. Iyer
- Department of Psychiatry, McGill University, 845 Sherbrooke St W, Montreal, QC H3A 0G4 Canada
- Douglas Research Centre, 6875 Boulevard LaSalle, Montreal, QC H4H 1R3 Canada
| | - Julian Eaton
- Centre for Global Mental Health, Department of Population Health, London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT UK
- CBM UK, 8 Oakington Business Park, Dry Drayton Rd, Oakington, CB24 3DQ UK
| | - Mary De Silva
- Health of Population Health, Wellcome Trust, 215 Euston Rd, Bloomsbury, London, NW1 2BE UK
| | - Jill Murphy
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, 2255 Westbrook Mall, Vancouver, BC V6T 2A1 Canada
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Guo S, Xiong J, Liu F, Su Y. Mental Health Literacy Levels of Medical Staff in China: An Assessment Based on a Meta-Analysis. Front Psychiatry 2021; 12:683832. [PMID: 34803749 PMCID: PMC8602804 DOI: 10.3389/fpsyt.2021.683832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 09/10/2021] [Indexed: 11/24/2022] Open
Abstract
Background: The awareness rate of mental health knowledge among medical staff is an important evaluation index to assess the service capacity of a country or region, and this indicator in China has not been quantitatively evaluated. Study Design: This study systematically combined pertinent quantitative study data from previous related studies to conclude the awareness rate of mental health knowledge among Chinese medical staff. Methods: Related studies from five electronic databases were searched, and a meta-analysis was conducted to obtain the combined result. The primary outcome of the present study was the awareness rate of medical staff or the sample size and the number of those who can answer the relevant questions correctly. We also performed a hierarchical analysis according to the sample group's region and specialty. The awareness rate of medical staff and corresponding 95% confidence intervals (CIs) were calculated. The heterogeneity was assessed with the I 2 test, and Egger's test was used to evaluate publication bias. Results: A total of 15 articles with 11,526 medical staff were included in the present study; the overall awareness rate of mental health knowledge among Chinese medical staff was as low as 81%. The awareness rate of mental health knowledge among medical workers in developed regions is higher than that in developing regions. The awareness rate of mental health among medical staff in the department of psychiatry, non-psychiatry, and community medical staff was 88, 68, and 82%, respectively. Conclusion: The overall awareness rate among medical staff in this country is unsatisfactory, and the awareness rate in developed regions is higher than medical staff in developing regions. Psychiatric hospital staff has a higher awareness rate than community medical staff, and non-psychiatric hospital staff has the lowest awareness rate.
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Affiliation(s)
- Shengyu Guo
- Department of Economics and Management, Changsha University, Changsha, China
| | - Jie Xiong
- Department of Mathematics and Computer Science, Changsha University, Changsha, China
| | - Feiyue Liu
- Department of Economics and Management, Changsha University, Changsha, China
| | - Yanlin Su
- Department of Gynaecology and Obstetrics, The Affiliated Changsha Central Hospital, University of South China, Changsha, China
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Ryan GK, Nwefoh E, Aguocha C, Ode PO, Okpoju SO, Ocheche P, Woyengikuro A, Abdulmalik J, Eaton J. Partnership for the implementation of mental health policy in Nigeria: a case study of the Comprehensive Community Mental Health Programme in Benue State. Int J Ment Health Syst 2020; 14:10. [PMID: 32110245 PMCID: PMC7033947 DOI: 10.1186/s13033-020-00344-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 02/13/2020] [Indexed: 11/14/2022] Open
Abstract
Background 71% of countries in the World Health Organisation’s (WHO’s) African Region have a stand-alone mental health policy or plan, but only 14% have fully implemented it. In Nigeria, integration of mental health into primary care has been a stumbling block to the implementation of the 1991 National Mental Health Policy, 2013 Policy on Mental Health Services Delivery and the National Mental, Neurological and Substance Use Programme and Action Plan. A partnership between public and private not-for-profits in Benue State, the Comprehensive Community Mental Health Programme (CCMHP) has successfully integrated mental health into primary care in alignment with the national mental health policy and the WHO’s mental health Gap Action Programme Intervention Guide (mhGAP-IG). There is a need to document such examples in order to inform policy implementation in Nigeria and other low- and middle-income countries (LMICs). Methods We followed the Case Study Methodology to Monitor and Evaluate Community Mental Health Programmes in LMICs. Four field visits were conducted between 2013 and 2017 to document the first phase of activities of CCMHP, covering the period of January 2011 through June 2016. Results In its first phase, CCMHP trained 19 community psychiatric nurses and 48 community health extension workers in mhGAP-IG, establishing 45 new mental health clinics in primary care facilities across Benue, a state more populous than many countries. As a result, 13,785 clients (55% male, 45% female) were enrolled in mental health services either in primary care or in one of two pre-existing community-based rehabilitation facilities. Most are adults over age 18 (82.75%), and present to services with epilepsy (52.38%) or psychosis (38.41%). Conclusion The case of CCMHP demonstrates it is possible to rapidly scale-up mental health services in line with national mental health policy using the mhGAP-IG, even in a challenging, low-resource setting. Multi-sectoral partnerships may help to overcome some of the barriers to successful integration of mental health into general healthcare by capitalising on the resources and expertise of both state and non-state actors. However, a difficult political context could threaten the sustainability of the programme if funder requirements force a rapid transition to full government ownership.
