1
|
Appiah R, Raviola G, Weobong B. Balancing Ethics and Culture: A Scoping Review of Ethico-Cultural and Implementation Challenges of the Individual-Based Consent Model in African Research. J Empir Res Hum Res Ethics 2024:15562646241237669. [PMID: 38497301 DOI: 10.1177/15562646241237669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Objective: This review explores the ethico-cultural and implementation challenges associated with the individual-based informed consent (IC) model in the relatively collectivistic African context and examines suggested approaches to manage them. Methods: We searched four databases for peer-reviewed studies published in English between 2000 to 2023 that examined the ethico-cultural and implementation challenges associated with the IC model in Africa. Results: Findings suggest that the individual-based IC model largely misaligns with certain African social values and ethos and subverts the authority and functions of community gatekeepers. Three recommendations were proffered to manage these challenges, that researchers should: adopt a multi-step approach to IC, conduct a rapid ethical assessment, and generate an African-centered IC model. Conclusions: A pluriversal, context-specific, multi-step IC model that critically harmonizes the cultural values of the local population and the general principles of IC can minimize ethics dumping, safeguard the integrity of the research process, and promote respectful engagement.
Collapse
Affiliation(s)
- Richard Appiah
- Department of Psychology, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
- Center for African Studies, Harvard University, Cambridge, MA, USA
- College of Health Sciences, University of Ghana, Accra, Ghana
- Department of Psychology, University of Johannesburg, Johannesburg, South Africa
| | - Giuseppe Raviola
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Benedict Weobong
- College of Health Sciences, University of Ghana, Accra, Ghana
- School of Global Health, Faculty of Health, York University, Toronto, ON, Canada
| |
Collapse
|
2
|
Ackah M, Ameyaw L, Appiah R, Owiredu D, Boakye H, Donaldy W, Yarfi C, Abonie US. 30-day in-hospital stroke case fatality and significant risk factors in sub-Saharan-Africa: A systematic review and meta-analysis. PLOS Glob Public Health 2024; 4:e0002769. [PMID: 38241232 PMCID: PMC10798456 DOI: 10.1371/journal.pgph.0002769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 01/01/2024] [Indexed: 01/21/2024]
Abstract
Existing studies investigating 30-day in-hospital stroke case fatality rates in sub-Saharan Africa have produced varying results, underscoring the significance of obtaining precise and reliable estimations for this indicator. Consequently, this study aimed to conduct a systematic review and update of the current scientific evidence regarding 30-day in-hospital stroke case fatality and associated risk factors in sub-Saharan Africa. Medline/PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), APA PsycNet (encompassing PsycINFO and PsychArticle), Google Scholar, and Africa Journal Online (AJOL) were systematically searched to identify potentially relevant articles. Two independent assessors extracted the data from the eligible studies using a pre-tested and standardized excel spreadsheet. Outcomes were 30-day in-hospital stroke case fatality and associated risk factors. Data was pooled using random effects model. Ninety-three (93) studies involving 42,057 participants were included. The overall stroke case fatality rate was 27% [25%-29%]. Subgroup analysis revealed 24% [21%-28%], 25% [21%-28%], 29% [25%-32%] and 31% [20%-43%] stroke case fatality rates in East Africa, Southern Africa, West Africa, and Central Africa respectively. Stroke severity, stroke type, untyped stroke, and post-stroke complications were identified as risk factors. The most prevalent risk factors were low (<8) Glasgow Coma Scale score, high (≥10) National Institute Health Stroke Scale score, aspiration pneumonia, hemorrhagic stroke, brain edema/intra-cranial pressure, hyperglycemia, untyped stroke (stroke diagnosis not confirmed by neuroimaging), recurrent stroke and fever. The findings indicate that one in every four in-hospital people with stroke in sub-Saharan Africa dies within 30 days of admission. Importantly, the identified risk factors are mostly modifiable and preventable, highlighting the need for context-driven health policies, clinical guidelines, and treatments targeting these factors.
