scholarly journals Perceptions of Asha Workers in the Hope Collaborative Care Mental Health Intervention in Rural South India: A Qualitative Analysis

2020 ◽  
Author(s):  
Stuti Bansal ◽  
Krishnamachari Sriniva ◽  
Maria L Ekstrand
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Illness ◽  
Rural Health ◽  
Collaborative Care ◽  
Rural Areas ◽  
Health Workers ◽  
Common Mental Disorders ◽  
Positive Interactions ◽  
Barriers To Treatment

Abstract Background:Common mental disorders are responsible for a heavy disease burden in India and are often highly co-morbid with non-communicable diseases like diabetes and cardiovascular disease, which are increasing in prevalence across India as well. There is a severe lack of mental health resources in India, particularly in rural areas. Rural health care is often dependent on ASHA workers (Accredited Social Health Activists), high school-educated village women trained as community health workers. ASHA workers have been effectively involved in a variety of interventions, including a handful targeting mental illness, but perspectives of ASHA workers have been greatly overlooked.Methods:One-on-one qualitative interviews were conducted with 15 ASHA workers, all of whom completed the parent HOPE study, a collaborative-care randomized controlled trial that aims to integrate mental health care into existing primary care systems in rural Karnataka. The 15 ASHA workers in this substudy were asked questions about their role in HOPE, as well as their perspectives on patient health, mental illness, and the HOPE study.Results:ASHA workers mostly had positive interactions with patients, including encouraging them to attend sessions, helping to explain the topics and techniques, and checking in on the patients frequently. Occasionally ASHAs had negative relationships with patients. ASHA workers were able to identify key barriers to treatment and facilitators to treatment. ASHAs claimed that their knowledge about mental illness improved because of the HOPE study, though some gaps remained in their understanding of mental illness etiology and treatment. Overall, ASHA workers viewed the HOPE study as a necessary and effective intervention, and requested that it continue and expand.Conclusions: ASHA workers are important in establishing and maintaining relationships with patients that encourage attendance and participation, and the efforts of ASHAs often help in mitigating common barriers to treatment. Our results show that the beliefs and knowledge of ASHA workers can be changed in regards to mental illness, and ASHAs can become effective advocates for patients. The perspectives of ASHA workers need to be understood in order to understand the complexities of a rural health system that relies on their work, and most effectively help patients.

scholarly journals Perceptions of ASHA workers in the HOPE collaborative care mental health intervention in rural South India: a qualitative analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. e047365
Author(s):  
Stuti Bansal ◽  
Krishnamachari Srinivasan ◽  
Maria Ekstrand
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Collaborative Care ◽  
Health Workers ◽  
Controlled Trial ◽  
Community Outreach ◽  
Health Intervention ◽  
Positive Interactions ◽  
Mental Health Intervention ◽  
Barriers To Treatment

ObjectiveThe main objective of this exploratory study was to investigate the overlooked perspectives and beliefs of Accredited Social Health Activists (ASHA workers) regarding a collaborative care mental health intervention (HOPE: Healthier Options through Empowerment), mental illness and the health of their rural communities.DesignSemi-structured, one-on-one, qualitative interviews.SettingSeven primary health centres (PHCs) in rural Karnataka, India. All PHCs had previously completed the HOPE study.Participants15 ASHA workers, selected via purposive sampling. ASHAs are high school-educated village women trained as community health workers. ASHAs were included if they had previously participated in the HOPE intervention, a collaborative-care randomised controlled trial that aimed to integrate mental healthcare into existing primary care systems in rural Karnataka.InterventionsNo interventions were introduced.ResultsASHA workers mostly had positive interactions with patients, including encouraging them to attend sessions, helping to explain the topics and techniques, and checking on the patients frequently. ASHA workers were able to identify key barriers to treatment and facilitators to treatment. ASHAs claimed that their knowledge about mental illness improved because of the HOPE study, though gaps remained in their understanding of aetiology and treatment. Several expressed interest in receiving additional mental health training. Overall, ASHAs viewed the HOPE study as a necessary and effective intervention, and requested that it expand.ConclusionsThis paper discusses the perspectives of ASHAs who participated in a novel effort to extend the collaborative care model to their own communities. ASHA workers help maintain relationships with patients that encourage participation, and the efforts of ASHAs often aid in mitigating common barriers to treatment. ASHA workers’ beliefs and knowledge regarding mental illness can be changed, and ASHAs can become effective advocates for patients. Future collaborative care interventions would likely benefit from involving ASHA workers in community outreach efforts.

scholarly journals Systematic Medical Appraisal, Referral and Treatment (SMART) Mental Health Programme for providing innovative mental health care in rural communities in India

2015 ◽  
Vol 2 ◽  
Author(s):  
P. K. Maulik ◽  
S. Devarapalli ◽  
S. Kallakuri ◽  
D. Praveen ◽  
V. Jha ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mixed Methods ◽  
Mental Health Services ◽  
Health Services ◽  
Mental Health Care ◽  
Rural Areas ◽  
Health Workers ◽  
Mental Health Programme ◽  
Health Programme

