scholarly journals Intra-household Variation in Pathways to Care for Epilepsy and Mental Disorders in Eastern Uganda

2021 ◽  
Vol 9 ◽  
Author(s):  
Nandini D. P. Sarkar ◽  
Azucena Bardaji ◽  
Florence K. Baingana ◽  
Joan Muela Rivera ◽  
Bart Criel ◽  
...  

Integrating mental, neurological, and substance use (MNS) health care into the public health system has become a global priority, with mental health, and well-being now being part of the Sustainable Development Goals. In the aim to provide good quality care for MNS disorders, understanding patients' pathways to care is key. This qualitative study explores the pathways to care of patients attending an outpatient mental health clinic of a district hospital in eastern rural Uganda, from the perspectives of their caregivers. Twenty seven in-depth interviews were conducted with caregivers of MNS patients visiting the clinic, with a focus on four case-presentations. Data analysis consisted of thematic and emergent content analyses using NVivo 11. Results across all interviews highlight that chosen help-seeking itineraries were largely pluralistic, combining and alternating between traditional healing practices, and biomedical care, regardless of the specific MNS disorder. Intra-household differences in care seeking pathways—e.g., where one patient received traditional help or no care at all, while the other received biomedical care—depended on caregivers' perceived contextual illness narrative for each patient, in combination with a variety of other factors. If interpreted as a form of bewitchment, traditional medicine and healing was often the first form of care sought, while the mental health clinic was seen as a recourse to “free” care. Patients, especially younger children, who showed visible improvements once stabilized on psychotropic medication was a source of motivation for caregivers to continue with biomedical care at the mental health clinic. However, stock-outs of the free psychotropic medication at the clinic led to dissatisfaction with services due to out-of-pocket expenses and precipitated returning to alternative therapy choices. This article showcases the importance of understanding the complex and varied combinations of individual, cultural, socioeconomic and structural factors that may affect caregivers' choices of pathways to care for patients with MNS disorders in eastern rural Uganda. These cumulative complex processes and context-specific help-seeking behaviors, which ultimately impact patient treatment and MNS health outcomes, need to be first acknowledged, understood and taken into account if we are to promote more inclusive, effective and integrated public mental health systems globally.

2002 ◽  
Vol 17 (2) ◽  
pp. 219-232 ◽  
Author(s):  
Briggett C. Ford

Exposure to violence and trauma has become a major mental health and public health problem in the United States. This study assesses the rates of exposure to traumatic events of 55 adult African American women receiving treatment in an urban community mental health clinic. The study examined three research questions. First, what is the rate of exposure to violence and trauma among African American women in an urban community mental health clinic? Second, what effect does violence and trauma exposure have on mental health? Finally, does exposure to violence and trauma have an effect on well-being as measured with the Medical Outcomes Survey (MOS/SF-36)? A significant negative relationship between diagnostic burden and well-being was found. A negative non-significant relationship was found between Posttraumatic Diagnostic Scale (PDS) and well-being. Study findings suggest that use of a screening and assessment tool for violence and trauma exposure may have important clinical implications in providing appropriate mental health services to African American women.


Author(s):  
Claudia M. Valles ◽  
Juventino Hernandez Rodriguez ◽  
Gabriela Hurtado Alvarado ◽  
Argero A. Zerr ◽  
Armando A. Pina ◽  
...  

2016 ◽  
Vol 13 (03) ◽  
pp. 152-157
Author(s):  
A. O. Berg ◽  
K. Leopold ◽  
S. Zarafonitis-Müller ◽  
M. Nerhus ◽  
L. H. Stouten ◽  
...  

Summary Background: Immigrants have increased risk of a poor recovery from first episode psychosis (FEP). Early treatment can improve prognosis, but having an immigrant background may influence pathways to care. Method: We present research of service use and factors influencing treatment outcome in immigrants with FEP. Service use was assessed in in-patients at an early intervention center in Berlin, Germany. Duration of untreated psychosis and beliefs about illness was assessed in a FEP study in Oslo, Norway and cognitive functioning in patients with FEP schizophrenia from the regular mental health services in The Hague, the Netherlands. The proportion of immigrants in Berlin and Oslo was at level with the local populations, while the proportion in The Hague appeared to be higher. Result: There were clear indications that mental health literacy, probably based in different cultural expectations, were lower in first generation immigrants (FGI). Findings regarding clinical insight were ambiguous. There were also indications that FGI had more cognitive problems, based in higher stress levels or in cognitive styles. Early psychosis services must take issues of immigration and ethnicity into consideration.