Collapse
Affiliation(s)
- Martin Ackah
- Faculty of Health and Life Sciences Northumbria University University, Department of Sport, Exercise & Rehabilitation, Newcastle upon Tyne, United Kingdom
| | - Louise Ameyaw
- Department of Medicine, Achimota Government Hospital, Accra, Ghana
| | - Richard Appiah
- Faculty of Health and Life Sciences Northumbria University University, Department of Psychology, Newcastle upon Tyne, United Kingdom
- Department of Occupational therapy, College of Health Sciences, University of Ghana, Korle-Bu, Accra, Ghana
| | - David Owiredu
- Centre for Evidence synthesis, University of Ghana, Accra, Ghana
| | - Hosea Boakye
- Department of Physiotherapy, LEKMA Hospital, Accra, Ghana
| | | | - Comos Yarfi
- Department of Physiotherapy, University of Allied and Health Sciences, Ho, Ghana
| | - Ulric S. Abonie
- Faculty of Health and Life Sciences Northumbria University University, Department of Sport, Exercise & Rehabilitation, Newcastle upon Tyne, United Kingdom
| |
Collapse
|
3
|
Appiah R. Facilitating change processes in group-based behaviour change interventions in rural African contexts: practical lessons from Ghana. Int J Ment Health Syst 2023; 17:3. [PMID: 36747199 PMCID: PMC9900900 DOI: 10.1186/s13033-023-00571-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 01/30/2023] [Indexed: 02/08/2023] Open
Abstract
Evidence from implementation research suggests that group-based behaviour change interventions (GBCIs) can encourage the development of peer support, promote psychosocial skills, and facilitate collaborative therapeutic relationships. However, although the mechanisms of action that mediate the behaviour change process have been extensively described in other settings, less is known about the implementation strategies and contextual factors that actuate the reported behaviour changes among programme participants in Ghana and sub-Saharan Africa, more generally. We draw on insights from the literature and field experiences from designing, implementing, and evaluating GBCIs across several rural and peri-urban communities in Ghana to discuss a range of theoretical, methodological, and contextual factors that facilitate the behaviour change process in programme participants. We offer suggestions to guide researchers to envision and manage potential challenges with the programme development and implementation processes. We propose that intervention programmes designed to facilitate health behaviour change in the defined context should (i) have a context-relevant focus, (ii) be coherent and well-structured, (iii) have explicit techniques to facilitate inter-personal and intra-personal change processes, (iv) include appropriate mechanisms to monitor and assess the progress of the interventional sessions; and (v) be implemented by trained facilitators with a deep knowledge of the sociocultural values and norms of the target group and of the principles and theories underlying the intervention programme. We envisage that these insights could serve to guide the design, implementation, and evaluation of contextually-tailored and potentially effective GBCIs that align with the needs, capacities, and circumstances of the local population.
Collapse
Affiliation(s)
- Richard Appiah
- College of Health Sciences, University of Ghana, Accra, Ghana. .,Center for African Studies, Harvard University, Cambridge, MA, USA. .,Department of Psychology, University of Johannesburg, Johannesburg, South Africa.
| |
Collapse
|
4
|
Oppong S, Appiah R, Hapunda G, Kheswa JG. Editorial: Contextualizing psychological assessment in Africa: COVID-19 and beyond. Front Psychol 2023; 14:1150387. [PMID: 36895746 PMCID: PMC9990900 DOI: 10.3389/fpsyg.2023.1150387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 02/07/2023] [Indexed: 02/23/2023] Open
Affiliation(s)
- Seth Oppong
- Department of Psychology, University of Botswana, Gaborone, Botswana.,Department of Psychology, University of the Witwatersrand, Johannesburg, South Africa
| | - Richard Appiah
- College of Health Sciences, University of Ghana, Accra, Ghana.,Center for African Studies, Harvard University, Cambridge, MA, United States
| | - Given Hapunda
- Department of Psychology, University of Zambia, Lusaka, Zambia
| | | |
Collapse
|
5
|
Appiah R. Context matters: Sociocultural considerations in the design and implementation of community-based positive psychology interventions in sub-Saharan Africa. Culture & Psychology 2022. [DOI: 10.1177/1354067x221118916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Scholars conducting cross-cultural research in mental health often import intervention programs found to be efficacious in one social context (e.g., Western) and directly implement them in other contexts (e.g., African and Asian) without recourse to the sociocultural disparities between the target populations and the theoretical foundations of the constructs and principles underpinning the intervention programs. Such efforts mistakenly assume that positive psychology interventions (PPIs), most of which were developed from Western perspectives and assumed individualistic cultural orientation and value systems, operate equally across all contexts. Drawing on the extant literature and on insights from designing, implementing, and evaluating group-based (mental) health behavior change intervention programs across several communities in Ghana, we discuss some sociocultural, theoretical, and methodological issues that can significantly constrain the design, uptake, and effectiveness of PPIs in the rural, low literate, socioeconomically disadvantaged, highly collectivistic context of Ghana, and sub-Saharan Africa more generally. In all illustrations, we offer suggestions to guide the design and implementation processes to ensure culturally appropriate, highly acceptable, and potentially effective intervention programs. We argue that PPIs can be potentially fructuous in the sub-region when adapted to, or embedded in, the cultural values of the target population and tailored to the needs, capacities, and circumstances of participants.
Collapse
Affiliation(s)
- Richard Appiah
- College of Health Sciences, University of Ghana, Ghana; and Center for African Studies, Harvard University, Cambridge, MA, USA
| |
Collapse
|
6
|
Khumalo IP, Appiah R, Wilson Fadiji A. Measuring Positive Mental Health and Depression in Africa: A Variable-Based and Person-Centred Analysis of the Dual-Continua Model. Front Psychol 2022; 13:885278. [PMID: 35795445 PMCID: PMC9252463 DOI: 10.3389/fpsyg.2022.885278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
The dual-continua model of mental health provides a contemporary framework for conceptualising and operationalising mental health. According to this model, mental health is distinct from but related to mental illness, and not the opposite or merely the absence of psychopathology symptoms. To examine the validity of the dual-continua model, previous studies have either applied variable-based analysis such as confirmatory factor analysis (CFA), or used predetermined cut-off points for subgroup division. The present study extends this contribution by subjecting data from an African sample to both CFA and latent class analysis (LCA) to test the dual-continua model in Africa. We applied CFA separately for the Mental Health Continuum—Short Form (MHC-SF) and Patient Health Questionnaire—9 (PHQ-9); and LCA on combined item responses. College students (N = 892; average age = 22.74, SD = 4.92; female = 58%) from Ghana (n = 309), Kenya (n = 262), Mozambique (n = 232), and South Africa (n = 89) completed the MHC-SF and PHQ-9. With minor modifications to the measurement models, the CFA results of this study confirm the three-factor structure of the MHC-SF, and a unidimensional solution for the PHQ-9. LCA results show the presence of three distinct latent classes: languishing with moderate endorsement of depressive symptoms (25.9%), flourishing with low endorsement of depressive symptoms (63.7%), and moderate mental health with high endorsement of depressive symptoms (10.4%). These findings further contribute to affirming the evidence for the dual-continua model of mental health, with implications for the assessment of mental health, to inform policy, practise, and future research in community and clinical settings in Africa.
