scholarly journals Building capacity in mental health care in low- and middle-income countries by training primary care physicians using the mhGAP: a randomized controlled trial

2019 ◽  
Vol 35 (2) ◽  
pp. 186-198 ◽  
Author(s):  
Jessica Spagnolo ◽  
François Champagne ◽  
Nicole Leduc ◽  
Michèle Rivard ◽  
Wahid Melki ◽  
...  
Keyword(s):  
Mental Health ◽  
Self Efficacy ◽  
Primary Care Physicians ◽  
Health Knowledge ◽  
Control Group ◽  
Middle Income ◽  
Middle Income Countries ◽  
Group 2 ◽  
Mental Health Knowledge ◽  
Group 1

Abstract To address the rise in mental health conditions in Tunisia, a training based on the Mental Health Gap Action Programme (mhGAP) Intervention Guide (IG) was offered to primary care physicians (PCPs) working in the Greater Tunis area. Non-specialists (such as PCPs)’ training is an internationally supported way to target untreated mental health symptoms. We aimed to evaluate the programme’s impact on PCPs’ mental health knowledge, attitudes, self-efficacy and self-reported practice, immediately following and 18 months after training. We conducted an exploratory trial with a combination of designs: a pretest–posttest control group design and a one-group pretest–posttest design were used to assess the training’s short-term impact; and a repeated measures design was used to assess the training’s long-term impact. The former relied on a delayed-intervention strategy: participants assigned to the control group (Group 2) received the training after the intervention group (Group 1). The intervention consisted of a weekly mhGAP-based training session (totalling 6 weeks), comprising lectures, discussions, role plays and a support session offered by trainers. Data were collected at baseline, following Group 1’s training, following Group 2’s training and 18 months after training. Descriptive, bivariate and ANOVA analyses were conducted. Overall, 112 PCPs were randomized to either Group 1 (n = 52) or Group 2 (n = 60). The training had a statistically significant short-term impact on mental health knowledge, attitudes and self-efficacy scores but not on self-reported practice. When comparing pre-training results and results 18 months after training, these changes were maintained. PCPs reported a decrease in referral rates to specialized services 18 months after training in comparison to pre-training. The mhGAP-based training might be useful to increase mental health knowledge and self-efficacy, and decrease reported referral rates and negative mental health attitudes among PCPs in Tunisia and other low- and middle-income countries. Future studies should examine relationships among these outcome variables.

scholarly journals The influence of primary care physicians’ mental health knowledge, attitudes and self-efficacy on referrals to specialised services: findings from a longitudinal pilot trial

BJPsych Open ◽  
2020 ◽  
Vol 6 (6) ◽  
Author(s):  
Jessica Spagnolo ◽  
Helen-Maria Vasiliadis ◽  
Djamal Berbiche ◽  
François Champagne ◽  
Nicole Leduc ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Health Services ◽  
Health Services ◽  
Self Efficacy ◽  
Primary Care Physicians ◽  
Health Knowledge ◽  
Pilot Trial ◽  
Health Attitudes ◽  
Mental Health Knowledge

Background Training based on the Mental Health Gap Action Programme (mhGAP) is being increasingly adopted by countries to enhance non-specialists’ mental health capacities. However, the influence of these enhanced capacities on referral rates to specialised mental health services remains unknown. Aims We rely on findings from a longitudinal pilot trial to assess the influence of mental health knowledge, attitudes and self-efficacy on self-reported referrals from primary to specialised mental health services before, immediately after and 18 months after primary care physicians (PCPs) participated in an mhGAP-based training in the Greater Tunis area of Tunisia. Method Participants included PCPs who completed questionnaires before (n = 112), immediately after (n = 88) and 18 months after (n = 59) training. Multivariable analyses with linear mixed models accounting for the correlation among participants were performed with the SAS version 9.4 PROC MIXED procedure. The significance level was α < 0.05. Results Data show a significant interaction between time and mental health attitudes on referrals to specialised mental health services per week. Higher scores on the attitude scale were associated with more referrals to specialised services before and 18 months after training, compared with immediately after training. Conclusion Findings indicate that, in parallel to mental health training, considering structural/organisational supports to bring about a sustainable change in the influence of PCPs’ mental health attitudes on referrals is important. Our results will inform the scale-up of an initiative to further integrate mental health into primary care settings across Tunisia, and potentially other countries with similar profiles interested in further developing task-sharing initiatives.

