Systematic review of feasibility and acceptability of psychosocial interventions for schizophrenia in low and middle income countries

Brooke-Sumner, Carrie; Petersen, Inge; Asher, Laura; Mall, Sumaya; Egbe, Catherine O.; Lund, Crick

doi:10.1186/s12888-015-0400-6

Cited by 65 publications

(99 citation statements)

References 45 publications

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“…Still, while the effectiveness of interventions for schizophrenia in LMICs is evident, implementation research is needed on how interventions can be integrated into existing services, including attention to human resource constraints and insurance coverage [49•]. For example, Asher et al (e.g., [50]) piloted an intervention for community-based rehabilitation in Ethiopia, and a collaborative study in Brazil and Chile is now examining the implementation of the Critical Time Intervention delivered by lay health workers [51].…”

Section: Integrating Treatment Of Common Mental Disorders In Primary mentioning

confidence: 99%

Challenges and Opportunities in Global Mental Health: a Research-to-Practice Perspective

Wainberg

Scorza

Shultz

et al. 2017

Curr Psychiatry Rep

474

290

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Purpose of Review Globally, the majority of those who need mental health care worldwide lack access to high-quality mental health services. Stigma, human resource shortages, fragmented service delivery models, and lack of research capacity for implementation and policy change contribute to the current mental health treatment gap. In this review, we describe how health systems in low- and middle-income countries (LMICs) are addressing the mental health gap and further identify challenges and priority areas for future research. Recent Findings Common mental disorders are responsible for the largest proportion of the global burden of disease; yet, there is sound evidence that these disorders, as well as severe mental disorders, can be successfully treated using evidence-based interventions delivered by trained lay health workers in low-resource community or primary care settings. Stigma is a barrier to service uptake. Prevention, though necessary to address the mental health gap, has not solidified as a research or programmatic focus. Research-to-practice implementation studies are required to inform policies and scale-up services. Summary Four priority areas are identified for focused attention to diminish the mental health treatment gap and to improve access to high-quality mental health services globally: diminishing pervasive stigma, building mental health system treatment and research capacity, implementing prevention programs to decrease the incidence of mental disorders, and establishing sustainable scale up of public health systems to improve access to mental health treatment using evidence-based interventions.

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Section: Integrating Treatment Of Common Mental Disorders In Primary mentioning

confidence: 99%

Challenges and Opportunities in Global Mental Health: a Research-to-Practice Perspective

Wainberg

Scorza

Shultz

et al. 2017

Curr Psychiatry Rep

474

290

View full text Add to dashboard Cite

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“…Translating evidence-based interventions from high-income countries (HICs) to LMICs requires an indepth understanding of contextual barriers and facilitators to implementation [17], factors which should be considered before implementation of any novel intervention to ensure the greatest chance of a successful outcome [18,19]. Therefore, this study aims to identify the perceived implementation facilitators and barriers of an evidence-based, digital, psychosocial intervention for patients with psychosis in ve LMICs in SEE.…”

Section: Introductionmentioning

confidence: 99%

Implementing a Digital Mental Health Intervention for Individuals With Psychosis - A Multi-country Qualitative Study