Collapse
Affiliation(s)
- Itumeleng P. Khumalo
- Department of Psychology, University of Johannesburg, Johannesburg, South Africa
- *Correspondence: Itumeleng P. Khumalo,
| | - Richard Appiah
- Department of Occupational Therapy, College of Health Sciences, University of Ghana, Accra, Ghana
- Center for African Studies, Harvard University, Cambridge, MA, United States
| | - Angelina Wilson Fadiji
- University of Pretoria, Pretoria, South Africa
- North-West University, Potchefstroom, South Africa
| |
Collapse
|
7
|
Appiah R. A look back, a path forward: Revisiting the mental health and well-being research and practice models and priorities in sub-Saharan Africa. New Ideas in Psychology 2022. [DOI: 10.1016/j.newideapsych.2022.100931] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
8
|
Appiah R, Wilson Fadiji A, Wissing MP, Schutte L. The Inspired Life Program: Development of a multicomponent positive psychology intervention for rural adults in Ghana. J Community Psychol 2022; 50:302-328. [PMID: 33821476 DOI: 10.1002/jcop.22566] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 02/03/2021] [Accepted: 03/10/2021] [Indexed: 06/12/2023]
Abstract
Although several theories and studies have explored human strengths and mental well-being at the global level, these insights are rarely tested and translated into practice in sub-Saharan Africa. This study aims to describe the development of a 10-session multicomponent positive psychology intervention, the Inspired Life Program (ILP), designed to promote mental health and reduce symptoms of depression and negative affect in rural adults in Ghana. Guided by the Medical Research Council's framework for developing complex interventions, a seven-step iterative community-based participatory research approach was adopted to develop the ILP, based on constructs and principles of positive psychology and cognitive-behavioral model. The final intervention components included a 10-session, two-hourly, once-weekly manualized program designed to promote meaningful and purposeful living, self-acceptance, personal growth, goal-setting and problem-solving skills, and positive thinking through group discussion and activity sessions. We describe the program theory and implementation strategy of the final intervention, and reflect on the challenges and lessons learned from applying this framework in the study context. The development of strengths-based interventions and practicality of methods to promote positive mental health in rural adults are feasible, and have important policy implications for mental health and social care in sub-Saharan Africa.
Collapse
Affiliation(s)
- Richard Appiah
- Africa Unit for Transdisciplinary Health Research, North-West University, Potchefstroom, South Africa
- College of Health Sciences, University of Ghana, Accra, Ghana
| | - Angelina Wilson Fadiji
- Africa Unit for Transdisciplinary Health Research, North-West University, Potchefstroom, South Africa
- Department of Educational Psychology, Faculty of Education, University of Pretoria, Pretoria, South Africa
| | - Marié P Wissing
- Africa Unit for Transdisciplinary Health Research, North-West University, Potchefstroom, South Africa
| | - Lusilda Schutte
- Africa Unit for Transdisciplinary Health Research, North-West University, Potchefstroom, South Africa
| |
Collapse
|
9
|
Asante KO, Asiama-Sampong E, Appiah R. A qualitative exploration of the role of NGOs in the recovery support for persons with substance use disorders in a low-income African setting. Subst Abuse Treat Prev Policy 2021; 16:62. [PMID: 34404431 PMCID: PMC8369729 DOI: 10.1186/s13011-021-00400-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In sub-Saharan Africa, most government mental health facilities are under-resourced to cater for the mental health needs of the population, including the provision of treatment and recovery support services for persons with substance use disorders (SUDs). However, in other settings, non-governmental organizations (NGOs) play significant roles by complementing governments' efforts in the provision of care for vulnerable groups. Presently, no study exists that examines the contributions of NGOs in the recovery support of individuals with SUDs in the Ghanaian context. This study sets out to explore the role of NGOs in the recovery of persons with SUDs in Ghana. METHOD Using a descriptive qualitative design, eight staff (directors and senior recovery practitioners) from eight NGOs in southern Ghana were purposively selected and interviewed face-to-face using semi-structured interview guide. The interviews were audio-taped, transcribed verbatim, and analyzed using the thematic analysis within an inductive approach. RESULTS The results showed that NGOs provide three main services: treatment of drug addiction (through psychotherapy and recovery capital), re-integration of recovered individuals into society, and advocacy and awareness creation in schools and communities. These efforts are thwarted by limited qualified professionals and inadequate government support. CONCLUSION Our results underscore the need for government agencies to collaborate with NGOs involved in the recovery management of persons with SUDs and other mental disorders to complement their efforts in strategizing, designing, and implementing context-appropriate substance misuse prevention and intervention programs and policies in Ghana.
