Concepts of mental illness and medical pluralism in Harare

1995 ◽  
Vol 25 (3) ◽  
pp. 485-493 ◽  
Author(s):  
V. Patel ◽  
T. Musara ◽  
T. Butau ◽  
P. Maramba ◽  
S. Fuyane
Keyword(s):  
Primary Care ◽  
Mental Illness ◽  
Traditional Healers ◽  
Explanatory Models ◽  
Psychiatric Nurses ◽  
Medical Pluralism ◽  
Care Providers ◽  
Illness Episode ◽  
Screening Criteria ◽  
Case Vignettes

SYNOPSISThe Focus Group Discussions (FGD) described in this paper are the first step of a study aiming to develop an ‘emic’ case-finding instrument. In keeping with the realities of primary care in Zimbabwe, nine FGD were held with 76 care providers including 30 village community workers, 22 traditional and faith healers (collectively referred to as traditional healers in this paper), 15 relatives of patients and 9 community psychiatric nurses. In addition to the general facets of concepts of mental illness, three ‘etic’ case vignettes were also presented.A change in behaviour or ability to care for oneself emerged as the central definition of mental illness. Both the head and the heart were regarded as playing an important role in the mediation of emotions. The types of mental illness described were intimately related to beliefs about spiritual causation. Angered ancestral spirits, evil spirits and witchcraft were seen as potent causes of mental illness. Families not only bore the burden of caring for the patient and all financial expenses involved, but were also ostracized and isolated. Both biomedical and traditional healers could help mentally ill persons by resolving different issues relating to the same illness episode. All case vignettes were recognized by the care providers in their communities though many felt that the descriptions did not reflect ‘illnesses’ but social problems and that accordingly, the treatment for these was social, rather than medical.The data enabled us to develop screening criteria for mental illness to be used by traditional healers and primary care nurses in the next stage of the study in which patients selected by these care providers on the grounds of suspicion of suffering from mental illness will be interviewed to elicit their explanatory models of illness and phenomenology.

Spiritual Explanatory Models of Mental Illness in West Nile, Uganda

2018 ◽  
Vol 50 (2) ◽  
pp. 233-253 ◽  
Author(s):  
Lucia Verginer ◽  
Barbara H. Juen
Keyword(s):  
Mental Illness ◽  
Qualitative Content Analysis ◽  
Participant Observation ◽  
Psychiatric Patients ◽  
Traditional Healers ◽  
Explanatory Models ◽  
Cultural Knowledge ◽  
Research Field ◽  
West Nile ◽  
Holistic View

Integrating indigenous cultural knowledge into conceptualizing mental illness offers highly valuable insights to better contextualize mental health. The meaning given to symptoms determines what is abnormal and requiring treatment. In Uganda, the formal health care system is neither the only nor the most widespread treatment provider. Help is often sought from traditional and religious healers, too. Despite numerous calls for cooperation between the healing systems, this has translated into reality only to a very limited degree. The purpose of this study was to gain insight into local explanatory models of mental illness, to gain an understanding of the different patients’ needs, and to develop a more comprehensive system of care. We used an ethnographic investigation approach, which allowed for a more holistic view of the research field. This was geographically delimited to the West Nile subregion in Northern Uganda. We conducted a total of 56 semistructured interviews with traditional healers ( n = 5), Christian religious healers ( n = 3), psychiatric patients ( n = 16), their attendants ( n = 16), and community members ( n = 16). In addition, we used the method of participant observation. The data collected were analyzed using Qualitative Content Analysis and Grounded Theory methodology. For the purpose of this article, we exclusively extracted the spiritual explanatory models. These were spirit possession and curse. Both were traditional concepts with a religious reinterpretation involving the action of spirits.

Conceptualizing depression in Vietnam: Primary health care providers’ explanatory models of depression

2018 ◽  
Vol 55 (2) ◽  
pp. 219-241 ◽  
Author(s):  
Jill Murphy ◽  
Elliot Goldner* ◽  
Kitty K. Corbett ◽  
Marina Morrow ◽  
Vu Cong Nguyen ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care Providers ◽  
Help Seeking ◽  
Healthcare Providers ◽  
Community Outreach ◽  
Health Service Delivery ◽  
Explanatory Models ◽  
Care Providers ◽  
Urban District ◽  
Mental Health Service Delivery