Background.India has few mental health professionals to treat the large number of people suffering from mental disorders. Rural areas are particularly disadvantaged due to lack of trained health workers. Ways to improve care could be by training village health workers in basic mental health care, and by using innovative methods of service delivery. The ongoing Systematic Medical Appraisal, Referral and Treatment Mental Health Programme will assess the acceptability, feasibility and preliminary effectiveness of a task-shifting mobile-based intervention using mixed methods, in rural Andhra Pradesh, India.Method.The key components of the study are an anti-stigma campaign followed by a mobile-based mental health services intervention. The study will be done across two sites in rural areas, with intervention periods of 1 year and 3 months, respectively. The programme uses a mobile-based clinical decision support tool to be used by non-physician health workers and primary care physicians to screen, diagnose and manage individuals suffering from depression, suicidal risk and emotional stress. The key aim of the study will be to assess any changes in mental health services use among those screened positive following the intervention. A number of other outcomes will also be assessed using mixed methods, specifically focussed on reduction of stigma, increase in mental health awareness and other process indicators.Conclusions.This project addresses a number of objectives as outlined in the Mental Health Action Plan of World Health Organization and India's National Mental Health Programme and Policy. If successful, the next phase will involve design and conduct of a cluster randomised controlled trial.

Mental illness and "self"-management in rural Australia: caregivers' perspectives

2003 ◽  
Vol 9 (3) ◽  
pp. 90 ◽  
Author(s):  
Shari Siegloff ◽  
Rosalie Aroni
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Illness ◽  
Chronic Disease ◽  
Mental Health Care ◽  
Rural Areas ◽  
Personal Control ◽  
Self Management ◽  
Illness Management ◽  
Implicit And Explicit

Current models of chronic disease self-management incorporate an understanding that people with chronic illnesses, their carers and clinicians need to work together in addressing illness management issues (Von Korff, Gruman, Schaefer, Curry, & Wagner, 1997) and that this process enhances personal control of health (Lorig, Ritter et al., 2000). The question we ask is whether the understandings in these models, both implicit and explicit, apply to those people living with mental illness in rural areas in Australia. In-depth interviews were used to explore and examine the way in which carers of people living with mental illness in rural Victoria experienced and perceived the nature of chronic disease self-management. Our findings indicate that illness management in rural areas occurs predominantly as a partnership between the person with mental illness and the family members who act as caregivers, rather than a partnership with health professionals. This confirms that the lack of resources in the rural mental health care system results in a crisis-oriented service rather than a service that is able to respond to preventative and ongoing mental health care. This is recognised as a considerable burden for many families and requires further examination. In addition, a finding of considerable clinical and policy importance in this arena is the experience of family caregivers as partners in not only the support of the ?management? aspects of self-management of mental illness, but also in supporting the person living with mental illness in the maintenance of the ?self? aspect of self-management.

Improving Ghana's Mental Health Care Through Task Shifting – Psychiatrists and Health Policy Directors Views

2016 ◽  
Vol 33 (S1) ◽  
pp. S488-S488
Author(s):  
V. Agyapong ◽  
E. McAuliffe ◽  
C. Farren
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Health Policy ◽  
Mental Health Care ◽  
Health Care Delivery ◽  
Health Workers ◽  
Common Mental Disorders ◽  
Care Delivery ◽  
Task Shifting ◽  
Resource Base

BackgroundCurrently, Ghana has only twelfth psychiatrists in active service providing for the mental health needs of a population of nearly 25 million people. Ghana has therefore adopted a system of task-shifting to address the critical shortage of psychiatrists.AimTo examine the perception of psychiatrists and health policy directors about the government's policy to expand metal health care delivery in Ghana through a system of task-shifting from psychiatrists to community mental health workers (CMHWs).MethodsA self-administered semi-structured questionnaire was developed and administered to 11 psychiatrists and 29 health policy directors.ResultsOnly one psychiatrist and 3 (10.3%) health policy directors reported they were not aware of task-shifting within Ghana's mental health delivery system. Ten (91.1%) psychiatrists and 23 (79.3%) health policy directors were aware of a policy of the Government of Ghana to improve on the human resource base within mental health through a system task-shifting. Overall, 5 (45.5%) of the psychiatrists and 9 (31%) health policy directors perceived there are some resistance to the implementation of a policy of task shifting including resistance from traditional and spiritual healers, some psychiatrists, some community psychiatric nurses and psychologists. The majority of psychiatrists and health policy directors were of the view that CMHWs should be allowed to assess, diagnose and treat most of the common mental disorders.ConclusionPsychiatrists and health policy directors in Ghana support Governments policy to expand on mental health care delivery through a system of task-shifting despite their knowledge of resistance from certain professionals.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Mental health care delivery in poor settings through trained female community health workers: A five-year intervention program in Somaliland

