abstract: 'Background: Care for schizophrenia in low and middle income countries is

  predominantly facility based and led by specialists, with limited use of

  non-pharmacological treatments. Although community based psychosocial

  interventions are emphasised, there is little evidence about their

  acceptability and feasibility. Furthermore, the shortage of skilled

  manpower is a major barrier to improving access to these interventions.

  Our study aimed to develop a lay health worker delivered community based

  intervention in three sites in India. This paper describes how the

  intervention was developed systematically, following the MRC framework

  for the development of complex interventions.

  Methods: We reviewed the lierature on the burden of schizophrenia and

  the treatment gap in low and middle income countries and the evidence

  for community based treatments, and identified intervention components.

  We then evaluated the acceptability and feasibility of this package of

  care through formative case studies with individuals with schizophrenia

  and their primary caregivers and piloted its delivery with 30 families.

  Results: Based on the reviews, our intervention comprised five

  components (psycho-education; adherence management; rehabilitation;

  referral to community agencies; and health promotion) to be delivered by

  trained lay health workers supervised by specialists. The intervention

  underwent a number of changes as a result of formative and pilot work.

  While all the components were acceptable and most were feasible,

  experiences of stigma and discrimination were inadequately addressed;

  some participants feared that delivery of care at home would lead to

  illness disclosure; some participants and providers did not understand

  how the intervention related to usual care; some families were unwilling

  to participate; and there were delivery problems, for example, in

  meeting the targeted number of sessions. Participants found delivery by

  health workers acceptable, and expected them to have knowledge about the

  subject matter. Some had expectations regarding their demographic and

  personal characteristics, for example, preferring only females or those

  who are understanding/friendly. New components to address stigma were

  then added to the intervention, the collaborative nature of service

  provision was strengthened, a multi-level supervision system was

  developed, and delivery of components was made more flexible. Criteria

  were evolved for the selection and training of the health workers based

  on participants'' expectations.

  Conclusions: A multi-component community based intervention, targeting

  multiple outcomes, and delivered by trained lay health workers,

  supervised by mental health specialists, is an acceptable and feasible

  intervention for treating schizophrenia in India.'
affiliation: 'Patel, V (Corresponding Author), Sangath Ctr, 841-1 Alto Porvorim, Bardez
  403521, Goa, India.

  Balaji, Madhumitha; Chatterjee, Sudipto; Kumar, Pratheesh; Patel, Vikram, Sangath
  Ctr, Bardez 403521, Goa, India.

  Koschorke, Mirja; Patel, Vikram, London Sch Hyg \& Trop Med, London WC1E 7HT, England.

  Rangaswamy, Thara; Dakshin, Lilly; John, Sujit, Schizophrenia Res Fdn Ctr, Madras
  600101, Tamil Nadu, India.

  Chavan, Animish, Nirmitee, Sadar Bazar 415001, Satara, India.

  Dabholkar, Hamid, Parivartan, Sadar Bazar 415001, Satara, India.

  Thornicroft, Graham, Kings Coll London, Hlth Serv \& Populat Res Dept, Inst Psychiat,
  London SE5 8AF, England.'
article-number: '42'
author: Balaji, Madhumitha and Chatterjee, Sudipto and Koschorke, Mirja and Rangaswamy,
  Thara and Chavan, Animish and Dabholkar, Hamid and Dakshin, Lilly and Kumar, Pratheesh
  and John, Sujit and Thornicroft, Graham and Patel, Vikram
author-email: vikram.patel@lshtm.ac.uk
author_list:
- family: Balaji
  given: Madhumitha
- family: Chatterjee
  given: Sudipto
- family: Koschorke
  given: Mirja
- family: Rangaswamy
  given: Thara
- family: Chavan
  given: Animish
- family: Dabholkar
  given: Hamid
- family: Dakshin
  given: Lilly
- family: Kumar
  given: Pratheesh
- family: John
  given: Sujit
- family: Thornicroft
  given: Graham
- family: Patel
  given: Vikram
da: '2023-09-28'
doi: 10.1186/1472-6963-12-42
eissn: 1472-6963
files: []
journal: BMC HEALTH SERVICES RESEARCH
keywords: 'Low and middle income countries; India; Community care; Mental health;

  Schizophrenia'
keywords-plus: 'SEVERE MENTAL-ILLNESS; PSYCHOEDUCATIONAL INTERVENTION; FAMILIES; CARE;

  CHINA'
language: English
month: FEB 16
number-of-cited-references: '26'
orcid-numbers: 'Thornicroft, Graham/0000-0003-0662-0879

  Balaji, Madhumitha/0000-0002-7399-8057

  Patel, Vikram/0000-0003-1066-8584

  John, Sujit/0000-0001-7157-3533'
papis_id: b07e927ea950a5e4287e95975283e00a
ref: Balaji2012developmentlay
researcherid-numbers: 'Thornicroft, Graham/B-4027-2010

  '
times-cited: '89'
title: The development of a lay health worker delivered collaborative community based
  intervention for people with schizophrenia in India
type: article
unique-id: WOS:000301930500001
usage-count-last-180-days: '0'
usage-count-since-2013: '26'
volume: '12'
web-of-science-categories: Health Care Sciences \& Services
year: '2012'