scholarly journals Interventional nephrology and vascular access practice: A perspective from South and Southeast Asia

2021 ◽  
pp. 112972982110113
Author(s):  
Raja Ramachandran ◽  
Vinant Bhargava ◽  
Sanjiv Jasuja ◽  
Maurizio Gallieni ◽  
Vivekanand Jha ◽  
...  
Keyword(s):  
Southeast Asia ◽  
Vascular Access ◽  
Central Catheter ◽  
Middle Income ◽  
Middle Income Countries ◽  
South And Southeast Asia ◽  
Group 2 ◽  
Venous Fistula ◽  
Economic Constraints ◽  
Group 1

South and Southeast Asia is the most populated, heterogeneous part of the world. The Association of Vascular Access and InTerventionAl Renal physicians (AVATAR Foundation), India, gathered trends on epidemiology and Interventional Nephrology (IN) for this region. The countries were divided as upper-middle- and higher-income countries as Group-1 and lower and lower-middle-income countries as Group-2. Forty-three percent and 70% patients in the Group 1 and 2 countries had unplanned hemodialysis (HD) initiation. Among the incident HD patients, the dominant Vascular Access (VA) was non-tunneled central catheter (non-TCC) in 70% of Group 2 and tunneled central catheter (TCC) in 32.5% in Group 1 countries. Arterio-Venous Fistula (AVF) in the incident HD patients was observed in 24.5% and 35% of patients in Group-2 and Group-1, respectively. Eight percent and 68.7% of the prevalent HD patients in Group-2 and Group-1 received HD through an AVF respectively. Nephrologists performing any IN procedure were 90% and 60% in Group-2 and Group 1, respectively. The common procedures performed by nephrologists include renal biopsy (93.3%), peritoneal dialysis (PD) catheter insertion (80%), TCC (66.7%) and non-TCC (100%). Constraints for IN include lack of time (73.3%), lack of back-up (40%), lack of training (73.3%), economic issues (33.3%), medico-legal problems (46.6%), no incentive (20%), other interests (46.6%) and institution not supportive (26%). Routine VA surveillance is performed in 12.5% and 83.3% of Group-2 and Group-1, respectively. To conclude, non-TCC and TCC are the most common vascular access in incident HD patients in Group-2 and Group-1, respectively. Lack of training, back-up support and economic constraints were main constraints for IN growth in Group-2 countries.

scholarly journals Using pictorial action instructions to build a basic humanitarian engineering project

2019 ◽  
Vol 14 (1) ◽  
pp. 60-70
Author(s):  
Kathleen Paco Cadman ◽  
Du Feng
Keyword(s):  
Self Efficacy ◽  
Intervention Group ◽  
Control Group ◽  
Low Literacy ◽  
Engineering Project ◽  
Middle Income ◽  
Middle Income Countries ◽  
Humanitarian Engineering ◽  
Engineering Projects ◽  
Low And Middle Income

Humanitarian engineering projects mitigate environmental hazards disproportionately affecting health in low- and middle-income countries. However, widespread literacy deficits can create barriers in training low-literacy adults to construct these projects, indicating a need for literacy-adapted training materials. A randomized control trial in rural Guatemala tested the usability of pictorial action instructions, compared to demonstration-only methods, in training low-literacy adults (N = 60; n = 30 per group) to construct a solar bottle bulb. Fourteen days after the training, participants individually constructed the solar bottle bulb. The intervention group received pictorial action instructions to guide them, and the control group completed construction based on memory. Usability was evaluated by measuring the effectiveness and efficiency of construction, as well as user satisfaction and self-efficacy levels. Effectiveness and self-efficacy were significantly better among those in the intervention group compared to the control group. Considering this, the findings support the use of pictorial action instructions in training low-literacy adults to construct humanitarian engineering projects. This method may allow more individuals in rural regions of low- and middle-income countries to successfully construct their own humanitarian engineering projects in a way that is sustainable and scalable. Further research is needed to test these instructions in different settings, on a larger scale, as well as to test the long-term effects of using pictorial action instructions. 