Collapse
Affiliation(s)
- Kwaku Oppong Asante
- Department of Psychology, University of Ghana, P. O. Box LG 84, Legon, Accra, Ghana.
- Department of Psychology, University of the Free State, Bloemfontein, South Africa.
| | | | - Richard Appiah
- College of Health Sciences, University of Ghana, Accra, Ghana
| |
Collapse
|
10
|
Abstract
BACKGROUND Researchers conducting community-based participatory action research (CBPAR) in highly collectivistic and socioeconomically disadvantaged community settings in sub-Saharan Africa are confronted with the distinctive challenge of balancing universal ethical standards with local standards, where traditional customs or beliefs may conflict with regulatory requirements and ethical guidelines underlying the informed consent (IC) process. The unique ethnic, socioeconomic, and cultural diversities in these settings have important implications for the IC process, such as individual decisional autonomy, beneficence, confidentiality, and signing the IC document. MAIN TEXT Drawing on insights and field observations from conducting CBPARs across several rural, highly communal, low literate, and low-income communities in Ghana, we discuss some theoretical, ethico-cultural, and methodological challenges associated with applying the universal, Western individualistic cultural value-laden IC process in sub-Saharan Africa. By citing field situations, we discuss how local cultural customs and the socioeconomic adversities prevalent in these settings can influence (and disrupt) the information disclosure process, individual decisional authority for consent, and voluntariness. We review the theoretical assumptions of the Declaration of Helsinki's statement on IC and discuss its limitations as an ultimate guide for the conduct of social science research in the highly communal African context. We argue that the IC process in these settings should include strategies directed at preventing deception and coercion, in addition to ensuring respect for individual autonomy. We urge Universities, research institutions, and institutional review boards in Africa to design and promote the use of context-appropriate ethical IC guidelines that take into consideration both the local customs and traditional practices of the people as well as the scientific principles underpinning the universal IC standards. CONCLUSION We recommend that, rather than adopt a universal one-size-fits-all IC approach, researchers working in the rural, highly collectivistic, low literate, socioeconomically disadvantaged settings of sub-Saharan Africa should deeply consider the roles and influence of cultural values and traditional practices on the IC and the research process. We encourage researchers to collaborate with target communities and stakeholders in the design and implementation of context-appropriate IC to prevent ethics dumping and safeguard the integrity of the research process.
Collapse
Affiliation(s)
- Richard Appiah
- College of Health Sciences, University of Ghana, Korle-Bu, P. O. Box KB 143, Accra, Ghana.
| |
Collapse
|
11
|
Abstract
Objectives With increasing survival rates of children with sickle cell disease (SCD) reaching adulthood, there has been a growing interest in the quality of life and mental health functioning of affected individuals. Positive mental health is recognised as a significant dimension of human health that plays an important role in advancing well-being. This study explored the prevalence of positive mental health and functioning among a sample of Ghanaian adults with SCD. Methods A quantitative cross-sectional survey design was implemented for data-gathering. A random sample of 62 adult SCD patients (21 to 56 years; mean age of 29 years) receiving treatment at the Sickle Cell Clinic of the Ghana Institute of Clinical Genetics at the Korle-Bu Teaching Hospital completed the Mental Health Continuum-Short Form (MHC-SF). Descriptive statistics and reliability indices were estimated for the MHC-SF. We implemented Keyes's criteria for the assessment and categorisation of levels of mental health to determine the prevalence of positive mental health and functioning. Results We found a high level of positive mental health (66% flourishing; 26% moderately mentally healthy; 8% languishing) and functioning, with no significant difference between the genders. A total of 34% of the participants were functioning at suboptimal levels and were at risk of psychopathology. Conclusion This study gives the first overview of the prevalence of positive mental health and functioning in a clinical population in Ghana. Although the majority of participants were flourishing, contextually appropriate positive psychological interventions are needed to promote the mental health of SCD patients who are functioning at suboptimal levels, which would, inherently, also buffer against psychopathology. Funding Self-funded.
