163 lines
5.2 KiB
YAML
163 lines
5.2 KiB
YAML
abstract: 'Background: Care for schizophrenia in low and middle income countries is
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predominantly facility based and led by specialists, with limited use of
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non-pharmacological treatments. Although community based psychosocial
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interventions are emphasised, there is little evidence about their
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acceptability and feasibility. Furthermore, the shortage of skilled
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manpower is a major barrier to improving access to these interventions.
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Our study aimed to develop a lay health worker delivered community based
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intervention in three sites in India. This paper describes how the
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intervention was developed systematically, following the MRC framework
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for the development of complex interventions.
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Methods: We reviewed the lierature on the burden of schizophrenia and
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the treatment gap in low and middle income countries and the evidence
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for community based treatments, and identified intervention components.
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We then evaluated the acceptability and feasibility of this package of
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care through formative case studies with individuals with schizophrenia
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and their primary caregivers and piloted its delivery with 30 families.
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Results: Based on the reviews, our intervention comprised five
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components (psycho-education; adherence management; rehabilitation;
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referral to community agencies; and health promotion) to be delivered by
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trained lay health workers supervised by specialists. The intervention
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underwent a number of changes as a result of formative and pilot work.
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While all the components were acceptable and most were feasible,
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experiences of stigma and discrimination were inadequately addressed;
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some participants feared that delivery of care at home would lead to
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illness disclosure; some participants and providers did not understand
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how the intervention related to usual care; some families were unwilling
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to participate; and there were delivery problems, for example, in
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meeting the targeted number of sessions. Participants found delivery by
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health workers acceptable, and expected them to have knowledge about the
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subject matter. Some had expectations regarding their demographic and
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personal characteristics, for example, preferring only females or those
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who are understanding/friendly. New components to address stigma were
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then added to the intervention, the collaborative nature of service
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provision was strengthened, a multi-level supervision system was
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developed, and delivery of components was made more flexible. Criteria
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were evolved for the selection and training of the health workers based
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on participants'' expectations.
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Conclusions: A multi-component community based intervention, targeting
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multiple outcomes, and delivered by trained lay health workers,
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supervised by mental health specialists, is an acceptable and feasible
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intervention for treating schizophrenia in India.'
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affiliation: 'Patel, V (Corresponding Author), Sangath Ctr, 841-1 Alto Porvorim, Bardez
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403521, Goa, India.
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Balaji, Madhumitha; Chatterjee, Sudipto; Kumar, Pratheesh; Patel, Vikram, Sangath
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Ctr, Bardez 403521, Goa, India.
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Koschorke, Mirja; Patel, Vikram, London Sch Hyg \& Trop Med, London WC1E 7HT, England.
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Rangaswamy, Thara; Dakshin, Lilly; John, Sujit, Schizophrenia Res Fdn Ctr, Madras
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600101, Tamil Nadu, India.
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Chavan, Animish, Nirmitee, Sadar Bazar 415001, Satara, India.
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Dabholkar, Hamid, Parivartan, Sadar Bazar 415001, Satara, India.
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Thornicroft, Graham, Kings Coll London, Hlth Serv \& Populat Res Dept, Inst Psychiat,
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London SE5 8AF, England.'
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article-number: '42'
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author: Balaji, Madhumitha and Chatterjee, Sudipto and Koschorke, Mirja and Rangaswamy,
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Thara and Chavan, Animish and Dabholkar, Hamid and Dakshin, Lilly and Kumar, Pratheesh
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and John, Sujit and Thornicroft, Graham and Patel, Vikram
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author-email: vikram.patel@lshtm.ac.uk
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author_list:
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- family: Balaji
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given: Madhumitha
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- family: Chatterjee
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given: Sudipto
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- family: Koschorke
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given: Mirja
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- family: Rangaswamy
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given: Thara
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- family: Chavan
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given: Animish
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- family: Dabholkar
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given: Hamid
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- family: Dakshin
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given: Lilly
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- family: Kumar
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given: Pratheesh
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- family: John
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given: Sujit
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- family: Thornicroft
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given: Graham
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- family: Patel
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given: Vikram
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da: '2023-09-28'
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doi: 10.1186/1472-6963-12-42
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eissn: 1472-6963
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files: []
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journal: BMC HEALTH SERVICES RESEARCH
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keywords: 'Low and middle income countries; India; Community care; Mental health;
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Schizophrenia'
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keywords-plus: 'SEVERE MENTAL-ILLNESS; PSYCHOEDUCATIONAL INTERVENTION; FAMILIES; CARE;
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CHINA'
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language: English
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month: FEB 16
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number-of-cited-references: '26'
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orcid-numbers: 'Thornicroft, Graham/0000-0003-0662-0879
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Balaji, Madhumitha/0000-0002-7399-8057
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Patel, Vikram/0000-0003-1066-8584
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John, Sujit/0000-0001-7157-3533'
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papis_id: b07e927ea950a5e4287e95975283e00a
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ref: Balaji2012developmentlay
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researcherid-numbers: 'Thornicroft, Graham/B-4027-2010
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'
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times-cited: '89'
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title: The development of a lay health worker delivered collaborative community based
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intervention for people with schizophrenia in India
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type: article
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unique-id: WOS:000301930500001
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usage-count-last-180-days: '0'
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usage-count-since-2013: '26'
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volume: '12'
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web-of-science-categories: Health Care Sciences \& Services
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year: '2012'
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