Service user involvement in mental health system strengthening in a rural African setting: qualitative study
Service user involvement in mental health system strengthening in a rural African setting: qualitative study
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DOI：
10.1186/s12888-017-1352-9
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发表时间：
2017-05-18
期刊：
影响因子：
4.4
通讯作者：
Hanlon, Charlotte
中科院分区：
文献类型：
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作者：
Abayneh, Sisay;Lempp, Heidi;Hanlon, Charlotte
背景：在低收入和中等收入国家（LMICs）的综合初级保健环境中，让服务使用者参与扩大获得精神卫生保健服务的努力是至关重要的。然而，很少有来自中低收入国家的证据来指导这一进程。本研究的目的是探索埃塞俄比亚农村服务用户/护理人员参与的障碍和促进因素，为可扩展方法的发展提供信息。方法：对有目的选择的心理健康服务使用者（n = 13）、护理人员（n = 10）、初级保健机构负责人（n = 8）和政策制定者/规划者/服务开发者（n = 8）进行39次半结构化访谈。访谈用阿姆哈拉语录音和抄写，并翻译成英语。采用专题分析。结果：所有组的参与者都支持服务使用者和照顾者参与精神卫生系统的加强。潜在的好处被确定为：(1)改善服务的适当性和质量；(2)更好地防止虐待和促进对服务使用者的尊重。然而，几乎没有应答者有服务用户参与的经验。污名被认为是普遍存在的障碍，在卫生系统、当地社区和个人中都存在。服务使用者相互竞争的优先事项包括需要获得适当的个人护理和为生存而工作。对服务使用者的潜在贡献认识不足似乎与服务使用者的授权和动员有限有关。潜在的卫生系统促进因素包括社区监督初级保健服务的文化。所有答复者群体都认为需要提高认识和培训，使服务使用者、照顾者、服务提供者和当地社区有能力参与。在个人服务使用者层面（关于精神健康状况、护理和权利的信息）和群体层面（宣传和代表）增强权能，以及改进、可获得的精神保健和生计干预措施，被认为是必不可少的。结论：随着埃塞俄比亚增加获得精神卫生保健的机会，妨碍服务使用者参与的一个根本障碍正在开始得到解决。我们的研究确定了需要解决的进一步障碍，包括支持性的政治气候和利益相关者之间的接受程度。调查结果将为制定服务用户参与模式提供参考，该模式将进行试验和评价。
Background: It is essential to involve service users in efforts to expand access to mental health care in integrated primary care settings in low-and middle-income countries (LMICs). However, there is little evidence from LMICs to guide this process. The aim of this study was to explore barriers to, and facilitators of, service user/caregiver involvement in rural Ethiopia to inform the development of a scalable approach.Methods: Thirty nine semi-structured interviews were carried out with purposively selected mental health service users (n = 13), caregivers (n = 10), heads of primary care facilities (n = 8) and policy makers/planners/service developers (n = 8). The interviews were audio-recorded and transcribed in Amharic, and translated into English. Thematic analysis was applied.Results: All groups of participants supported service user and caregiver involvement in mental health system strengthening. Potential benefits were identified as (i) improved appropriateness and quality of services, and (ii) greater protection against mistreatment and promotion of respect for service users. However, hardly any respondents had prior experience of service user involvement. Stigma was considered to be a pervasive barrier, operating within the health system, the local community and individuals. Competing priorities of service users included the need to obtain adequate individual care and to work for survival. Low recognition of the potential contribution of service users seemed linked to limited empowerment and mobilization of service users. Potential health system facilitators included a culture of community oversight of primary care services. All groups of respondents identified a need for awareness-raising and training to equip service users, caregivers, service providers and local community for involvement. Empowerment at the level of individual service users (information about mental health conditions, care and rights) and the group level (for advocacy and representation) were considered essential, alongside improved, accessible mental health care and livelihood interventions.Conclusion: As Ethiopia increases access to mental health care, a fundamental barrier to service user involvement is beginning to be addressed. Our study identified further barriers that need to be tackled, including a supportive political climate, and receptiveness amongst stakeholders. The findings will inform the development of a model of service user involvement, which will be piloted and evaluated.