Collapse
Affiliation(s)
- Richard Appiah
- Department of Occupational Therapy, College of Health Sciences, University of Ghana, Accra
| | - Bempah O Tutu
- Department of Occupational Therapy, College of Health Sciences, University of Ghana, Accra
| | - Mavis E Oman
- Department of Psychology, School of Social Sciences, University of Ghana, Accra
| | - Peter Ndaa
- Department of Occupational Therapy, College of Health Sciences, University of Ghana, Accra
| |
Collapse
|
12
|
Appiah R, Wilson Fadiji A, Wissing MP, Schutte L. Participants' experiences and impressions of a group-based positive psychology intervention programme for rural adults in Ghana. Int J Qual Stud Health Well-being 2021; 16:1891760. [PMID: 33641624 PMCID: PMC7919891 DOI: 10.1080/17482631.2021.1891760] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction: There is growing evidence that group-based mental health intervention programmes can encourage the development of peer support, psychosocial skills, and collaborative therapeutic relationships with longer lasting effects. This study explored participants’ experiences of, perceived benefits of, and recommendations to improve a 10-session group-based multicomponent positive psychology intervention (mPPI)—the Inspired Life Programme (ILP)—designed to promote positive mental health and reduce symptoms of depression and negative affect in a sample of rural Ghanaian adults. Method: Face-to-face semi-structured individual interviews were conducted with 18 randomly selected programme participants three months after their participation in the ILP. Data were analysed thematically with an inductive approach. Results: Participants described their experience of the ILP as a forum for growth that granted them the opportunity to introspect, practicalise and situate everyday life challenges, connect with others, and to develop a sense of mutual accountability. Results indicate that the ILP led participants to develop a stronger sense of positivity and well-being, fructify their ideas, and to cultivate stronger social networks and relationships that led to increased vocational productiveness. Participants recommended that researchers include facets of physical health promotion in the programme and invite close relations of participants to participate in the programme. Conclusion: This study provides the first insight into participants’ experiences of a group-based mPPI in Ghana. These findings may provide useful information to inform the design of context-appropriate community-based mental health interventions to fit participants’ specific needs, capacities, and circumstances.
Collapse
Affiliation(s)
- Richard Appiah
- Africa Unit for Transdisciplinary Health Research, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa.,College of Health Sciences, University of Ghana, Accra, Ghana
| | - Angelina Wilson Fadiji
- Africa Unit for Transdisciplinary Health Research, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa.,Department of Educational Psychology, Faculty of Education, University of Pretoria, Pretoria, South Africa
| | - Marie P Wissing
- Africa Unit for Transdisciplinary Health Research, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Lusilda Schutte
- Africa Unit for Transdisciplinary Health Research, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| |
Collapse
|
13
|
Appiah R. Community-based participatory research in rural African contexts: Ethico-cultural considerations and lessons from Ghana. Public Health Rev 2020; 41:27. [PMID: 33292760 PMCID: PMC7694909 DOI: 10.1186/s40985-020-00145-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/15/2020] [Indexed: 12/22/2022] Open
Abstract
Researchers conducting community-based participatory research (CBPR) with vulnerable populations in rural African settings are confronted with distinctive ethical and cultural challenges due to the community context of their research, their methods of investigation, and the implications of their findings for populations. Ethical considerations such as informed consent, the protection of privacy and confidentiality, and relationships between researchers and participants take on greater complexity and have implications beyond the individual research participant. Drawing on careful reflections of experiences from conducting mental health promotion intervention research using the CBPR approach and multi-methods in resource-poor rural communities in Ghana, we examine a range of ethico-cultural issues associated with community-based group intervention research in rural remote settings of Ghana. We offer suggestions to help researchers to envision and manage these complexities in a more appropriate way. Approaches aimed to promote relationships, fairness, respect, and cultural harmony between researchers and study participants are outlined. We urge prospective researchers to carefully explore and respect the cultural values and practices of community members and observe locally-defined ethical values and principles when conducting CBPRs in rural African settings to minimise ethics dumping and safeguard the integrity of their research.
Collapse
Affiliation(s)
- Richard Appiah
- College of Health Sciences, University of Ghana, Accra, Ghana.
| |
Collapse
|
14
|
Abstract
In spite of several decades of research and treatment efforts, the rate of relapse to substance abuse remains high, averaging about 75% within a 3- to 6-month duration after treatment. Recent research has focused on exploring contextually relevant relapse prevention approaches. This study explores relapse prevention strategies utilized by individuals to support their abstinence efforts four years after treatment for poly-substance use disorders in a Psychiatric Rehabilitation Unit in Ghana. Using a qualitative exploratory approach (descriptive phenomenology), semi-structured interviews were conducted with 14 individuals previously treated for poly-substance use disorders. Interviews were digitally recorded, transcribed verbatim, and analyzed thematically with an inductive approach. Participants employed a multitude of factors and strategies, including finding a sense of purpose and meaning in life, religious and spiritual engagements, family and social support, and self-initiated schemes to maintain long-term sobriety. Clinicians should collaborate with and thoroughly explore personal, familial, and contextual factors and strategies that support the abstinence efforts of individuals recovering from poly-substance use disorder.
