The development of a lay health worker delivered collaborative community based intervention for people with schizophrenia in India.
The development of a lay health worker delivered collaborative community based intervention for people with schizophrenia in India.
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DOI：
10.1186/1472-6963-12-42
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发表时间：
2012-02-16
影响因子：
2.8
通讯作者：
Patel V
中科院分区：
文献类型：
--
作者：
Balaji M;Chatterjee S;Koschorke M;Rangaswamy T;Chavan A;Dabholkar H;Dakshin L;Kumar P;John S;Thornicroft G;Patel V
在低收入和中等收入国家，精神分裂症的护理主要是以设施为基础，由专家领导，非药物治疗的使用有限。虽然强调以社区为基础的心理社会干预，但很少有证据表明其可接受性和可行性。此外，缺乏熟练的人力是改善获得这些干预措施的一个主要障碍。我们的研究旨在开发一个外行卫生工作者提供的社区为基础的干预在印度的三个地点。本文介绍了如何系统地制定干预措施，以下MRC框架的发展复杂的干预措施。我们回顾了有关精神分裂症负担的文献、低收入和中等收入国家的治疗差距以及基于社区的治疗的证据，并确定了干预成分。然后，我们通过对精神分裂症患者及其主要照顾者的形成性案例研究，评估了这种一揽子护理的可接受性和可行性，并在30个家庭中进行了试点。根据审查，我们的干预措施包括五个组成部分（心理教育;坚持管理;康复;转介到社区机构;和健康促进），由训练有素的非专业卫生工作者在专家的监督下提供。由于开展了初步和试点工作，干预措施经历了一些变化。虽然所有组成部分都是可以接受的，而且大多数是可行的，但污名化和歧视的经历没有得到充分解决;一些参与者担心在家里提供护理会导致疾病披露;一些参与者和提供者不了解干预措施与日常护理的关系;一些家庭不愿意参与;以及在提供服务方面存在问题，例如，在达到预定的治疗次数方面。与会者认为卫生工作者提供服务是可以接受的，并希望他们了解这一主题。有些人对他们的人口统计和个人特征有期望，例如，只喜欢女性或那些理解/友好的人。然后，在干预措施中增加了解决污名化问题的新内容，加强了提供服务的协作性质，建立了多层次的监督制度，并使各部分的提供更加灵活。根据参与者的期望，制定了选择和培训卫生工作者的标准。在印度，由受过培训的非专业卫生工作者在精神卫生专家的监督下提供的多成分社区干预措施是治疗精神分裂症的一种可接受和可行的干预措施。
Care for schizophrenia in low and middle income countries is predominantly facility based and led by specialists, with limited use of non-pharmacological treatments. Although community based psychosocial interventions are emphasised, there is little evidence about their acceptability and feasibility. Furthermore, the shortage of skilled manpower is a major barrier to improving access to these interventions. Our study aimed to develop a lay health worker delivered community based intervention in three sites in India. This paper describes how the intervention was developed systematically, following the MRC framework for the development of complex interventions. We reviewed the lierature on the burden of schizophrenia and the treatment gap in low and middle income countries and the evidence for community based treatments, and identified intervention components. We then evaluated the acceptability and feasibility of this package of care through formative case studies with individuals with schizophrenia and their primary caregivers and piloted its delivery with 30 families. Based on the reviews, our intervention comprised five components (psycho-education; adherence management; rehabilitation; referral to community agencies; and health promotion) to be delivered by trained lay health workers supervised by specialists. The intervention underwent a number of changes as a result of formative and pilot work. While all the components were acceptable and most were feasible, experiences of stigma and discrimination were inadequately addressed; some participants feared that delivery of care at home would lead to illness disclosure; some participants and providers did not understand how the intervention related to usual care; some families were unwilling to participate; and there were delivery problems, for example, in meeting the targeted number of sessions. Participants found delivery by health workers acceptable, and expected them to have knowledge about the subject matter. Some had expectations regarding their demographic and personal characteristics, for example, preferring only females or those who are understanding/friendly. New components to address stigma were then added to the intervention, the collaborative nature of service provision was strengthened, a multi-level supervision system was developed, and delivery of components was made more flexible. Criteria were evolved for the selection and training of the health workers based on participants' expectations. A multi-component community based intervention, targeting multiple outcomes, and delivered by trained lay health workers, supervised by mental health specialists, is an acceptable and feasible intervention for treating schizophrenia in India.
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影响因子：
15.8
作者：
Saha, S;Chant, D;Welham, J;McGrath, J
通讯作者：
McGrath, J
影响因子：
15.8
作者：
Patel V;Farooq S;Thara R
通讯作者：
Thara R
影响因子：
2.5
作者：
Chatterjee, Sudipto;Leese, Morven;Thornicroft, Graham
通讯作者：
Thornicroft, Graham
影响因子：
10.5
作者：
Chatterjee, S;Patel, V;Weiss, HA
通讯作者：
Weiss, HA
影响因子：
6.7
作者：
THARA, R;HENRIETTA, M;EATON, WW
通讯作者：
EATON, WW