Pemovska

Arënliu

Konjufca

et al. 2020

Preprint

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Background: Implementation of psychosocial interventions in mental health services has the potential to improve the treatment of psychosis spectrum disorders (PSD) in low- and middle-income countries (LMICs) where care is predominantly focused on pharmacotherapy. The first step is to understand the views of key stakeholders. We conducted a multi-language qualitative study to explore the contextual barriers and facilitators to implementation of a cost-effective, digital psychosocial intervention, called DIALOG+, for treating PSD. DIALOG+ builds on existing clinician-patient relationships without requiring development of new services, making it well-fitting for healthcare systems with scarce resources.Methods: The focus group study included 174 participants (patients, clinicians, policymakers and carers), who were familiarized with DIALOG+ through a presentation. The Southeast European LMICs included in this research were: Bosnia and Herzegovina, Kosovo[1], North Macedonia, Montenegro and Serbia. Framework analysis was used to analyse the participants’ accounts.Results: Six major themes were identified. Three themes (Intervention characteristics; Carers’ involvement; Patient and organisational benefits) were interpreted as perceived implementation facilitators. The theme Attitudes and perceived preparedness of potential adopters comprised of subthemes that were interpreted as both perceived implementation facilitators and barriers. Two other themes (Frequency of intervention delivery; Suggested changes to the intervention) were more broadly related to the intervention’s implementation. Participants were exceedingly supportive of the implementation of a digital psychosocial intervention such as DIALOG+. The attractive intervention’s characteristics, efficient use of scarce resources for its implementation and potential to improve mental health services were seen as the main implementation facilitators. The major implementation barrier identified was psychiatrists’ time constrains.Conclusions: This study yielded important insights regarding implementation of digital psychosocial interventions for people with PSD in low-resource settings by including perspectives from four stakeholder groups in five LMICs in Southeast Europe – a population and region rarely explored in the literature. The perceived limited availability of psychiatrists could be potentially resolved by increased inclusion of other mental health professionals in service delivery for PSD. These findings will be used to inform the implementation strategy of DIALOG+ across the participating countries. The study also offers insights into multi-country qualitative research. [1] By United Nations resolution 1244

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“…There is also increasing agreement that the management of schizophrenia should be guided by the principle of recovery, in which the focus is on empowerment, self-direction, personal responsibility and hope [ 13 , 14 ]. The WHO’s mental health Gap Action Programme (mhGAP) recommends that schizophrenia management should include psychosocial interventions, including community-based rehabilitation (CBR), where available, although evidence from LMIC settings is limited [ 15 , 16 ]. CBR is a strategy that aims to reduce disability and improve the quality of life and social inclusion of people with disabilities.…”

Section: Introductionmentioning

confidence: 99%

Development of a Community-Based Rehabilitation Intervention for People with Schizophrenia in Ethiopia

et al. 2015

Self Cite

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BackgroundCommunity-based rehabilitation (CBR) is a multi-sectoral strategy to improve the functioning and quality of life of people with disabilities. The RISE (Rehabilitation Intervention for people with Schizophrenia in Ethiopia) trial will evaluate the effectiveness of CBR for people with schizophrenia in Ethiopia. Nevertheless, the components of CBR that are both feasible and likely to prove effective in low and middle-income countries such as Ethiopia are unclear.MethodsIn this study intervention development work was undertaken to design a CBR intervention that is acceptable and feasible in the local context. The development work consisted of five phases. 1: Identify potential components of CBR for schizophrenia, 2: Situational analysis, 3: Determine feasibility of CBR (Theory of Change workshops with experts and local stakeholders), 4: Determine acceptability of CBR (16 in-depth interviews and five focus group discussions with people with schizophrenia, caregivers, health workers and community leaders) and 5: Synthesise results to finalise intervention. A Theory of Change map was constructed showing the causal pathway for how we expect CBR to achieve its impact.ResultsPeople with schizophrenia in rural Ethiopia experience family conflict, difficulty participating in work and community life, and stigma. Stakeholders perceived CBR to be acceptable and useful to address these problems. The focus of CBR will be on the individual developing the skills and confidence to perform their previous or desired roles and activities. To ensure feasibility, non-health professionals will be trained to deliver CBR and provide supervision, rather than mental health specialists. Novel components of CBR for schizophrenia included family intervention and dealing with distressing symptoms. Microfinance was excluded due to concerns about stress and exploitation. Community mobilisation was viewed as essential to ensure the effectiveness and sustainability of CBR.ConclusionExtensive formative research using a variety of methods has enabled the design of a culturally appropriate CBR intervention for people with schizophrenia that is acceptable and feasible.

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Systematic review of feasibility and acceptability of psychosocial interventions for schizophrenia in low and middle income countries

Cited by 65 publications

References 45 publications

Challenges and Opportunities in Global Mental Health: a Research-to-Practice Perspective

Challenges and Opportunities in Global Mental Health: a Research-to-Practice Perspective

Implementing a Digital Mental Health Intervention for Individuals With Psychosis - A Multi-country Qualitative Study

Development of a Community-Based Rehabilitation Intervention for People with Schizophrenia in Ethiopia

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