scholarly journals Understanding mental health and wellbeing among aboriginal postsecondary students

2021 ◽  
Author(s):  
Caitlin Joy Davey
Keyword(s):  
Mental Health ◽  
Self Efficacy ◽  
Health Knowledge ◽  
Health Issues ◽  
Community Based ◽  
Post Secondary ◽  
Aboriginal Students ◽  
Mental Health Issues ◽  
Mental Health Knowledge

First Nations, Inuit and Métis youth in Canada report higher rates of mental health (i.e., depression, anxiety, addiction and suicide) issues than the non-Aboriginal population of youth, which impacts their ability to achieve their educational goals. Understanding mental health from an Aboriginal worldview and through culturally safe strategies designed to translate mental health information to Aboriginal people is lacking. The objectives of the present study were to develop, implement and evaluate a knowledge translation (KT) strategy to enhance wellbeing knowledge and self-efficacy in coping with mental health issues among Aboriginal postsecondary students using a community-based approach. The Tool Development Phase involved focus groups and interviews with Aboriginal post-secondary students (n=9) and community members (n=3) to develop a KT activity. The KT Phase involved a pre/post design where participants (n=4) were asked about their mental health knowledge and self-efficacy in improving their wellbeing prior to and after the KT activity. All students participated in an individual interview one month later about their knowledge and the helpfulness of activity. Key informants (n=4) were interviewed during a Follow-Up and Debriefing phase regarding the community-based approach. Mental health was defined wholistically, as related to community and as being impacted by identity, stigma, cultural connection, intergenerational trauma, and a clash between Aboriginal and positivist Western worldviews. KT preferences included incorporating traditional ceremonies; covering particular topics such as resources, traditional teachings and coping strategies; and incorporating active participation. The KT activity increased knowledge and self-efficacy related to mental health and some knowledge was retained and used at one-month follow-up. As well, participants appreciated the sense of community that the activity created and provided feedback regarding what could be changed (e.g., more active participation). Key informants thought the project addressed some community needs and that it was built on relationships. This study will contribute to increasing the wellbeing of Aboriginal students by expanding upon their mental health knowledge, and sense of self-efficacy in coping with their own mental health issues, with the aim of addressing mental health barriers to the completion of post-secondary education among Aboriginal students.

scholarly journals The Monetary Value of Human Lives Lost to Suicide in the African Continent: Beating the African War Drums

Healthcare ◽  
2020 ◽  
Vol 8 (2) ◽  
pp. 84
Author(s):  
Joses M. Kirigia ◽  
Rosenabi D.K. Muthuri ◽  
Newton G. Muthuri
Keyword(s):  
Discount Rate ◽  
Economic Burden ◽  
Years Of Life Lost ◽  
African Continent ◽  
Middle Income ◽  
Middle Income Countries ◽  
Monetary Value ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Background: Suicide is an important public health problem in the African continent whose economic burden remains largely unknown. This study estimated the monetary value of human lives lost due to suicide in the African continent in 2017. Methods: The human capital approach was applied to monetarily value the years of life lost due to premature mortality from suicide deaths (SD) among 54 African countries. A 3% discount rate was used to convert future losses into their present values. The sensitivity of monetary value of human lives lost to changes in discount rate and average life expectancy was tested. Results: The 75,505 human lives lost from suicide had a grand total monetary value of International Dollars (Int$) 6,989,963,325; and an average present value of Int$ 92,576 per SD. About 31.1% of the total monetary value of SD was borne by high-income and upper-middle-income countries (Group 1); 54.4% by lower-middle-income countries (Group 2); and 14.5% by low-income countries (Group 3). The average monetary value per human life lost from SD was Int$ 234,244 for Group 1, Int$ 109,545 for Group 2 and Int$ 32,223 for Group 3. Conclusions: Evidence shows that suicide imposes a substantive economic burden on African economies. The evidence reinforces the case for increased investments to ensure universal coverage of promotive, preventive, curative and rehabilitative mental health services.

