Community-based rehabilitation intervention for people with schizophrenia in Ethiopia (RISE): a 12 month mixed methods pilot study

IntroductionA common problem low-income and middle-income countries face is the scarcity of community-based rehabilitation (CBR) resources and low service utilisation among persons with severe mental illness (SMI). Despite this problem, the factors and pathways followed influencing one’s decision on service utilisation in China have not been fully comprehended. This study aims to develop a theory-based model that systematically describes the integrated decision-making process of mental health CBR utilisation among persons with SMI in China.Methods/DesignThis cross-sectional, mixed-methods study involves three main stages and is expected to last 3 years, from January 2018 to December 2020. In stage 1, the Social Exchange Theory is deployed as an analytical framework to comprehensively capture factors associated with tendency to use CBR services in China using semistructured interview methodology involving patients with SMI, their primary caregivers and CBR service providers. In stage 2, interpretive structural modelling will be applied to analyse the relationships between factors in different dimensions, at different levels and with different levels of impact. Stage 3 involves a multiregion survey among at least 300 family decision-makers (either the patient or their caregivers) in six communities in three cities to statistically validate the initial model derived in stage 2 using a further structural equation modelling.Ethics and disseminationEthical approval was granted by the Ethics Committee of Tongji Medical College, Huazhong University of Science and Technology (No 2017S319). All interviewees will be provided with written information about the study, and a signed consent will be retrieved prior to the interview. Rules on confidentiality and anonymity of data will be strictly followed. The findings of this study will be disseminated via international and domestic peer-reviewed journals, reports, conference presentations and symposium discussions. Reports will be submitted to the National Natural Science Foundation of China.

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A Palliative Care Program for Volunteers in a Community Setting: A Mixed-Methods Pilot Study

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909119895213 ◽

2019 ◽

Vol 37 (6) ◽

pp. 455-464 ◽

Cited By ~ 1

Author(s):

Jiwon Lee ◽

Jong-Eun Lee

Keyword(s):

Palliative Care ◽

Mixed Methods ◽

Pilot Study ◽

Meaning In Life ◽

Palliative Care Service ◽

Care Program ◽

Palliative Care Program ◽

Community Based ◽

Volunteer Program ◽

Coping With Death

Background: The objective of community-based palliative care is to improve the quality of life of patients and their families and to share the responsibility of caregiving. However, the evidence of the efficacy of volunteer services in community-based palliative care is insufficient. Purpose: This pilot study sought to uncover the feasibility and efficacy of a volunteer program in palliative care. Methods: The study used a sequential mixed-methods design. A total of 19 volunteers participated in the training program, and 6 trained volunteers provided services for a period of 10 weeks to 5 families. Quantitative data were collected on death anxiety, coping with death, and meaning in life for volunteers before and after the training and after completing their services. Qualitative data were collected about volunteering experiences. Results: Significant increases in coping with death and meaning in life after training and in meaning in life after providing services were observed among volunteers. Three categories (“Volunteer’s growing influence at home,” “Discovering meaning-in-life through volunteering,” and “Death as the final journey in life”) emerged from the qualitative findings. The caregivers’ satisfaction score was high. Conclusions: A palliative care program was found to be useful for volunteers in finding meaning in life, motivating continued volunteering. Moreover, caregivers were satisfied with the palliative care service of volunteers.

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Development of a functional rehabilitation intervention for post knee arthroplasty patients: COmmunity based Rehabilitation post Knee Arthroplasty (CORKA) trial

Physiotherapy ◽

10.1016/j.physio.2019.06.004 ◽

2020 ◽

Vol 106 ◽

pp. 52-64

Author(s):

J. Room ◽

M. Batting ◽

K.L. Barker

Keyword(s):

Knee Arthroplasty ◽

Community Based ◽

Functional Rehabilitation ◽

Rehabilitation Intervention ◽

Community Based Rehabilitation

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

PLoS ONE ◽

10.1371/journal.pone.0143572 ◽

2015 ◽

Vol 10 (11) ◽

pp. e0143572 ◽

Cited By ~ 19

Author(s):

Laura Asher ◽

Abebaw Fekadu ◽

Charlotte Hanlon ◽

Gemechu Mideksa ◽

Julian Eaton ◽

...

Keyword(s):

Community Based ◽

Rehabilitation Intervention ◽

Community Based Rehabilitation

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Development of a functional rehabilitation intervention for post knee arthroplasty patients: COmmunity based Rehabilitation post Knee Arthroplasty (CORKA) trial

Physiotherapy ◽

10.1016/j.physio.2018.11.161 ◽

2019 ◽

Vol 105 ◽

pp. e160

Author(s):

J. Room ◽

M. Newman ◽

M. Batting ◽

N. Kenealy ◽

K. Barker

Keyword(s):

Knee Arthroplasty ◽

Community Based ◽

Functional Rehabilitation ◽

Rehabilitation Intervention ◽

Community Based Rehabilitation

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“Like a doctor, like a brother”: Achieving competence amongst lay health workers delivering community-based rehabilitation for people with schizophrenia in Ethiopia

PLoS ONE ◽

10.1371/journal.pone.0246158 ◽

2021 ◽

Vol 16 (2) ◽

pp. e0246158

Author(s):

Laura Asher ◽

Rahel Birhane ◽

Solomon Teferra ◽

Barkot Milkias ◽

Benyam Worku ◽

...

Keyword(s):

Pilot Study ◽

Problem Solving ◽

Health Workers ◽

Core Competencies ◽

Lay Health Workers ◽

Personal Factors ◽

Group Discussions ◽

Community Based ◽

Peer Supervision ◽

Community Based Rehabilitation

Background There are gaps in our understanding of how non-specialists, such as lay health workers, can achieve core competencies to deliver psychosocial interventions in low- and middle-income countries. Methods We conducted a 12-month mixed-methods study alongside the Rehabilitation Intervention for people with Schizophrenia in Ethiopia (RISE) pilot study. We rated a total of 30 role-plays and 55 clinical encounters of ten community-based rehabilitation (CBR) lay workers using an Ethiopian adaptation of the ENhancing Assessment of Common Therapeutic factors (ENACT) structured observational rating scale. To explore factors influencing competence, six focus group discussions and four in-depth interviews were conducted with 11 CBR workers and two supervisors at three time-points. We conducted a thematic analysis and triangulated the qualitative and quantitative data. Results There were improvements in CBR worker competence throughout the training and 12-month pilot study. Therapeutic alliance competencies (e.g., empathy) saw the earliest improvements. Competencies in personal factors (e.g., substance use) and external factors (e.g., assessing social networks) were initially rated lower, but scores improved during the pilot. Problem-solving and giving advice competencies saw the least improvements overall. Multimodal training, including role-plays, field work and group discussions, contributed to early development of competence. Initial stigma towards CBR participants was reduced through contact. Over time CBR workers occupied dual roles of expert and close friend for the people with schizophrenia in the programme. Competence was sustained through peer supervision, which also supported wellbeing. More intensive specialist supervision was needed. Conclusion It is possible to equip lay health workers with the core competencies to deliver a psychosocial intervention for people with schizophrenia in a low-income setting. A prolonged period of work experience is needed to develop advanced skills such as problem-solving. A structured intervention with clear protocols, combined with peer supervision to support wellbeing, is recommended for good quality intervention delivery. Repeated ENACT assessments can feasibly and successfully be used to identify areas needing improvement and to guide on-going training and supervision.

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