Laura Asher1, Rahel Birhane2, Solomon Teferra2, Barkot Milkias2, Benyam Worku2, Alehegn Habtamu2, Brandon A Kohrt3, Charlotte Hanlon2,4,5. 1. Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom. 2. Department of Psychiatry, College of Health Sciences, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia. 3. Division of Global Mental Health, Department of Psychiatry, George Washington University, Washington DC, United States of America. 4. Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia. 5. Psychology and Neuroscience, Health Service and Population Research Department, King's College London, Institute of Psychiatry, Centre for Global Mental Health, London, United Kingdom.
Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
Authors: Brandon A Kohrt; Alison Schafer; Ann Willhoite; Edith Van't Hof; Gloria A Pedersen; Sarah Watts; Katherine Ottman; Kenneth Carswell; Mark van Ommeren Journal: World Psychiatry Date: 2020-02 Impact factor: 49.548
Authors: Gregory Armstrong; Michelle Kermode; Shoba Raja; Sujatha Suja; Prabha Chandra; Anthony F Jorm Journal: Int J Ment Health Syst Date: 2011-08-05
Authors: Dixon Chibanda; Petra Mesu; Lazarus Kajawu; Frances Cowan; Ricardo Araya; Melanie A Abas Journal: BMC Public Health Date: 2011-10-26 Impact factor: 3.295
Authors: Daisy R Singla; Benedict Weobong; Abhijit Nadkarni; Neerja Chowdhary; Sachin Shinde; Arpita Anand; Christopher G Fairburn; Sona Dimijdan; Richard Velleman; Helen Weiss; Vikram Patel Journal: Behav Res Ther Date: 2014-06-30
Authors: Laura Asher; Abebaw Fekadu; Charlotte Hanlon; Gemechu Mideksa; Julian Eaton; Vikram Patel; Mary J De Silva Journal: PLoS One Date: 2015-11-30 Impact factor: 3.240
Authors: Laura Asher; Rahel Birhane; Helen A Weiss; Girmay Medhin; Medhin Selamu; Vikram Patel; Mary De Silva; Charlotte Hanlon; Abebaw Fekadu Journal: Lancet Glob Health Date: 2022-04 Impact factor: 38.927
Authors: Anum Nisar; Juan Yin; Yiping Nan; Huanyuan Luo; Dongfang Han; Lei Yang; Jiaying Li; Duolao Wang; Atif Rahman; Xiaomei Li Journal: Int J Environ Res Public Health Date: 2022-03-30 Impact factor: 3.390