2020 ◽  
Vol 10 (2) ◽  
Author(s):  
Errix Kristian Julianto ◽  
Yusuf Efendi

ABSTRAKSelf Help Group merupakan kelompok-kelompok termasuk orang dengan ikatan bersama yang secara sukarela datang bersama-sama untuk berbagi, menjangkau dan belajar satu sama lain dalam lingkungan yang terpercaya, mendukung dan terbuka (Knight, 2014). Tujuan penelitian ini adalah Menganalisis pengaruh Pengaruh Self Help Group  Terhadap Tingkat Harga Diri Keluarga Dengan Penderita Skizofrenia Di Poli Jiwa Puskesmas KalitiduDesain penelitian ii menggunakan Pre eksperiment dengan pendekatan one group pre-posttest design. Populasi pada penelitian ini adalah Seluruh keluarga penderita Skizofrenia di PKU Jiwa Kalitidu yang berjumlah 32 dengan teknik total sampling diperoleh 32 responden. Instrumen yang digunakan adalah kuesioner Harga diri. Kemudian penelitian ini dianalisa menggunakan wilcoxon sign rank.Dari hasil penelitian menunjukkan bahwa lebih dari sebagian responden mempunyai tingkat harga diri rendah yaitu terdapat 18 (56,2%) responden sebelum di beri self help group sedangkan setelah diberikan Self Help group menunjukkan bahwa sebagian besar responden mempunyai harga diri tinggi yaitu terdapat 25 (78,1%)  responden. Berdasarkan uji statistik dengan menggunakan SPSS uji Wilcoxon  Signed Ranks antara nilai pre test dan post test menunjukkan bahwa kondisi responden sebelum dan setelah dilakukan intervensi dengan self help group pada harga diri dengan  nilai uji wilcoxon  sebesar 0, 001 dengan nilai kesalahan sebesar   0,05.Berdasarkan hasil penelitian dapat disimpulkan ada pengaruh dari Self Help Group terhadap harga diri  keluarga dengan penderita depresi di poli jiwa puskesmas kalitidu Bojonegoro. Diharapkan para keluarga dengan penderita depresi di poli jiwa puskesmas kalitidu bojonegoro tetap aktif dalam mengikuti kegiatan Self Help Group di poli jiwa puskesmas kalitidu bojonegoro sehingga keluarga mampu meningkatkan harga diri. Kata Kunci       : Self Help Group, Harga diri, Skizofrenia  ABSTRACTSelf Help Groups are groups including people with common ties who voluntarily come together to share, reach out and learn from each other in a trusted, supportive and open environment (Knight, 2014). The purpose of this study was to Analyze the effect of Self Help Group Influence on the Self-Esteem Level of Family with Schizophrenia Patients in Psychiatric Poly at Puskesmas Kalitidu. This research design uses Pre experiment with one group pre-posttest design approach. The population in this study were all families of Schizophrenics in PKU Kalitidu Mental, amounting to 32 with a total sampling technique obtained by 32 respondents. The instrument used was the self-esteem questionnaire. Then this study was analyzed using Wilcoxon sign rank.From the results of the study showed that more than a few respondents had low levels of self-esteem, there were 18 (56.2%) respondents before being given a self-help group while after being given a Self-Help group showed that most respondents had high self-esteem ie there were 25 (78 , 1%) of respondents. Based on statistical tests using the SPSS Wilcoxon Signed Ranks test between the pre test and post test values indicate that the condition of respondents before and after intervention with self help groups on self-esteem with Wilcoxon test values of 0, 001 with an error value of 0.05. Based on the results of the study it can be concluded that there is an effect of the Self Help Group on the self-esteem of families with depressed patients at the mental health clinic of Bojonegoro kalitidu. It is expected that families with depression sufferers at the Kalitidu Bojonegoro mental health clinic remain active in participating in the Self Help Group activities in the mental health clinic at Kalitidu Bojonegoro so that families are able to increase self-esteem.Keywords         : Self Help Group, Self-Esteem, Schizophreni


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