Z Factor: Drama as a tool to tackle mental health stigma: study design and protocol for community and public engagement in rural Zimbabwe

Abstract

Background: Mental health is slowly gaining global significance as a key health issue, yet the stigma attached to psychosis is still a major problem. There has been little in-depth exploration of sustainable, cost-effective, and replicable community engagement strategies that address mental health myths and stigma, which are major barriers to early health-seeking behaviours. In low-income countries such as Zimbabwe, cultural and spiritual beliefs are at the centre of most mental health explanatory models, perpetuating an environment where mental health conversations are a cultural taboo. Mental health interventions should be accompanied by creative, evidence-based community engagement, ensuring that interventions are suitable for local settings and giving communities a voice in directing their health initiatives. Methods: Z Factor aimed to engage young adults and their support networks across a variety of socioeconomic groups in a rural district of Zimbabwe through their participation in an inter-ward five-staged drama competition. The focus was on psychosis, with subcategories of initial presentation/detection, seeking help/pathway to care, and the road to recovery/treatment. Each drama group’s composition included a young adult and a typical support network seeking treatment from the service provider of choice. Dramas were to act as discussion starters, paving the way toward broader and deeper psychosis treatment discussions among rural communities and gaining insight into service user expectations from health research. Conclusions: Outcomes of the pilot community engagement project will be instrumental in improving understanding community perceptions about psychosis treatment and recovery in rural Zimbabwe and increasing community awareness about psychosis, as well as paving the way for initiating service provider collaboration to promote early detection and encouraging early health-seeking behaviours. The above outcomes will also inform the design of models for more responsive community and public engagement initiatives in similar low resource settings in Zimbabwe and beyond.

Evaluation of a pilot, community-led mental illness de-stigmatization theater intervention in rural Uganda

“…Because such community-led interventions are culturally adapted, lowcost, and tailored to address specific stigmas within a community, they have been reported to have a high likelihood of success [8,13]. One similar study investigated the feasibility of community-directed theater competitions to address stigma against psychosis in Zimbabwe [14]. However, despite promising results, the intervention's impact on audience members' mental health stigma was not directly measured; [14] to our knowledge, this is the first study attempting to quantify impact that theatrical performances may have on mental illness stigma in a rural community in a low-income country.…”

Evaluation of a Pilot, Community-Led Mental Illness De-stigmatization Theater Intervention in Rural Uganda

“…8,9 One similar study investigated the feasibility of community-directed theater competitions to address stigma against psychosis in Zimbabwe. 10 However, despite promising results, the intervention's impact on audience members' knowledge, attitudes, and practices (KAP) was not directly measured; 10 to our knowledge, this is the rst study attempting to quantify impact that theatrical performances may have on mental illness stigma in a rural community in a LIC. 11 To assess the potential of culturally-speci c theater programs to change community attitudes and reduce mental health stigma in LICs, we developed and pilot-tested a community-led performance in the Busoga region of eastern Uganda which depicted an individual's struggle with mental illness and journey to receive appropriate care.…”