The purpose of this qualitative study was to elicit the explanatory models (EMs) of primary healthcare providers (PHPs) in Vietnam in order to (a) understand if and how the concept of depression is understood in Vietnam from the perspective of nonspecialist providers and community members, and (b) to inform the process of introducing services for depression in primary care in Vietnam. We conducted semistructured interviews with 30 PHPs in one rural and one urban district of Hanoi, Vietnam in 2014. We found that although PHPs possess low levels of formal knowledge about depression, they provide consistent accounts of its symptoms and aetiology among their patient population, suggesting that depression is a relevant concept in Vietnam. PHPs describe a predominantly psychosocial understanding of depression, with little mention of either affective symptoms or neurological aetiology. This implies that, with enhanced training, psychosocial approaches to depression care would be appropriate and acceptable in this context. Distinctions were identified between rural and urban populations in both understandings of depression and help-seeking, suggesting that enhanced services should account for the diversity of the Vietnamese context. Alcohol misuse among men emerged as a considerable concern, both in relation to depression and as stand-alone issue facing Vietnamese communities, indicating the need for further research in this area. Low help-seeking for depression in primary care implies the need for enhanced community outreach. The results of this study demonstrate the value of eliciting EMs to inform planning for enhanced mental health service delivery in a global context.

scholarly journals Integrated Smoking Cessation for Smokers With Serious Mental Illness: Protocol for a Convergent Mixed Methods Implementation Evaluation Study

10.2196/25390 ◽  
2021 ◽  
Vol 10 (7) ◽  
pp. e25390
Author(s):  
Kristina Schnitzer ◽  
Melissa Culhane Maravić ◽  
Diana Arntz ◽  
Nathaniel L Phillips ◽  
Gladys Pachas ◽  
...  
Keyword(s):  
Primary Care ◽  
Mental Illness ◽  
Smoking Cessation ◽  
Mixed Methods ◽  
Serious Mental Illness ◽  
Qualitative Data ◽  
Primary Care Providers ◽  
Care Providers ◽  
Pragmatic Clinical Trial ◽  
Implementation Evaluation

Background Tobacco smoking is associated with significant morbidity and premature mortality in individuals with serious mental illness. A 2-year pragmatic clinical trial (PCORI PCS-1504-30472) that enrolled 1100 individuals with serious mental illness in the greater Boston area was conducted to test 2 interventions for tobacco cessation for individuals with serious mental illness: (1) academic detailing, which delivers education to primary care providers and highlights first-line pharmacotherapy for smoking cessation, and (2) provision of community health worker support to smoker participants. Implementing and scaling this intervention in other settings will require the systematic identification of barriers and facilitators, as well as the identification of relevant subgroups, effective and unique components, and setting-specific factors. Objective This protocol outlines the proposed mixed methods evaluation of the pragmatic clinical trial to (1) identify barriers and facilitators to effective implementation of the interventions, (2) examine group differences among primary care physicians, and (3) identify barriers that stakeholders such as clinical, payor, and policy leaders would anticipate to impact the implementation of effective components of the intervention. Methods Qualitative interviews will be conducted with all study community health workers and selected smoker participants, primary care providers, and other stakeholders. Measures of performance and engagement will guide purposive sampling. The Consolidated Framework for Implementation Research will guide qualitative data collection and analysis in accordance with the following framework approach: (1) familiarization, (2) identifying a thematic framework, (3) indexing, (4) charting, and (5) mapping and interpretation. Joint display analyses will be constructed to analyze and draw conclusions across the quantitative and qualitative data. Results The 3-year cluster-randomized trial has concluded, and the analysis of primary outcomes is underway. Results from the pragmatic trial and this mixed methods implementation evaluation will be used to help disseminate, scale, and expand a systems intervention. Conclusions The results of this mixed methods implementation evaluation will inform strategies for dissemination and solutions to potential barriers to the implementation of interventions from a smoking cessation trial for individuals with serious mental illness. International Registered Report Identifier (IRRID) DERR1-10.2196/25390

scholarly journals The effect of a Housing First intervention on primary care retention among homeless individuals with mental illness

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0246859
Author(s):  
Adam Whisler ◽  
Naheed Dosani ◽  
Matthew J. To ◽  
Kristen O’Brien ◽  
Samantha Young ◽  
...  
Keyword(s):  
Primary Care ◽  
Mental Illness ◽  
Care Provider ◽  
Primary Care Provider ◽  
Medical Records ◽  
Primary Care Providers ◽  
Retention Rates ◽  
Housing First ◽  
Care Providers ◽  
Treatment As Usual