Collapse
|
15
|
Appiah R, Schutte L, Wilson Fadiji A, Wissing MP, Cromhout A. Factorial validity of the Twi versions of five measures of mental health and well-being in Ghana. PLoS One 2020; 15:e0236707. [PMID: 32780773 PMCID: PMC7418998 DOI: 10.1371/journal.pone.0236707] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 07/13/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Mental health is considered an integral part of human health. Reliable and valid measurement instruments are needed to assess various facets of mental health in the native language of the people involved. This paper reports on five studies examining evidence for the factorial validity of the Twi versions of five mental health and well-being measurement instruments: Affectometer-2 (AFM-2); Automatic Thought Questionnaire-Positive (ATQ-P); Generalized Self-Efficacy Scale (GSEs); Patient Health Questionnaire-9 (PHQ-9); and Satisfaction with Life Scale (SWLS) in a rural Ghanaian adult sample. METHOD Measures were translated and evaluated using a research-committee approach, pilot-tested, and administered to adults (N = 444) randomly selected from four rural poor communities in Ghana. We applied confirmatory factor analysis (CFA), bifactor CFA, exploratory structural equation modeling (ESEM), and bifactor ESEM to the AFM-2, ATQ-P, and the PHQ-9, and CFA to the GSEs and the SWLS. The omega coefficient of composite reliability was computed for each measure. RESULTS A two-factor bifactor ESEM model displayed superior model fit for the AFM-2. The total scale and the Negative Affect subscale, but not the Positive Affect subscale, attained sufficient reliability. Two models (a four-factor 22-item bifactor ESEM model and a 5-factor 22-item ESEM model) fitted the data best for the ATQ-P. The bifactor ESEM model displayed a high reliability value for the total scale and satisfactory reliability values for three of its four subscales. For the GSEs, a one-factor CFA model (residuals of items 4 and 5 correlated) demonstrated superior model fit with a high reliability score for the total scale. A two-factor ESEM model outperformed all other models fitted for the PHQ-9, with moderate and satisfactory reliability scores for the subscales. A one-factor CFA model (residuals of item 4 and 5 correlated) demonstrated superior model fit for the SWLS, with a satisfactory reliability value for the total scale. CONCLUSIONS Findings established evidence for the factorial validity of the Twi versions of all five measures, with the global scores, but not all subscale scores, demonstrating satisfactory reliability. These validated measurement instruments can be used to assess mental health and well-being in the research and practice contexts of the current sample.
Collapse
Affiliation(s)
- Richard Appiah
- Africa Unit for Transdisciplinary Health Research, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
- College of Health Sciences, University of Ghana, Accra, Ghana
| | - Lusilda Schutte
- Africa Unit for Transdisciplinary Health Research, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Angelina Wilson Fadiji
- Africa Unit for Transdisciplinary Health Research, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
- Inclusive Economic Development, Human Sciences Research Council, Cape Town, South Africa
| | - Marié P. Wissing
- Africa Unit for Transdisciplinary Health Research, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Amanda Cromhout
- Africa Unit for Transdisciplinary Health Research, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| |
Collapse
|
16
|
Appiah R, Wilson-Fadiji A, Schutte L, Wissing MP. Effects of a Community-Based Multicomponent Positive Psychology Intervention on Mental Health of Rural Adults in Ghana. Appl Psychol Health Well Being 2020; 12:828-862. [PMID: 32706933 DOI: 10.1111/aphw.12212] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 06/08/2020] [Accepted: 06/16/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND There is growing evidence that positive psychology interventions (PPIs) enhance positive mental health and lead to a decrease in symptoms of psychopathology. This study examines the effectiveness of a 10-week multicomponent PPI (the Inspired Life Program; ILP) in promoting positive mental health and reducing symptoms of depression and negative affect in a sample of rural poor adults in Ghana. METHODS Using a quasi-randomized controlled trial design, participants from four rural poor communities were randomly allocated to intervention (n = 40) or control (n = 42) conditions. The intervention group participated in the 10-week ILP. Both groups completed a battery of mental health measures, including the Mental Health Continuum-Short Form, at pre-intervention, immediately after the intervention, and at 3 months follow-up. Hierarchical linear modeling was applied to evaluate whether the intervention was effective. RESULTS There was a greater improvement in positive mental health, with a marked reduction in symptoms of depression in the intervention group compared to the control group, immediately and 3 months after the intervention. There were also larger increases in the proportion of flourishers in the intervention group compared to the control group, immediately and three months after the intervention. CONCLUSIONS The observed effects of the ILP intervention program suggest that group-based PPIs can promote positive mental health and buffer against psychopathology among people living in rural poor communities in sub-Saharan Africa.
Collapse
Affiliation(s)
- Richard Appiah
- Africa Unit for Transdisciplinary Health Research, North-West University, Potchefstroom, South Africa.,University of Ghana, Accra, Ghana
| | - Angelina Wilson-Fadiji
- Africa Unit for Transdisciplinary Health Research, North-West University, Potchefstroom, South Africa.,Human Sciences Research Council, Cape Town, South Africa
| | - Lusilda Schutte
- Africa Unit for Transdisciplinary Health Research, North-West University, Potchefstroom, South Africa
| | - Marié P Wissing
- Africa Unit for Transdisciplinary Health Research, North-West University, Potchefstroom, South Africa
| |
Collapse
|
17
|
Beson P, Appiah R, Adomah-Afari A. Modern contraceptive use among reproductive-aged women in Ghana: prevalence, predictors, and policy implications. BMC Womens Health 2018; 18:157. [PMID: 30253759 PMCID: PMC6156857 DOI: 10.1186/s12905-018-0649-2] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 09/14/2018] [Indexed: 11/18/2022]
Abstract
Background Modern contraceptive use remains an important public health intervention and a cost-effective strategy to reduce maternal mortality, avert unintended pregnancies and to control population explosion, especially in developing countries. Despite these benefits, there are reports of low usage among reproductive-aged women in most developing countries. This study examined the prevalence and predictors of use of modern contraceptive among reproductive-aged women in an urban center with a high density population in Ghana. Methods A cross-sectional, interviewer-administered survey was conducted with 217 randomly selected reproductive-aged women. Data was analyzed with STATA. Logistic regression was performed to identify factors influencing modern contraceptive use. Results Although we found high levels of knowledge and awareness (98%; n = 213) of modern contraception use, only 21% of participants were using modern contraceptives. Marital status, partner consent and support, and religious beliefs strongly predicted usage. Conclusion Usage of modern contraceptives among reproductive-aged women in the Ledzokuku Krowor Municipality is lower than the national target. A multilevel family planning intervention program that primarily focuses on promoting inclusive participation of husbands, targets the unmarried and non-literates reproductive-aged women, and dispels misconceptions, misinformation and religious myths about modern contraceptives has been discussed.