scholarly journals Understanding mental health and wellbeing among aboriginal postsecondary students

2021 ◽  
Author(s):  
Caitlin Joy Davey
Keyword(s):  
Mental Health ◽  
Self Efficacy ◽  
Health Knowledge ◽  
Health Issues ◽  
Community Based ◽  
Post Secondary ◽  
Aboriginal Students ◽  
Mental Health Issues ◽  
Mental Health Knowledge

First Nations, Inuit and Métis youth in Canada report higher rates of mental health (i.e., depression, anxiety, addiction and suicide) issues than the non-Aboriginal population of youth, which impacts their ability to achieve their educational goals. Understanding mental health from an Aboriginal worldview and through culturally safe strategies designed to translate mental health information to Aboriginal people is lacking. The objectives of the present study were to develop, implement and evaluate a knowledge translation (KT) strategy to enhance wellbeing knowledge and self-efficacy in coping with mental health issues among Aboriginal postsecondary students using a community-based approach. The Tool Development Phase involved focus groups and interviews with Aboriginal post-secondary students (n=9) and community members (n=3) to develop a KT activity. The KT Phase involved a pre/post design where participants (n=4) were asked about their mental health knowledge and self-efficacy in improving their wellbeing prior to and after the KT activity. All students participated in an individual interview one month later about their knowledge and the helpfulness of activity. Key informants (n=4) were interviewed during a Follow-Up and Debriefing phase regarding the community-based approach. Mental health was defined wholistically, as related to community and as being impacted by identity, stigma, cultural connection, intergenerational trauma, and a clash between Aboriginal and positivist Western worldviews. KT preferences included incorporating traditional ceremonies; covering particular topics such as resources, traditional teachings and coping strategies; and incorporating active participation. The KT activity increased knowledge and self-efficacy related to mental health and some knowledge was retained and used at one-month follow-up. As well, participants appreciated the sense of community that the activity created and provided feedback regarding what could be changed (e.g., more active participation). Key informants thought the project addressed some community needs and that it was built on relationships. This study will contribute to increasing the wellbeing of Aboriginal students by expanding upon their mental health knowledge, and sense of self-efficacy in coping with their own mental health issues, with the aim of addressing mental health barriers to the completion of post-secondary education among Aboriginal students.

scholarly journals Household-focused interventions to enhance the treatment and management of HIV in low- and middle-income countries: a scoping review

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Ferdinand C. Mukumbang ◽  
Lucia Knight ◽  
Caroline Masquillier ◽  
Anton Delport ◽  
Neo Sematlane ◽  
...  
Keyword(s):  
Mental Health ◽  
Social Support ◽  
Treatment Outcomes ◽  
Self Efficacy ◽  
Perceived Social Support ◽  
World Health ◽  
People Living With Hiv ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

Abstract Background HIV remains a major public health challenge in many low- and middle-income countries (LMICs). The initiation of a greater number of people living with HIV (PLHIV) onto antiretroviral therapy (ART) following the World Health Organization’s ‘universal test and treat’ recommendation has the potential to overstretch already challenged health systems in LMICs. While various mainstream and community-based care models have been implemented to improve the treatment outcomes of PLHIV, little effort has been made to harness the potential of the families or households of PLHIV to enhance their treatment outcomes. To this end, we sought to explore the characteristics and effectiveness of household-focused interventions in LMICs on the management of HIV as measured by levels of adherence, viral suppression and different dimensions of HIV competence. Additionally, we sought to explore the mechanisms of change to explain how the interventions achieved the expected outcomes. Methods We systematically reviewed the literature published from 2003 to 2018, obtained from six electronic databases. We thematically analysed the 11 selected articles guided by the population, intervention, comparison and outcome (PICO) framework. Following the generative causality logic, whereby mechanisms are postulated to mediate an intervention and the outcomes, we applied a mechanism-based inferential reasoning, retroduction, to identify the mechanisms underlying the interventions to understand how these interventions are expected to work. Results The identified HIV-related interventions with a household focus were multi-component and multi-dimensional, incorporating aspects of information sharing on HIV; improving communication; stimulating social support and promoting mental health. Most of the interventions sought to empower and stimulate self-efficacy while strengthening the perceived social support of the PLHIV. Studies reported a significant positive impact on improving various aspects of HIV competent household – positive effects on HIV knowledge, communication between household members, and improved mental health outcomes of youths living in HIV-affected households. Conclusion By aiming to strengthen the perceived social support and self-efficacy of PLHIV, household-focused HIV interventions can address various aspects of household HIV competency. Nevertheless, the role of the household as an enabling resource to improve the outcomes of PLHIV remains largely untapped by public HIV programmes; more research on improving household HIV competency is therefore required. Trial registration PROSPERO registration: CRD42018094383.