Background Primary care retention, defined as ongoing periodic contact with a consistent primary care provider, is beneficial for people with serious chronic illnesses. This study examined the effect of a Housing First intervention on primary care retention among homeless individuals with mental illness. Methods Two hundred individuals enrolled in the Toronto site of the At Home Project and randomized to Housing First or Treatment As Usual were studied. Medical records were reviewed to determine if participants were retained in primary care, defined as having at least one visit with the same primary care provider in each of two consecutive six-month periods during the 12 month period preceding and following randomization. Results Medical records were obtained for 47 individuals randomized to Housing First and 40 individuals randomized to Treatment As Usual. During the one year period following randomization, the proportion of Housing First and Treatment As Usual participants retained in primary care was not significantly different (38.3% vs. 47.5%, p = 0.39). The change in primary care retention rates from the year preceding randomization to the year following randomization was +10.6% in the Housing First group and -5.0% in the Treatment As Usual group. Conclusion Among homeless individuals with mental illness, Housing First did not significantly affect primary care retention over the follow-up period. These findings suggest Housing First interventions may need to place greater emphasis on connecting clients with primary care providers.

scholarly journals Integrated Smoking Cessation for Smokers With Serious Mental Illness: Protocol for a Convergent Mixed Methods Implementation Evaluation Study (Preprint)

2020 ◽  
Author(s):  
Kristina Schnitzer ◽  
Melissa Culhane Maravić ◽  
Diana Arntz ◽  
Nathaniel L Phillips ◽  
Gladys Pachas ◽  
...  
Keyword(s):  
Primary Care ◽  
Mental Illness ◽  
Smoking Cessation ◽  
Mixed Methods ◽  
Serious Mental Illness ◽  
Qualitative Data ◽  
Primary Care Providers ◽  
Care Providers ◽  
Pragmatic Clinical Trial ◽  
Implementation Evaluation

BACKGROUND Tobacco smoking is associated with significant morbidity and premature mortality in individuals with serious mental illness. A 2-year pragmatic clinical trial (PCORI PCS-1504-30472) that enrolled 1100 individuals with serious mental illness in the greater Boston area was conducted to test 2 interventions for tobacco cessation for individuals with serious mental illness: (1) academic detailing, which delivers education to primary care providers and highlights first-line pharmacotherapy for smoking cessation, and (2) provision of community health worker support to smoker participants. Implementing and scaling this intervention in other settings will require the systematic identification of barriers and facilitators, as well as the identification of relevant subgroups, effective and unique components, and setting-specific factors. OBJECTIVE This protocol outlines the proposed mixed methods evaluation of the pragmatic clinical trial to (1) identify barriers and facilitators to effective implementation of the interventions, (2) examine group differences among primary care physicians, and (3) identify barriers that stakeholders such as clinical, payor, and policy leaders would anticipate to impact the implementation of effective components of the intervention. METHODS Qualitative interviews will be conducted with all study community health workers and selected smoker participants, primary care providers, and other stakeholders. Measures of performance and engagement will guide purposive sampling. The Consolidated Framework for Implementation Research will guide qualitative data collection and analysis in accordance with the following framework approach: (1) familiarization, (2) identifying a thematic framework, (3) indexing, (4) charting, and (5) mapping and interpretation. Joint display analyses will be constructed to analyze and draw conclusions across the quantitative and qualitative data. RESULTS The 3-year cluster-randomized trial has concluded, and the analysis of primary outcomes is underway. Results from the pragmatic trial and this mixed methods implementation evaluation will be used to help disseminate, scale, and expand a systems intervention. CONCLUSIONS The results of this mixed methods implementation evaluation will inform strategies for dissemination and solutions to potential barriers to the implementation of interventions from a smoking cessation trial for individuals with serious mental illness. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/25390

scholarly journals Stigmatizing attitudes of primary care professionals towards people with mental disorders: A systematic review

2018 ◽  
Vol 53 (4) ◽  
pp. 317-338 ◽  
Author(s):  
Angel O Rojas Vistorte ◽  
Wagner Silva Ribeiro ◽  
Denisse Jaen ◽  
Miguel R Jorge ◽  
Sara Evans-Lacko ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Mental Illness ◽  
Mental Disorders ◽  
Health Care Providers ◽  
Primary Care Physicians ◽  
Care Providers ◽  
Eligibility Criteria ◽  
Stigmatizing Attitudes ◽  
Primary Care Professionals

