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

Asher L, Fekadu A, Hanlon C, Mideksa G, Eaton J, Patel V, De Silva MJ - PLoS ONE (2015)

Bottom Line: To ensure feasibility, non-health professionals will be trained to deliver CBR and provide supervision, rather than mental health specialists.Microfinance was excluded due to concerns about stress and exploitation.Community mobilisation was viewed as essential to ensure the effectiveness and sustainability of CBR.

View Article: PubMed Central - PubMed

Affiliation: Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.

ABSTRACT

Background: Community-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.

Methods: In 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.

Results: People 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.

Conclusion: Extensive 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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Related in: MedlinePlus

RISE Theory of Change map.
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pone.0143572.g001: RISE Theory of Change map.

Mentions: A three-day intervention-planning workshop involved Ethiopian psychiatrists, the CBM West Africa mental health advisor, CBM Ethiopia director, RAPID manager, and the senior health administrator for Sodo. The synthesised findings of Phases 1 to 4 were presented to participants, who decided the detailed content and structure of the intervention. The final Theory of Change map is presented in Fig 1.


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

Asher L, Fekadu A, Hanlon C, Mideksa G, Eaton J, Patel V, De Silva MJ - PLoS ONE (2015)

RISE Theory of Change map.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4664267&req=5

pone.0143572.g001: RISE Theory of Change map.
Mentions: A three-day intervention-planning workshop involved Ethiopian psychiatrists, the CBM West Africa mental health advisor, CBM Ethiopia director, RAPID manager, and the senior health administrator for Sodo. The synthesised findings of Phases 1 to 4 were presented to participants, who decided the detailed content and structure of the intervention. The final Theory of Change map is presented in Fig 1.

Bottom Line: To ensure feasibility, non-health professionals will be trained to deliver CBR and provide supervision, rather than mental health specialists.Microfinance was excluded due to concerns about stress and exploitation.Community mobilisation was viewed as essential to ensure the effectiveness and sustainability of CBR.

View Article: PubMed Central - PubMed

Affiliation: Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.

ABSTRACT

Background: Community-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.

Methods: In 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.

Results: People 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.

Conclusion: Extensive 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.

Show MeSH
Related in: MedlinePlus