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Affiliation(s)
- G K Ryan
- 1Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK.,2Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - E Nwefoh
- 3CBM International, Stubenwald-Allee 5, 64625 Bensheim, Germany.,Benue State Comprehensive Community Mental Health Programme, Depot Road PMB 0360, Otukpo, Nigeria
| | - C Aguocha
- 4Department of Medicine, Imo State University, Okigwe Road, Ugwu Orji, Owerri, Nigeria
| | - P O Ode
- 3CBM International, Stubenwald-Allee 5, 64625 Bensheim, Germany.,Benue State Comprehensive Community Mental Health Programme, Depot Road PMB 0360, Otukpo, Nigeria
| | - S O Okpoju
- Benue State Comprehensive Community Mental Health Programme, Depot Road PMB 0360, Otukpo, Nigeria
| | - P Ocheche
- Benue State Comprehensive Community Mental Health Programme, Depot Road PMB 0360, Otukpo, Nigeria
| | - A Woyengikuro
- Benue State Comprehensive Community Mental Health Programme, Depot Road PMB 0360, Otukpo, Nigeria
| | - J Abdulmalik
- 6Department of Psychiatry, College of Medicine, University of Ibadan, University College Hospital, PMB 5116, Oyo, Nigeria
| | - J Eaton
- 1Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK.,2Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK.,3CBM International, Stubenwald-Allee 5, 64625 Bensheim, Germany
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Depressive symptoms, suicidal ideation, and mental health care-seeking in central Mozambique. Soc Psychiatry Psychiatr Epidemiol 2019; 54:1519-1533. [PMID: 31317245 PMCID: PMC7050264 DOI: 10.1007/s00127-019-01746-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 07/10/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE There is scant research on depressive symptoms (DS), suicidal ideation (SI), and mental health care-seeking in Mozambique. METHODS Generalized estimating equations were used to assess factors associated with DS, SI, and mental health care-seeking among 3080 individuals interviewed in a representative household survey in Sofala and Manica provinces, Mozambique. RESULTS 19% (CI 17-21%) of respondents reported DS in the past year and 17% (CI 15-18%) lifetime SI. Overall, only 10% (CI 8-11%) of respondents ever sought any care for mental illness, though 26% (CI 23-29%) of those reporting DS and/or SI sought care. 90% of those who sought care for DS received treatment; however, only 46% of those who sought care for SI received treatment. Factors associated with DS and SI include: female gender, divorced/separated, widowed, and > 55 years old. Respondents in the bottom wealth quintile reported lower DS, while those in upper wealth quintiles reported higher prevalence of SI. Individuals with DS or SI had significantly elevated measures of disability-especially in doing household chores, work/school activities, standing for long periods, and walking long distances. Factors associated with care-seeking include: female gender, rural residence, divorced/separated, and > 45 years old. Individuals in lower wealth quintiles and with no religious affiliation had lower odds of seeking care. CONCLUSIONS DS and SI are prevalent in central Mozambique and treatment gaps are high (68% and 89%, respectively). An urgent need exists for demand- and supply-side interventions to optimize the delivery of comprehensive community-based mental healthcare in Mozambique.