Collapse
Affiliation(s)
- Paul Beson
- MPH, BSN, Lekma Hospital, Greater Accra Region, Accra, Ghana.
| | - Richard Appiah
- Africa Unit for Transdisciplinary Health Research, North-West University, Potchefstroom, South Africa.,Department of Occupational Therapy, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Augustine Adomah-Afari
- Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Accra, Ghana
| |
Collapse
|
18
|
Appiah R, Boakye KE, Ndaa P, Aziato L. “Tougher than ever”: An exploration of relapse prevention strategies among patients recovering from poly-substance use disorders in Ghana. Drugs: Education, Prevention and Policy 2017. [DOI: 10.1080/09687637.2017.1337080] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Richard Appiah
- Africa Unit for Transdisciplinary Health Research, North-West University, Potchefstroom, South Africa,
- Department of Occupational Therapy, University of Ghana, Accra, Ghana, and
| | - Kofi E. Boakye
- Institute of Criminology, University of Cambridge, Cambridge, United Kingdom of Great Britain and Northern Ireland,
| | - Peter Ndaa
- Department of Occupational Therapy, University of Ghana, Accra, Ghana, and
| | - Lydia Aziato
- Department of Adult Health, School of Nursing, University of Ghana, Accra, Ghana
| |
Collapse
|
19
|
Abstract
Relapse to substance abuse is a global problem and is conceptualized as an integral component of the recovery process. Global statistics on rates of relapse after substance abuse treatment are disturbingly high, averaging about 75% within a 3- to 6-month duration after treatment. This study sought to gain full understanding of the factors that precipitate relapse among substance abusers in Ghana. Data were collected through in-depth interviews with 15 relapsed substance abusers who were previously treated for substance abuse, and three mental health professionals at a psychiatric rehabilitation unit in Ghana. Findings showed that seven factors, including positive/negative emotional reinforcements, sense of loss, interpersonal conflicts, peer influence, familial, religio-cultural, and treatment-based issues complot to instigate and maintain the relapse cycle. The findings provide valuable insights into the relapse phenomenon in Ghana. Clinicians should actively engage family members in the relapse prevention process, and provide insight into religio-cultural relapse precipitants.
Collapse
|
20
|
Hecker JM, Lorenz R, Appiah R, Vangerow B, Loss M, Kunz R, Schmidtko J, Mengel M, Klempnauer J, Piepenbrock S, Dickneite G, Neidhardt H, Rückoldt H, Winkler M. C1-inhibitor for prophylaxis of xenograft rejection after pig to cynomolgus monkey kidney transplantation. Transplantation 2002; 73:688-94. [PMID: 11907412 DOI: 10.1097/00007890-200203150-00006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Early rejection of discordant porcine xenografts in primate recipients is initiated by the intragraft binding of either preformed (hyperacute xenograft rejection) or induced (acute vascular rejection) antiporcine recipient antibodies with subsequent complement activation via the classical pathway. We have investigated the efficacy of the supplemental administration of C1-inhibitor (C1-INH), a specific inhibitor of the classical complement activation pathway, for prophylaxis of xenograft rejection in a pig to primate kidney xenotransplantation setting. METHODS Based on the results of pharmacokinetic studies performed in two nontransplanted monkeys, supplemental C1-INH therapy was administered daily to three Cynomolgus monkeys receiving a life-supporting porcine kidney transplant together with cyclophosphamide-induction/cyclosporine A/mycophenolat-mofetil/steroid immunosuppressive therapy. RESULTS In the three monkeys receiving porcine kidney xenografts and continuous C1-INH treatment none of the grafts underwent hyperacute rejection; all xenografts showed initial function. Recipient survival was 13, 15, and 5 days. No graft was lost due to acute vascular rejection. All animals died with a functioning graft (latest creatinine 96, 112, and 96 micromol/liter) due to bacterial septicemia. CONCLUSION We conclude that, in our model, supplemental C1-INH therapy together with a standard immunosuppressive regimen can be helpful for prevention of xenograft rejection in a pig to primate kidney xenotransplantation setting. The optimal dose and duration of C1-INH treatment, however, has yet to be determined.
