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Development of a Community-Based Rehabilitation Intervention for People with Schizophrenia in Ethiopia

Author

Listed:
  • Laura Asher
  • Abebaw Fekadu
  • Charlotte Hanlon
  • Gemechu Mideksa
  • Julian Eaton
  • Vikram Patel
  • Mary J De Silva

Abstract

Background: Community-based rehabilitation (CBR) is a multi-sectoral strategy to improve the functioning and quality of life of people with disabilities. The RISE (Rehabilitation Intervention for people with Schizophrenia in Ethiopia) trial will evaluate the effectiveness of CBR for people with schizophrenia in Ethiopia. Nevertheless, the components of CBR that are both feasible and likely to prove effective in low and middle-income countries such as Ethiopia are unclear. Methods: In this study intervention development work was undertaken to design a CBR intervention that is acceptable and feasible in the local context. The development work consisted of five phases. 1: Identify potential components of CBR for schizophrenia, 2: Situational analysis, 3: Determine feasibility of CBR (Theory of Change workshops with experts and local stakeholders), 4: Determine acceptability of CBR (16 in-depth interviews and five focus group discussions with people with schizophrenia, caregivers, health workers and community leaders) and 5: Synthesise results to finalise intervention. A Theory of Change map was constructed showing the causal pathway for how we expect CBR to achieve its impact. Results: People with schizophrenia in rural Ethiopia experience family conflict, difficulty participating in work and community life, and stigma. Stakeholders perceived CBR to be acceptable and useful to address these problems. The focus of CBR will be on the individual developing the skills and confidence to perform their previous or desired roles and activities. To ensure feasibility, non-health professionals will be trained to deliver CBR and provide supervision, rather than mental health specialists. Novel components of CBR for schizophrenia included family intervention and dealing with distressing symptoms. Microfinance was excluded due to concerns about stress and exploitation. Community mobilisation was viewed as essential to ensure the effectiveness and sustainability of CBR. Conclusion: Extensive formative research using a variety of methods has enabled the design of a culturally appropriate CBR intervention for people with schizophrenia that is acceptable and feasible.

Suggested Citation

  • Laura Asher & Abebaw Fekadu & Charlotte Hanlon & Gemechu Mideksa & Julian Eaton & Vikram Patel & Mary J De Silva, 2015. "Development of a Community-Based Rehabilitation Intervention for People with Schizophrenia in Ethiopia," PLOS ONE, Public Library of Science, vol. 10(11), pages 1-19, November.
    • Handle: RePEc:plo:pone00:0143572
    DOI: 10.1371/journal.pone.0143572
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    References listed on IDEAS

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    1. Padmanathan, Prianka & De Silva, Mary J., 2013. "The acceptability and feasibility of task-sharing for mental healthcare in low and middle income countries: A systematic review," Social Science & Medicine, Elsevier, vol. 97(C), pages 82-86.
    2. Anahita Khodabakhshi Koolaee & Ahmad Etemadi, 2010. "The Outcome of Family Interventions for the Mothers of Schizophrenia Patients in Iran," International Journal of Social Psychiatry, , vol. 56(6), pages 634-646, November.
    3. Medhin Selamu & Laura Asher & Charlotte Hanlon & Girmay Medhin & Maji Hailemariam & Vikram Patel & Graham Thornicroft & Abebaw Fekadu, 2015. "Beyond the Biomedical: Community Resources for Mental Health Care in Rural Ethiopia," PLOS ONE, Public Library of Science, vol. 10(5), pages 1-14, May.
    4. Mendenhall, Emily & De Silva, Mary J. & Hanlon, Charlotte & Petersen, Inge & Shidhaye, Rahul & Jordans, Mark & Luitel, Nagendra & Ssebunnya, Joshua & Fekadu, Abebaw & Patel, Vikram & Tomlinson, Mark &, 2014. "Acceptability and feasibility of using non-specialist health workers to deliver mental health care: Stakeholder perceptions from the PRIME district sites in Ethiopia, India, Nepal, South Africa, and U," Social Science & Medicine, Elsevier, vol. 118(C), pages 33-42.
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    Cited by:

    1. Jane Wilbur & Tess Bright & Thérèse Mahon & Shaffa Hameed & Belen Torondel & Wakisa Mulwafu & Hannah Kuper & Sarah Polack, 2018. "Developing Behaviour Change Interventions for Improving Access to Health and Hygiene for People with Disabilities: Two Case Studies from Nepal and Malawi," IJERPH, MDPI, vol. 15(12), pages 1-21, December.
    2. Sean A Kidd & Athena Madan & Susmitha Rallabandi & Donald C Cole & Elisha Muskat & Shoba Raja & David Wiljer & David Aylward & Kwame McKenzie, 2016. "A Multiple Case Study of Mental Health Interventions in Middle Income Countries: Considering the Science of Delivery," PLOS ONE, Public Library of Science, vol. 11(3), pages 1-17, March.
    3. Xanthe Hunt & Melissa Bradshaw & Steyn Lodewyk Vogel & Alberto Vasquez Encalada & Shanice Eksteen & Marguerite Schneider & Kelly Chunga & Leslie Swartz, 2022. "Community Support for Persons with Disabilities in Low- and Middle-Income Countries: A Scoping Review," IJERPH, MDPI, vol. 19(14), pages 1-17, July.

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