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Hamill LC, Haslam D, Abrahamsson S, Hill B, Dixon R, Burgess H, Jensen K, D’Souza S, Schmidt E, Downs P. People are neglected, not diseases: the relationship between disability and neglected tropical diseases. Trans R Soc Trop Med Hyg 2019; 113:829-834. [PMID: 31111941 PMCID: PMC6903785 DOI: 10.1093/trstmh/trz036] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 04/04/2019] [Accepted: 05/02/2019] [Indexed: 01/24/2023] Open
Abstract
People with disabilities and the neglected tropical diseases (NTDs) are separately receiving increased focus. In light of this positive development, and the similarities and intersections between the negative impacts experienced by both people with disabilities and people with NTDs, we believe now is the right time to focus attention on the overlap between the two. Both people with NTDs and people with disabilities experience a myriad of overlapping negative health, financial and socio-cultural consequences. Despite this, we believe that disability is not yet properly prioritised on the development agenda, and that there are multiple opportunities to make NTD programming more inclusive, to the benefit of those at this neglected intersection and beyond. There are both opportunities and need to scale up, integrate, and invest in inclusive, health system-focused NTD programming. Realisation of the Sustainable Development Goals, Universal Health Coverage, and the control and elimination of NTDs all rely on ensuring people with disabilities are not left behind.
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Affiliation(s)
| | - Dominic Haslam
- Sightsavers, 35 Perrymount Road, Haywards Heath, West Sussex, UK
| | | | - Becks Hill
- Sightsavers, 35 Perrymount Road, Haywards Heath, West Sussex, UK
| | - Ruth Dixon
- Sightsavers, 35 Perrymount Road, Haywards Heath, West Sussex, UK
| | - Heather Burgess
- Sightsavers, 35 Perrymount Road, Haywards Heath, West Sussex, UK
| | - Kimberly Jensen
- Sightsavers, 35 Perrymount Road, Haywards Heath, West Sussex, UK
| | - Susan D’Souza
- Sightsavers, 35 Perrymount Road, Haywards Heath, West Sussex, UK
| | - Elena Schmidt
- Sightsavers, 35 Perrymount Road, Haywards Heath, West Sussex, UK
| | - Philip Downs
- Sightsavers, 35 Perrymount Road, Haywards Heath, West Sussex, UK
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Tora A, Mengiste A, Davey G, Semrau M. Community Involvement in the Care of Persons Affected by Podoconiosis-A Lesson for Other Skin NTDs. Trop Med Infect Dis 2018; 3:E87. [PMID: 30274483 PMCID: PMC6161108 DOI: 10.3390/tropicalmed3030087] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 08/08/2018] [Accepted: 08/11/2018] [Indexed: 12/30/2022] Open
Abstract
Podoconiosis is a neglected tropical disease (NTD) characterized by lower-leg swelling (lymphedema), which is caused by long-term exposure to irritant red-clay soils found within tropical volcanic high-altitude environments with heavy rainfall. The condition places a substantial burden on affected people, their families and communities, including disability, economic consequences, social exclusion, and stigma; mental disorders and distress are also common. This paper focuses on community-based care of podoconiosis, and, in particular, the role that community involvement can have in the reduction of stigma against people affected by podoconiosis. We first draw on research conducted in Ethiopia for this, which has included community-based provision of care and treatment, education, and awareness-raising, and socioeconomic rehabilitation to reduce stigma. Since people affected by podoconiosis and other skin NTDs often suffer the double burden of mental-health illness, which is similarly stigmatized, we then point to examples from the mental-health field in low-resource community settings to suggest avenues for stigma reduction and increased patient engagement that may be relevant across a range of skin NTDs, though further research is needed on this.
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Affiliation(s)
- Abebayehu Tora
- Department of Sociology, Wolaita Sodo University, Sodo, Ethiopia.
| | - Asrat Mengiste
- National Podoconiosis Action Network, Addis Ababa, Ethiopia.
| | - Gail Davey
- Department of Global Health and Infection, Brighton and Sussex Medical School, Falmer Campus, University of Sussex, Brighton BN1 9PX, UK.
| | - Maya Semrau
- Department of Global Health and Infection, Brighton and Sussex Medical School, Falmer Campus, University of Sussex, Brighton BN1 9PX, UK.
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