Collapse
Affiliation(s)
- Jens M Hecker
- Klinik für Viszeral- und Transplantationschirurgie, Zentrum Anästhesiologie, Institut für Pathologie, Medizinische Hochschule Hannover, Hannover, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Vangerow B, Hecker JM, Lorenz R, Loss M, Przemeck M, Appiah R, Schmidtko J, Jalali A, Rueckoldt H, Winkler M. C1-Inhibitor for treatment of acute vascular xenograft rejection in cynomolgus recipients of h-DAF transgenic porcine kidneys. Xenotransplantation 2001; 8:266-72. [PMID: 11737852 DOI: 10.1034/j.1399-3089.2001.00130.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
At present, the major barrier to successful discordant xenotransplantation of unmodified or complement regulator transgenic porcine xenografts is acute vascular xenograft rejection (AVR). AVR is associated with the intragraft deposition of induced recipient xenoreactive antibodies and subsequent complement activation. In a life-supporting pig to primate kidney xenotransplantation setting using h-DAF transgenic donor organs and postoperative immunosuppression, episodes of AVR were either treated with boluses of cyclophosphamide and steroids or with the same regimen supplemented by a three-day course of C1-Inhibitor, a multifunctional complement regulator. In 8 out of 10 animals stable initial graft function was achieved; in all animals one or more episodes of AVR were observed. When, in 4 animals, C1-Inhibitor was added to the standard anti-rejection treatment regimen, AVR was successfully reversed in 6 out of 7 episodes, while in another group of 4 animals receiving the standard anti-rejection treatment 0 out of 4 episodes of AVR responded to treatment. Response to anti-rejection treatment was associated with a significant increase in recipient survival time. We conclude that AVR of h-DAF transgenic porcine kidneys can be successfully treated by additional short-term fluid phase complement inhibition.
Collapse
Affiliation(s)
- B Vangerow
- Department of Anesthesiology, Hannover Medical School, D-30625 Hannover, Germany
| | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Loss M, Lorenz R, Appiah R, Hecker JM, Klempnauer J, Winkler M. Disorders of coagulation unrelated to xenograft rejection following pig-to-cynomolgus kidney transplantation. Transplant Proc 2001; 33:3867-8. [PMID: 11750647 DOI: 10.1016/s0041-1345(01)02639-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- M Loss
- Klinik für Viszeral- und Transplantationschirurgie, Medizinische Hochschule Hannover, Hannover, Germany
| | | | | | | | | | | |
Collapse
|
23
|
Creutzig A, Hiller S, Appiah R, Thum J, Caspary L. Nailfold capillaroscopy and laser Doppler fluxmetry for evaluation of Raynaud's phenomenon: how valid is the local cooling test? VASA 1997; 26:205-9. [PMID: 9286153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Since there is a need for an objective parameter of microcirculation in follow-up of patients with Raynaud's syndrome we evaluated the reproducibility of the reaction to a cold exposure test with nailfold capillaroscopy and laser Doppler fluxmetry during a winter period. PATIENTS AND METHODS 10 healthy subjects and 16 patients with primary Raynaud's syndrome were evaluated with nailfold capillaroscopy and laser Doppler fluxmetry of the finger tips during and after a standardized cold exposure stress test. The measurements were repeated in the controls within 2 weeks, in the patient population twice within 24 weeks. RESULTS In the healthy controls the percentage of capillaries with flow stop was stable (r = 0.785) and the duration of flow stop was reproducible (r = 0.993). Both parameters were significantly lower in controls than in the patients. The flow stop durations in patients varied intra-individually to a great extent between the different weeks without any significant correlation. For all calculated laser Doppler perfusion and time parameters we did not find any significant differences between controls and patients nor any consistent correlations in the intra-individual comparison within the different weeks for both, controls and patients. CONCLUSION Nailfold capillaroscopy during cold exposure is able to discriminate between healthy persons and patients with primary Raynaud's syndrome, but seems to be of minor value for follow-up evaluation of patients because of intraindividual variations. Laser Doppler fluxmetry is invalid for both purposes when using the applied cold exposure test.
Collapse
Affiliation(s)
- A Creutzig
- Department of Angiology, Hannover Medical School
| | | | | | | | | |
Collapse
|
24
|
Abstract
OBJECTIVE Evaluation of the effects of a standardized acupuncture treatment in primary Raynaud's syndrome. DESIGN A controlled randomized prospective study. SETTING A winter period of 23 weeks, angiological clinic of Hannover Medical School. SUBJECTS Thirty-three patients with primary Raynaud's syndrome (16 control, 17 treatment). INTERVENTIONS The patients of the treatment group were given seven acupuncture treatments during the weeks 10 and 11 of the observation period. MAIN OUTCOME MEASURES All patients kept a diary throughout the entire observation period noting daily frequency, duration and severity of their vasospastic attacks. A local cooling test combined with nailfold capillaroscopy was performed for all patients at baseline (week 1) and in weeks 12 and 23, recording flowstop reactions of the nailfold capillaries. RESULTS The treated patients showed a significant decrease in the frequency of attacks from 1.4 day-1 to 0.6 day-1, P < 0.01 (control 1.6 to 1.2, P = 0.08). The overall reduction of attacks was 63% (control 27%, P = 0.03). The mean duration of the capillary flowstop reaction decreased from 71 to 24 s (week 1 vs. week 12, P = 0.001) and 38 s (week 1 vs. week 23, P = 0.02) respectively. In the control group the changes were not significant. CONCLUSIONS These findings suggest that traditional Chinese acupuncture is a reasonable alternative in treating patients with primary Raynaud's syndrome.
Collapse
Affiliation(s)
- R Appiah
- Medizinische Hochschule Hannover, Department of Angiology, Germany
| | | | | | | | | |
Collapse
|