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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

Overview of RISE intervention structure
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pone.0143572.g002: Overview of RISE intervention structure

Mentions: The focus of the RISE CBR intervention will be on the individual developing the skills and confidence to perform their previous or desired roles and activities. These may relate to family life, work and community life. The intervention will be recovery oriented, emphasising hope and the individual’s strengths. Fig 2 summarises the final intervention structure. Basic counselling and problem solving skills will be employed by CBR workers to deliver the intervention. The intervention is delivered in three phases. In Phase 1, lasting one to two months, there are weekly home visits and the focus is on engagement with the family and addressing core needs through compulsory modules such as “Understanding Schizophrenia”. Following a needs and risk assessment, structured goal setting will be used to support individuals to select appropriate goals from a pre-defined list. In addition to four core modules, the goal selection will determine which additional CBR components the individual will receive. In Phase 2, lasting approximately five to six months, home visits are every two weeks and address the specific needs of the individual through optional modules such as “Getting Back to Work”. In Phase 3, lasting approximately four months, the emphasis is on preventing relapse as well as maintaining the progress made towards addressing specific needs. The three intervention phases reflect the changing needs of participants over 12 months. The transition between phases is conditional on achievement of goals rather than specific time points.


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)

Overview of RISE intervention structure
© Copyright Policy
Related In: Results  -  Collection

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

pone.0143572.g002: Overview of RISE intervention structure
Mentions: The focus of the RISE CBR intervention will be on the individual developing the skills and confidence to perform their previous or desired roles and activities. These may relate to family life, work and community life. The intervention will be recovery oriented, emphasising hope and the individual’s strengths. Fig 2 summarises the final intervention structure. Basic counselling and problem solving skills will be employed by CBR workers to deliver the intervention. The intervention is delivered in three phases. In Phase 1, lasting one to two months, there are weekly home visits and the focus is on engagement with the family and addressing core needs through compulsory modules such as “Understanding Schizophrenia”. Following a needs and risk assessment, structured goal setting will be used to support individuals to select appropriate goals from a pre-defined list. In addition to four core modules, the goal selection will determine which additional CBR components the individual will receive. In Phase 2, lasting approximately five to six months, home visits are every two weeks and address the specific needs of the individual through optional modules such as “Getting Back to Work”. In Phase 3, lasting approximately four months, the emphasis is on preventing relapse as well as maintaining the progress made towards addressing specific needs. The three intervention phases reflect the changing needs of participants over 12 months. The transition between phases is conditional on achievement of goals rather than specific time points.

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