"Like a doctor, like a brother": Achieving competence amongst lay health workers delivering community-based rehabilitation for people with schizophrenia in Ethiopia.
"Like a doctor, like a brother": Achieving competence amongst lay health workers delivering community-based rehabilitation for people with schizophrenia in Ethiopia.
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DOI：
10.1371/journal.pone.0246158
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发表时间：
2021
期刊：
影响因子：
3.7
通讯作者：
Hanlon C
中科院分区：
文献类型：
--
作者：
Asher L;Birhane R;Teferra S;Milkias B;Worku B;Habtamu A;Kohrt BA;Hanlon C
对于非专业人士（例如非专业卫生工作者）如何获得在低收入和中等收入国家提供社会心理干预的核心能力，我们的理解存在差距。我们在埃塞俄比亚精神分裂症患者康复干预 (RISE) 试点研究的同时进行了一项为期 12 个月的混合方法研究。我们使用埃塞俄比亚改编的常见治疗因素增强评估 (ENACT) 结构化观察评级量表，对 10 名社区康复 (CBR) 外行工作者的总共 30 次角色扮演和 55 次临床经历进行了评级。为了探讨影响能力的因素，我们在三个时间点对 11 名社区康复工作人员和两名主管进行了 6 次焦点小组讨论和 4 次深度访谈。我们进行了主题分析并对定性和定量数据进行了三角测量。在整个培训和 12 个月的试点研究中，社区康复工作人员的能力得到了提高。治疗联盟能力（例如同理心）最早得到改善。个人因素（例如物质使用）和外部因素（例如评估社交网络）的能力最初被评为较低，但在试点期间分数有所提高。解决问题和提供建议的能力总体上进步最少。多模式培训，包括角色扮演、现场工作和小组讨论，有助于早期能力的发展。通过接触减少了最初对社区康复参与者的耻辱。随着时间的推移，社区康复工作人员在项目中扮演了精神分裂症患者的专家和亲密朋友的双重角色。能力是通过同行监督来维持的，这也支持了福祉。需要更深入的专家监督。可以让非专业卫生工作者具备为低收入环境中的精神分裂症患者提供心理社会干预的核心能力。需要长期的工作经验来培养解决问题等高级技能。建议采用具有明确协议的结构化干预措施，并结合同伴监督以支持福祉，以提供高质量的干预措施。重复的 ENACT 评估可以可行且成功地用于识别需要改进的领域并指导持续的培训和监督。
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. 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. 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. 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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影响因子：
4.4
作者：
Brooke-Sumner C;Petersen I;Asher L;Mall S;Egbe CO;Lund C
通讯作者：
Lund C
影响因子：
4.4
作者：
Asher L;Hanlon C;Birhane R;Habtamu A;Eaton J;Weiss HA;Patel V;Fekadu A;De Silva M
通讯作者：
De Silva M
影响因子：
168.9
作者：
Kakuma, Ritsuko;Minas, Harry;Scheffler, Richard M.
通讯作者：
Scheffler, Richard M.
DOI：
10.1192/bjp.bp.114.153676
发表时间：
2016-01
期刊：
The British journal of psychiatry : the journal of mental science
影响因子：
--
作者：
Fekadu A;Hanlon C;Medhin G;Alem A;Selamu M;Giorgis TW;Shibre T;Teferra S;Tegegn T;Breuer E;Patel V;Tomlinson M;Thornicroft G;Prince M;Lund C
通讯作者：
Lund C
影响因子：
5.4
作者：
Kohrt, Brandon A.;Turner, Elizabeth L.;Jordans, Mark J. D.
通讯作者：
Jordans, Mark J. D.