Perceived compassionate care and associated factors among patients with mental illness at Tibebe Ghion specialized and Felege Hiwot comprehensive specialized hospital, Northwest Ethiopia

BACKGROUND

Compassion is the first ethical principle of health care to provide high- quality care that influences patient satisfaction and treatment outcome. However, there is limited data on the level of compassionate mental health care practice in low-resource countries like Ethiopia.

OBJECTIVES

This study aimed to assess the level of perceived compassionate care and associated factors among patients with mental illness at Tibebe Ghion specialized and Felege Hiwot comprehensive specialized hospital, North West, Ethiopia, 2022.

METHODS

An institutional-based cross-sectional study design was conducted from June 18 to July 16, 2022, at Tibebe Ghion Specialized and Felege Hiwot Comprehensive Specialized Hospital. A systematic random sampling technique was used. The level of perceived compassionate care was assessed by the validated 12-item Schwartz Center Compassionate Care Scale among 423 patients with mental illness. Epicollect-5 was used to collect data, which was then exported to the Statistical Product and Service solution version 25 for analysis. Variables with a P-value < 0.05, and 95% confidence interval (CI) were used to declare significant variables at the multivariate logistic regression analysis.

RESULT

The level of perceived good compassionate care was 47.5% (95% CI 42.6%-52.4%). Factors including urban residence (AOR = 1.90; 95%CI 1.08-3.36), duration of illness < 24 months (AOR = 2.68; 95% CI 1.27-5.65), strong social support (AOR = 4.43; 95%CI 2.16-9.10), shared decision making (AOR = 3.93; 95% CI 2.27-6.81), low perceived stigma(AOR = 2.97; 95% CI 1.54-5.72) and low patient anticipated stigma (AOR = 2.92; 95% CI 1.56-5.48) were positively associated with good compassionate care.

CONCLUSION AND RECOMMENDATION

Less than half of the patients had received good compassionate care. Compassionate mental health care needs public health attention. Policymakers should emphasize on compassionate care continuity by including it in the health care curriculum and design appropriate policies to strengthen compassionate care.

Level of shared decision making and associated factors among patients with mental illness in Northwest Ethiopia: Explanatory sequential mixed method study

BACKGROUND

Shared decision-making is a patient-centered and a recovery-oriented mental health system in which consumers are encouraged to actively engage in illness management. Although shared decision-making research in mental health has evolved rapidly in the past two decades, there is a lack of studies examining the level and factors associated with shared decision-making practice in low-income countries like Ethiopia.

METHODS

An institutional-based explanatory sequential mixed method study design was conducted from July 18 to September 18, 2022, at Bahir Dar city specialized hospitals. A systematic random sampling technique was used. The level of shared-decision making was measured by 9-item shared decision-making questionnaire among 423 patients with mental illness. Epicollect5 was used to collect data, which was then exported to the Statistical Package for social science version 25 for analysis. Variables with a P-value < 0.25 were considered candidates for the multivariate logistic regression analysis. The odds ratio with a 95% confidence interval was used to show the strength of the association. An in-depth interview was conducted among ten purposively selected participants.

RESULT

Low shared decision-making practice was found to be 49.2% (95% CI 45.9%-55.7%). The Multivariate analysis showed that low perceived compassionate care (AOR = 4.45; 95%CI 2.52-7.89), low social support (AOR = 1.72; 95% CI 1.06-2.80), and no community-based health insurance (AOR = 1.96; 95%CI l.04-3.69) were positively associated with low shared decision making. The qualitative result showed that the most common barriers to shared decision-making were a lack of empathy and a shortage of mental health workers.

CONCLUSION AND RECOMMENDATION

Almost half of the patients had low shared decision-making practices. This implies that shared decision-making requires high attention as it is essential for patient-centered care.

Ebola, fragile health systems and tuberculosis care: a call for pre-emptive action and operational research

The Ebola outbreak that started in late 2013 is by far the largest and most sustained in history. It occurred in a part of the world where pre-existing health systems were already fragile, and these deteriorated further during the epidemic due to a large number of health worker deaths; temporary or permanent closure of health facilities; non-payment of health workers; intrinsic fear of contracting or being stigmatised by Ebola among the population, which negatively influenced health-seeking behaviour; enforced quarantine of Ebola-affected communities, restricting the access of vulnerable individuals to health facilities; and late response by the international community. There are also reports of drug and consumable stockouts due to deficiencies in the procurement and supply chain as a result of overriding Ebola-related priorities. Providing tuberculosis (TB) care and achieving favourable treatment outcomes require a fully functioning health system, accurate patient tracking and high patient adherence to treatment. Furthermore, as Ebola is easily transmitted through body fluids, the use of needles-essential for TB diagnosis and treatment-needs to be avoided during an outbreak. We highlight ways in which a sustained Ebola outbreak could jeopardise TB activities and suggest pre-emptive preventive measures while awaiting operational research evidence.