An ethnography exploring the quality of life of people living with schizophrenia in Zimbabwe: Implications for health service policy and practice

Abstract

BackgroundSchizophrenia is a complex and severe mental disorder affecting more than 20 million people worldwide. Although understanding peoples' experiences of living with an illness is core to assessment, planning and delivering culture specific health care, little is known about the experiences of people living with schizophrenia in resource-poor countries. This article reports on a study that explored the everyday lives of eighteen people living with schizophrenia in Zimbabwe and its impact on their quality of life. MethodsThis focused ethnography was conducted over a three-month period in 2015. Data were collected using semi-structured interviews, non-participant observational fieldwork, and the short form of the World Health Organization Quality of Life questionnaire. Interview data were digitally recorded, transcribed and translated from Shona (local language) to English. Descriptive statistics and nonparametric tests were used to analyse questionnaire data. Qualitative data were analysed thematically using an established framework. ResultsSurvey data indicate internal consistency in the psychological and social relationships domains and poor quality of life for people aged 20-40. The major factors related to quality of life were: age, gender, family dislocation: living with stigma and discrimination; and limited and variable access to treatment and support. Obtaining and paying for antipsychotic medications were challenging and female participants recounted experiencing gender-based stigma. ConclusionsFindings from our study suggest that age, gender, family dislocation, stigma, discrimination, and variable limited access to affordable medications and support undermine quality of life by disrupting participants' ability to function in socially acceptable ways, their sense of belonging and self-worth, and family, work and social relations. Strengthening access to mental health services, addressing the affordability and availability of medications and initiatives to alleviate stigma and promote a sense of 3 belonging, especially for younger adults and women should be a priority for government and health service providers. Further research on managing mental health issues such as schizophrenia in Zimbabwe, should focus on initiatives to strengthen quality of life. Background Mental disorders, including schizophrenia, account for 5 per cent of the total burden of disease, 19 per cent of all disability in Africa [1] and exert an enormous financial, caring and support burden on the individual, family and community [2, 3]. The majority of those seeking help are unable to access treatment [2, 4, 5]. The urgent need for mental health service improvement and provision in all sectors including at country level, has been widely reported [6-9]. However, there is a paucity of literature concerning the experiences and quality of life of people living with schizophrenia in Zimbabwe. Schizophrenia is a complex and debilitating mental disorder that affects a person's thinking, emotions, language, behaviour and sense of self....