Developing a Theory of Change model of service user and caregiver involvement in mental health system strengthening in primary health care in rural Ethiopia

Abayneh, Sisay; Lempp, Heidi; Alem, Atalay; Kohrt, Brandon A.; Fekadu, Abebaw; Hanlon, Charlotte

doi:10.1186/s13033-020-00383-6

Cited by 51 publications

(49 citation statements)

References 87 publications

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“…A similar qualitative study on service user involvement in mental health system strengthening found unreliable medication supplies as a source of dissatisfaction among service users and service providers. Additionally, problems with regards to communication between service users and providers and a lack of evidence-based information about the medication options were also mentioned as barriers for involvement [54].…”

Section: Structural Stigmamentioning

confidence: 99%

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Mental Health Stigma and Discrimination in Ethiopia: Evidence Synthesis to Inform Stigma Reduction Interventions

Girma

Ketema

Mulatu

et al. 2021

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Background People with mental illnesses are at an increased risk of experiencing human rights violations, stigma and discrimination. Even though mental health stigma and discrimination are universal, there appears to be a higher burden in low- and middle-income countries. Anti-stigma interventions need to be grounded in local evidence. The aim of this paper was to synthesize evidence on mental health stigma and discrimination in Ethiopia to inform the development of anti-stigma interventions. Methods This evidence synthesis was conducted as a part of formative work for the International Study of Discrimination and Stigma Outcomes (INDIGO) Partnership research program. Electronic searches were conducted using PubMed for scientific articles, and Google Search and Google Scholar were used for grey literature. Records fulfilling eligibility criteria were selected for the evidence synthesis. The findings were synthesized using a framework designed to capture features of mental health stigma to inform cultural adaptation of anti-stigma interventions. Results A total of 37 records (2 grey literature and 35 scientific articles) were included in the evidence synthesis. Some of these records were described more than once depending on themes of the synthesis. The records were synthesized under the themes of explanatory models of stigma (3 records on labels and 4 records on symptoms and causes), perceived and experienced forms of stigma (7 records on public stigma, 6 records on structural stigma, 2 records on courtesy stigma and 4 records on self-stigma), impact of stigma on help-seeking (6 records) and interventions to reduce stigma (12 records). Only two intervention studies assessed stigma reduction— one study showed reduced discrimination due to improved access to effective mental health care, whereas the other study did not find evidence on reduction of discrimination following a community-based rehabilitation intervention in combination with facility-based care. Conclusion There is widespread stigma and discrimination in Ethiopia which has contributed to under-utilization of available mental health services in the country. This should be addressed with contextually designed and effective stigma reduction interventions that engage stakeholders (service users, service providers, community representatives and service developers and policy makers) so that the United Nations universal health coverage goal for mental health can be achieved in Ethiopia.

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Section: Structural Stigmamentioning

confidence: 99%

“…Thus, using the community health workers especially health extension workers in rural Ethiopia could be important to enhance the community awareness due to their proximity to the community. Engaging the service users and caregivers in the awareness raising training could be effective in reducing public stigma [54].…”

Section: Interventions To Reduce Stigmamentioning

confidence: 99%

Mental Health Stigma and Discrimination in Ethiopia: Evidence Synthesis to Inform Stigma Reduction Interventions

Girma

Ketema

Mulatu

et al. 2021

Preprint

Self Cite

View full text Add to dashboard Cite

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“…However, even as new primary care opportunities look promising, it is clear that Ethiopia faces many challenges (Workneh et al, 2020 ) related to the collaboration and integration of resources across the micro-, meso-, and macro- levels (Abayneh et al, 2020 ). The most obvious examples are that there is limited government support and push in, limited policies supported by funding, lack of education and training opportunities—and the ever present stigma related to mental health problems—all resulting in individuals experiencing disability, illnesses, premature mortality rates, and human rights abuses, among other challenges (Abayneh et al, 2020 ). The following suggestions are recommended to systematically strengthen the mental health care system and delivery of services in Ethiopia.…”

Section: Call For Collaborative Effortsmentioning

confidence: 99%

“…Health professionals, organizational leaders, and community leaders have a responsibility to work collaboratively to mobilize, support, and empower mental health treatment. Therefore, they must be willing to undergo capacity building, training, engage in research, and develop a commitment to create enabling environments (Abayneh et al, 2020 ). With collaborative actions across government officials, community leaders, research, university professionals, health care professionals, medical professionals, and even individuals in the community, the mental health service system can be widely accepted and adapted to fit the needs of the individuals within the culture.…”

Section: Call For Collaborative Effortsmentioning

confidence: 99%

Developing a Framework to Increase Access to Mental Health Services for Children With Special Needs in Ethiopia

et al. 2020

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The availability and accessibility of Westernized mental health diagnostic processes and evidence-based treatments are limited in developing countries, such as Ethiopia (Kakuma et al., 2011; Hohenshil et al., 2013; Wondie, 2014; Zeleke et al., 2017b). Similar to other developing nations, there is (a) a lack of health care services for mental practices to build on, (b) limited services that are well-suited to the culture (Wondie, 2014; Zeleke et al., 2019), (c) limited scientific literature useful for documenting the needs of the Ethiopian public, and (d) too few mental health professional preparation programs (Zeleke et al., 2019). Whereas Western cultures generally follow the biomedical model conceptualization and treatment of disease, non-Western cultures, such as Ethiopia tend to adhere to traditional and religious views to explain the origin of mental illness (Kortmann, 1987; Jacobsson and Merdassa, 1991). Mental health symptoms may be attributed to supernatural causes or other spiritual crises, rather than a combination of biopsychosocial influences. As such, individuals seeking help with mental health symptoms in Ethiopia are mostly limited to family, friends and local community healers (Zeleke et al., 2017a, 2019). When individuals are brought to the few places providing Westernized mental health care, it is often only after exhausting other traditional and religious alternatives (Bekele et al., 2000). Even when there is a desire to seek Westernized services, socioeconomic circumstance, cultural factors (e.g., a focus on collectivism practices), negative attitudes toward mental illness, along with unfamiliarity and fear of these new practices, are noted barriers to receiving treatments. Beliefs passed down through cultural taboos go on to effect multiple generations. Not only do barriers affect individuals, but they also negatively impact the range of services for children, families and communities. With the ultimate goal of improving mental health care access for children, a full appreciation of the context is essential.

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“…Empowerment approaches are being used to equip service users with the skills, confidence and support they need to express their experiences and preferences to health workers and healthcare planners, with a view to effecting improvements in care (Kohrt et al ., 2020). Participatory action research is being used in rural Ethiopia to inform people with mental health conditions about their right to quality care and to mobilise people for action (Abayneh et al ., 2020). In the ASSET project (health system strengthening in sub-Saharan Africa: ), mental health service users will join CQI activities with health workers in learning health systems with the goal of improving care processes (including user experience) and the impact of care.…”

mentioning

confidence: 99%

Developing a Theory of Change model of service user and caregiver involvement in mental health system strengthening in primary health care in rural Ethiopia

Cited by 51 publications

References 87 publications

Mental Health Stigma and Discrimination in Ethiopia: Evidence Synthesis to Inform Stigma Reduction Interventions

Mental Health Stigma and Discrimination in Ethiopia: Evidence Synthesis to Inform Stigma Reduction Interventions

Developing a Framework to Increase Access to Mental Health Services for Children With Special Needs in Ethiopia

Quality not just quantity: how health system strengthening is essential for scale up of quality mental health care

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