scholarly journals The Indirect cost of illness in Africa

10.3823/2568 ◽  
2018 ◽  
Vol 11 ◽  
Author(s):  
Joses Muthuri Kirigia ◽  
Germano Mwiga Mwabu
Keyword(s):  
Indirect Cost ◽  
Cost Of Illness ◽  
Health System Strengthening ◽  
Age Group ◽  
Health Targets ◽  
Middle Income ◽  
Middle Income Countries ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Background: The current study estimated (a) the indirect costs associated with non-fatal disability and premature death across a wide range of diseases and health conditions in Africa in 2015 and (b) the potential savings that could be accrued if countries were to meet the 3 health targets of the substainable development goal (SDG) compared to the costs under the status quo. Methods: This study used the lost output or human capital approach to quantify the gross domestic product (GDP) losses associated with the disability-adjusted-life-years (DALYs) lost due to all causes by age group as well as by country economic classification (Group 1: 10 high/upper-middle income countries; Group 2: 17 lower-middle income countries; and Group 3: 27 low income countries). Results: The expected indirect cost of the 704,765,879 DALYs lost in Africa in 2015 was Int$ 2,983,187,560,197. Of this amount, 25.17%, 57.84% and 16.99% were incurred by the economies of the countries comprising Group 1, Group 2 and Group 3, respectively. Of the total continental indirect cost, 36.9%, 10.5%, 13.7%, 17.0%, 7.6%, 6.8% and 7.5% were associated with people aged 0-4, 5-14, 15-29, 30-49, 50-59, 60-69 and 70 years or older, respectively. Most of the total indirect cost (56.61%) was attributable to maternal conditions, AIDS, tuberculosis (TB), malaria, neglected tropicald diseases (NTDs), non-communicable diseases and traffic injuries. Approximately half (47%) of this cost could be avoided (or saved) every year if the 3 (health) targets of the SDG were fully met. Conclusion: The study estimated the total indirect cost of illness due to all causes by age group and country economic classification. The annual indirect cost is substantial. The findings contained in this paper suggest that health system strengthening should focus on both rich and poor countries, people of all ages and specific disease categories.  

The Mental Health Status of Chinese Medical Peacekeepers in Lebanon

2012 ◽  
Vol 40 (3) ◽  
pp. 375-380 ◽  
Author(s):  
Jing Li ◽  
Yongcong Shao ◽  
Mingdong Yun ◽  
Zhang Yan ◽  
Ke Yu ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Status ◽  
Depression Scale ◽  
Mental Health Status ◽  
Future Research ◽  
Control Group ◽  
Self Rating ◽  
Group 2 ◽  
Sum Scores ◽  
Group 1

We investigated the mental health status of Chinese medical peacekeepers in Lebanon. In total, 59 peacekeepers completed the Self-rating Depression Scale (SDS; Zung, 1965), Self-rating Anxiety Scale (SAS; Zung, 1971), and Symptom Checklist-90 (SCL-90; Wang, 1984) 1 week after their arrival in Lebanon. These data were compared with those of 62 military personnel (control group 1) and 58 medical workers (control group 2). Significant differences were found between the peacekeeping group and control group 1 concerning sum scores on the SDS and SAS, and a number of SCL-90 factors. Although peacekeepers had good mental health status 1 week after arrival, this needs to be assessed longitudinally in future research.

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