Patients will continue to seek treatment from traditional and/or faith healers for mental illness if they perceive it to be effective regardless of alternative biomedical evidence. This provides opportunities for collaboration to address resource scarcity in low to middle income countries.
We examined the scope of collaborative care for persons with mental illness as implemented by traditional healers, faith healers, and biomedical care providers. We conducted semistructured focus group discussions in Ghana, Kenya, and Nigeria with traditional healers, faith healers, biomedical care providers, patients, and their caregivers. Transcribed data were thematically analyzed. A barrier to collaboration was distrust, influenced by factionalism, charlatanism, perceptions of superiority, limited roles, and responsibilities. Pathways to better collaboration were education, formal policy recognition and regulation, and acceptance of mutual responsibility. This study provides a novel cross-national insight into the perspectives of collaboration from four stakeholder groups. Collaboration was viewed as a means to reach their own goals, rooted in a deep sense of distrust and superiority. In the absence of openness, understanding, and respect for each other, efficient collaboration remains remote. The strongest foundation for mutual collaboration is a shared sense of responsibility for patient well-being.
BackgroundMood and anxiety disorders have a high lifetime prevalence, and their chronicity adds to the management burden of already scarce and strained mental health care resources, particularly in developing countries. Non-professional-assisted interventions and technology (such as weekly telephonic mood monitoring) could assist in the early identification of symptoms of relapse and hospitalization prevention. The present study aimed to determine participants’ perspectives and the feasibility of weekly telephonic mood monitoring in order to inform the development of the full study.MethodSemi-structured telephonic interviews (n = 37; 89.2% female; mean age = 33.1 years) were conducted as part of the full-scale feasibility study (N = 61; named the Bipolar Disorder Mood Monitoring (BDMM) Study). The BDMM Study was conducted to determine the viability of weekly telephonic mood monitoring, spanning 26 weeks and starting 1 week post-discharge. Frequency and descriptive statistical analyses (using SPSS version 24) were undertaken, and qualitative data were analyzed using thematic content analysis.ResultsThis article presents the findings from the semi-structured interview section of the BDMM Study. Participants generally expressed positive experiences and perceptions of weekly telephonic mood monitoring, stating that they would advise others to also take part in weekly telephonic mood monitoring. Nonetheless, some participants did make suggestions for improvement of mood monitoring while others expressed negative experiences of weekly telephonic mood monitoring.ConclusionThe results of the semi-structured interviews of the BDMM Study indicated that participants perceived weekly telephonic mood monitoring to be helpful in lightening the burden of mood and anxiety disorders (e.g., having someone to talk to, providing insight into their disorders). Not only did it help them, but they also perceived mood monitoring to be potentially helpful to future participants. However, weekly mood monitoring was also burdensome in itself (including being too time consuming and having to answer questions when feeling down). Importantly, the findings highlighted that participants’ and researchers’ perceptions and experiences may not be congruent (especially in terms of therapeutic misconception). The current findings may inform researchers’ future approach to study design and participant relationships.Electronic supplementary materialThe online version of this article (10.1186/s40814-018-0245-0) contains supplementary material, which is available to authorized users.
ObjectivesOur primary objective was to assess the feasibility of interepisodal telephonic mood monitoring in patients with affective disorders in a low-resource setting. Secondary objectives included gathering data on longitudinal mood trajectories and assessing patient acceptance of mood monitoring.MethodsInpatients with a primary mood or anxiety disorder were recruited predischarge. Assessment at intake included demographic information, the Life Events Checklist, and the Childhood Trauma Questionnaire. Participants telephonically completed the Altman Self-Rating Mania Scale (ASRM) and Quick Inventory of Depressive Symptomatology (QIDS), weekly, for 26 weeks. Units of alcohol consumed and life events were recorded. Semi-structured interviews were conducted midway through the mood monitoring protocol.ResultsOf the 61 eligible participants (77% female; mean age =35.3 years), 28 completed 26 weeks of telephonic mood monitoring. Thirty-three participants (54.1%) withdrew prematurely or were lost to follow-up. Males were more likely to terminate study participation prematurely. Despite the significant decline in depression scores over 26 weeks, participants endorsed persistent mild-to-moderate depressive symptoms. Statistically, participants who were married/in a relationship had higher mean depression scores throughout the study compared to participants who were single. Throughout the study, ASRM scores were not indicative of significant mania. Suicidality (as measured by QIDS item 12) was highest at Week 3 and Week 12 postdischarge for those who completed 26 weeks of monitoring.ConclusionDespite the high attrition rate, interepisodal telephonic mood monitoring was deemed to be feasible and it can provide useful information to track progress, encourage medication adherence, and manage early warning signs of relapse. Further research is required to determine the benefit of weekly mood monitoring on mood fluctuations and to examine strategies that enhance retention.
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