2021 ◽  
Author(s):  
Yakoub Aden Abdi ◽  
Nasir Ibrahim Said ◽  
Yusuf Abdi Hared ◽  
Ismail Ayeh ◽  
Said Ahmed Walhad
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Illness ◽  
Mental Health Care ◽  
Community Health ◽  
Community Health Workers ◽  
Health Workers ◽  
World Health ◽  
Baseline Survey ◽  
Female Community

Background: The situation of mental health globally is alarming particularly in developing countries. In Somaliland/Somalia, every third person may be suffering from some sort of mental illness according to the World Health Organization. Major barriers to improve mental health include stigma and lack of skilled human resources. Objectives: The aim was to explore the feasibility of organizing integrated community-based mental, epilepsy and mother and child health services delivered by trained female community health workers (FCHWs) in three urban sites (Borama, Baki and Dila) in the Awdal Region, Somaliland. Methods: After selection of the 3 project sites and recruitment and training of project staff, a baseline survey was carried out. First, the sites were properly mapped based on existing geographical administrative sectors and sub-sectors of the sites. Then a representative sample of 2,722 households was randomly selected from all the 3 sites. The female head of each of those households were then interviewed using a questionnaire containing 22 questions on the target groups. The questionnaire responses were coded, and data analysed using Statistical software program, SPSS. After the baseline survey, the FCHWs were deployed in the sites assigning a specified area to each female worker. The FCHWs worked 6 hours per day 6 days per week and were required to visit 6 families each day including follow-ups. Their activities included identification of patients with severe mental illness (SMI) or with epilepsy, counselling, distribution of medications, follow-up of patients already on medication, referral, stigma reduction and documentation of their daily activities in logbooks. Results: The baseline study showed that 12% of the households were taking care of at least one person with SMI each, while 7% had one person with epilepsy each. Of the patients with SMI, 18% were on chains. During the project period (2015-2019), the number of people with SMI or with epilepsy who benefited from the project was 2.225 and 738 respectively and their families empowered through increased mental health awareness. Among the patients with SMI, 237 were on chains before intervention and 85% of them were successfully released from their shackles. Conclusions: This project has shown that deployment of trained and supported FCHWs can be used to reduce the mental health care gap in Somaliland. It is suggested as a model project which could, hopefully, be replicated and tested in other similar settings.

scholarly journals Comparing the current status with desired situation of the quality ofeducation and improvement for rural health workers in Iran

2021 ◽  
Vol 10 (1) ◽  
pp. 1-1
Author(s):  
Beheshteh Shamsaee ◽  
Mehdi Bagheri ◽  
Nader Gholi Ghourchian ◽  
Parivash Jafari
Keyword(s):  
Health Care ◽  
Health System ◽  
Rural Health ◽  
Health Care Providers ◽  
Rural Areas ◽  
Health Workers ◽  
Current Status ◽  
Care Providers ◽  
Fuzzy Delphi ◽  
The Impact

Background: Rural health workers (Behvarz) are considered health- care pioneers standing at the forefront of providing services for rural areas. Those health providers need to be optimally educated throughout the country. What can serve this purpose is an integrated high quality "education". Methods: The current descriptive research compared two situations of education quality. To this end 300, rural health workers completed researcher-made questionnaires, including 2 dimensions,7 components and, 80 questions obtained from the analysis of the qualitative process through the fuzzy Delphi method. Results: The results indicated a gap between the current status and desirable situations of qualitative improvement components of rural health workers’ education. The findings also showed that the highest standardized coefficient in the area of education was related to the variable of learning and transfer of education with a coefficient of 0.971. In the area of optimization, the highest standard coefficient for the desirable situation belonged to the interpersonal and functional relationship variable, with the value of 0.978, while the lowest standardized coefficient was related to the variable of information and communication technology (ICT) development as 0.956. Conclusion: In brief, optimal education for the health- care providers is considered an integral part of the health system; therefore, the impact of education on the general health of the people should be taken into consideration. Therefore, there is a need for theoretical and practical exploration of qualitative education towards health system improvement and promotion.

A Tribute to the Late William J. Curran

1996 ◽  
Vol 24 (3) ◽  
pp. 274-275
Author(s):  
O. Lawrence ◽  
J.D. Gostin
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Illness ◽  
United Nations ◽  
Mental Health Care ◽  
Harvard University ◽  
Legal Medicine ◽  
General Assembly ◽  
International Institute ◽  
University Professor

In the summer of 1979, a group of experts on law, medicine, and ethics assembled in Siracusa, Sicily, under the auspices of the International Commission of Jurists and the International Institute of Higher Studies in Criminal Science, to draft guidelines on the rights of persons with mental illness. Sitting across the table from me was a quiet, proud man of distinctive intelligence, William J. Curran, Frances Glessner Lee Professor of Legal Medicine at Harvard University. Professor Curran was one of the principal drafters of those guidelines. Many years later in 1991, after several subsequent re-drafts by United Nations (U.N.) Rapporteur Erica-Irene Daes, the text was adopted by the U.N. General Assembly as the Principles for the Protection of Persons with Mental Illness and for the Improvement of Mental Health Care. This was the kind of remarkable achievement in the field of law and medicine that Professor Curran repeated throughout his distinguished career.

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