Role of Faith and Traditional Healing Practices in the Care of Severe Mental Disorders and Impact on Patient Level Outcomes.
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Date
2013-06
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Addis Ababa University
Abstract
Introduction: Mental disorders are common and are associated with severe disability, cost and mortality. The burden of mental disorders in low income countries like Ethiopia is compounded by the huge treatment gap, which is over 90% for Severe Mental Disorders (SMD) such as schizophrenia, bipolar disorder and major depressive disorder. The current strategy of the Federal Ministry of Health to narrow the treatment gap focuses on integration of mental health care into primary care. This agenda of integration has been advocated by the World Health Organization (WHO), and relies on training primary care staff to provide evidence-based interventions for selected (priority) disorders. However, neither the WHO nor the Ministry of Health provided explicit suggestions on how the integration would occur. Although Faith and Traditional Healers (FTHs) are key for the success of such integration, there is no direction on how they may be engaged or support care provision. Understanding treatment practices, attitudes, cultural factors and explanatory models that influence community utilization of FTHs and the link of these factors with utilization of bio-medical services may allow development of strategies to support collaboration between the FTH sand the biomedical sector. It may also improve access to timely bio-medical care. This proposed study will explore the role of FTHs in the care of patients with SMD and the impact on bio-medical service utilization and patient level outcomes. The study hypothesizes that most patients with SMDs will use FTHs before accessing biomedical care and these patients are likely to have longer duration of untreated psychosis resulting in poorer clinical, social and economic outcomes.
Objectives: the main objective of the study is to explore the pattern and determinants of the use ofFTHs practices for the care of SMDs, and impact on patient level outcomes.
Methods: four complementary studies will be conducted using a mixed quantitative and qualitative research design.o Study I will have two components
o The first component will be a cross-sectional community based study on 1,500 randomly selected sample of community members in Sodo district to determine community attitude towards FTHs and describe the prevalence and pattern of use of FTHs by the community.
o The second part of the initial cross-sectional survey will describe the profile of FTHs, their EMs about SMDs as well as define types of use of available service (predominant use)
o Study I I will have two components o The first component will be to explore the prevalence, pattern and determinants of use of FTHs among community(Key informant) identified persons with SMD, completed using all available information(Butajira Case Detection Method BCDM);
o The second component to determine baseline clinical, social and economic profiles in the three groups of patients with SMD basedontheir level of service utilization: predominantly FTH users, Predominantly Boimedical service users and those who use both services.
o study III will be a follow up of participants in study II to examine short-term (six months) patient level outcomes (clinical, social and economic) and pathways in care in relation to baseline FTH use
pattern; and o study IVwill examine, on purposively selected sample of FTHs and BMPs, behavioral determinant of collaboration between FTHs and BMPs (beliefs, attitudes, subjective norms and perceived behavioral control as well as intention towards collaboration) and the changes in these determinants.
Assessments: A set of assessment tools will be used to establish diagnosis, symptomatic and functional state as well as costs. Qualitative assessment will consist of face-to-face interview using semi structured questionnaire, Focus Group Discussions, In-depth interview and observations using guides and checklists. Quantitative data will be entered in epiData version 3 and analyzed using SPSS version17 and STATA 8.Thematic content analysis will be used for qualitative data.
Ethical consideration: Ethical approval will be sought from the Scientific Committee of the Department of Psychiatry and the Institutional Review Board of the College of Health Sciences, Addis Ababa University. Official permission will be secured from the Sodo district health office and health institutions. very selected respondent will be briefed about the purpose of the study and informed written consent will be sought from each participant. All papers, computers, external hard drives, and USB memory sticks containing data will be password protected and kept in secure (locked) locations to ensure confidentiality of information.
Expected outcome: The results of the study would provide more objective determination of the impact of FTHs utilization on patient level outcomes. The findings would allow development of possible models of broader collaboration and interventions to improve access to quality mental healthcare and hence improve the mental health status of people with SMDs.
Budget: Part of the cost for the study will be covered by aPRIME fellowship to the candidate. But the study will be nested within the larger PRIME (‘PRogramme for Improving Mental health carE) project.
Research plan: The research proposal will be submitted inMarch2013 for ethical approval and data collection is expected to begin in May2013.The whole research work will be finalized in early 2015.
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Keywords
Traditional Healing Practices, Faith, Mental Disorders