Objective To examine stigmatizing attitudes towards people with mental disorders among primary care professionals and to identify potential factors related to stigmatizing attitudes through a systematic review. Methods A systematic literature search was conducted in Medline, Lilacs, IBECS, Index Psicologia, CUMED, MedCarib, Sec. Est. Saúde SP, WHOLIS, Hanseníase, LIS-Localizador de Informação em Saúde, PAHO, CVSO-Regional, and Latindex, through the Virtual Health Library portal ( http://www.bireme.br website) through to June 2017. The articles included in the review were summarized through a narrative synthesis. Results After applying eligibility criteria, 11 articles, out of 19.109 references identified, were included in the review. Primary care physicians do present stigmatizing attitudes towards patients with mental disorders and show more negative attitudes towards patients with schizophrenia than towards those with depression. Older and more experience doctors have more stigmatizing attitudes towards people with mental illness compared with younger and less-experienced doctors. Health-care providers who endorse more stigmatizing attitudes towards mental illness were likely to be more pessimistic about the patient’s adherence to treatment. Conclusions Stigmatizing attitudes towards people with mental disorders are common among physicians in primary care settings, particularly among older and more experienced doctors. Stigmatizing attitudes can act as an important barrier for patients to receive the treatment they need. The primary care physicians feel they need better preparation, training, and information to deal with and to treat mental illness, such as a user friendly and pragmatic classification system that addresses the high prevalence of mental disorders in primary care and community settings.

scholarly journals Family engagement as part of managing patients with mental illness in primary care

2021 ◽  
Vol 62 (5) ◽  
pp. 213-219 ◽  
Author(s):  
HS Ong ◽  
PA Fernandez ◽  
HK Lim
Keyword(s):  
Primary Care ◽  
Mental Illness ◽  
Mental Health Problems ◽  
Family Engagement ◽  
Primary Care Providers ◽  
Care Providers ◽  
The Family ◽  
Basic Functions ◽  
Short And Long Term

The family unit plays a crucial role in patients with mental illness. Mental health problems have been associated with an assortment of dysfunctional social and psychological processes in one’s family of origin, yet families are now expected to be responsible for the care of the patient with mental illness. There are many short- and long-term benefits of engaging the families in the care of patients with mental illness. However, the implementation of family engagement in patients with mental illness is fraught with challenges. The primary care provider possesses several distinctive characteristics that lend an advantage to successfully engaging the families of patients with mental illness, such as better accessibility, better rapport, and being associated with less stigma. Primary care providers could engage the family in various ways, ranging from basic functions such as psychoeducation and supporting the family’s needs, to more specialised interventions such as family assessment and family therapy.

A 12-Week Evidence-Based Education Project to Reduce Cardiovascular and Metabolic Risk in Adults With Serious Mental Illness in the Integrated Care Setting

2020 ◽  
pp. 107839032090282 ◽  
Author(s):  
Ashley Fenton ◽  
Phyllis Sharps ◽  
Karan Kverno ◽  
Jill RachBeisel ◽  
Marsha Gorth
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Mental Illness ◽  
Serious Mental Illness ◽  
Hemoglobin A1c ◽  
Self Care ◽  
Primary Care Providers ◽  
Evidence Based ◽  
Care Providers ◽  
Schizophrenia Spectrum Disorders

BACKGROUND: Individuals with serious mental illness (SMI) such as schizophrenia spectrum disorders, severe bipolar disorder, or severe recurrent major depressive disorder have a shorter life expectancy compared with those in the general population. This is largely due to the higher rates of diabetes, hyperlipidemia, and hypertension. Treatment adherence, diet, exercise, and weight management are modifiable risk factors for these cardiometabolic conditions, yet the use of educational lifestyle interventions is not common practice in the clinical setting. OBJECTIVE: The purpose of this project was to evaluate a 12-week evidence-based diabetes prevention education program integrated into a primary care behavioral health setting for adults with SMI, diabetes, or prediabetes, and who were overweight or obese. STUDY DESIGN: Outcomes for this project included diabetes knowledge, self-care, and health indicators (blood pressure, hemoglobin A1C, weight, body mass index, and medication adherence). The project also addressed feasibility and acceptability of the program in this setting. RESULTS: Project outcomes showed a reduction in weight, waist circumference, hemoglobin A1C, and blood pressure. Outcomes also indicated an improvement in participants’ self-knowledge and self-care. CONCLUSIONS: There was a high attendance rate and overall acceptability and feasibility described by participants. This project highlights the important role that primary care providers can play in providing health education to patients with SMI.

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