Community-based rehabilitation intervention for people with schizophrenia in Ethiopia (RISE): a 12 month mixed methods pilot study

Abstract

BackgroundCommunity-based rehabilitation (CBR), or community-based inclusive development, is an approach to address the complex health, social and economic needs of people with schizophrenia in low and middle-income countries. Formative work was undertaken previously to design a culturally appropriate CBR intervention for people with schizophrenia in Ethiopia. The current study explored the acceptability and feasibility of CBR in practice, as well as how CBR may improve functioning among people with schizophrenia.MethodsThis mixed methods pilot study took place in rural Ethiopia between December 2014 and December 2015. Ten people with schizophrenia who were unresponsive to treatment with medication alone, and their caregivers, participated in CBR. CBR was led by lay workers with five weeks training and involved home visits (education, family intervention and support returning to work) and community mobilisation. Theory of change was used to guide the pilot evaluation. Qualitative and quantitative data were collected at baseline, six months and 12 months. Forty in-depth interviews and two focus group discussions were conducted with 31 individuals comprising people with schizophrenia, caregivers, CBR workers, supervisors, health officers and community members.ResultsThe RISE CBR intervention may have a positive impact on functioning through the pathways of enhanced family support, improved access to health care, increased income and improved self-esteem. CBR was acceptable to CBR workers, community leaders and health officers. Some CBR workers found it challenging to accept the choices of people with schizophrenia. These concerns were felt to be resolvable with supplementary training for CBR workers. The intervention was feasible but further evaluation is needed on a larger scale.ConclusionIn low and middle-income countries, CBR may be an acceptable and feasible adjuvant approach to facility-based care for people with schizophrenia. However, contextual factors, including poverty and inaccessible anti-psychotic medication, remain substantial challenges. There were indications that CBR can impact on functioning but the RISE trial will determine effectiveness.Electronic supplementary materialThe online version of this article (10.1186/s12888-018-1818-4) contains supplementary material, which is available to authorized users.

Usefulness of Recovery services promoting personal recovery among Adults living with Severe Mental illness – A Comprehensive Integrative Review

“…Sixteen of the included papers described the integrated recovery services model used to achieve recovery for adults with severe mental illness ( Table 3). Most of the papers suggested that integrated recovery service model can be delivered through illness management (38)(39)(40)(41)(42)(43)(44), mindfulness-based interventions (45), task-sharing or shifting approach (25,26), home visits concept (29,46,47), active leisure or recreational activities (32,37) and music therapy (27) (see Table 4). The reviewed papers highlighted that the integrated recovery services generally aim at developing independent living skills, improve quality of life, community mobilisation (39), reducing inpatient and crisis services, adhering to treatment and setting meaningful goals towards recovery (40,41,46).…”

“…Conversely, music-creation therapy used as recovery services were run for 32 weekly sessions, with a duration of 90 min for each session (27). Generally, the activities of recovery service model covers components such as cognitive behaviour therapy techniques, psychoeducation, relapse prevention, social and coping skills training (meals, guidance in activities of daily living, role-playing, hobby groups) (38,40,46), adherence support, family therapy, crisis management, household contribution and understanding medication (25,29,46). More speci cally, Tjornstrand, Bejerholm (37) recommended that active leisure implemented as recovery services can take several activities, including playing sports, the opportunity to play games, eat, and socialize, embarking on excursions and relaxation (see Table 4).…”

“…painting, ceramics, silk screening, mosaics) and displays of art prints (56,57,59,60). Ten of the included papers highlighted that recovery services has helped to improve clinical outcomes of adults living with SMI (25,29,31,33,39,40,43,44,46,61). The services speci cally increase access to psychiatric medication, antipsychotic medication adherence, decrease relapse, improve knowledge and illness management, as well as decrease clinical contact (25,29,31,33,40,46,61).…”

Proxy WHO Disability Assessment Schedule 2.0 Is Clinically Useful for Assessing Psychosocial Functioning in Severe Mental Illness

“…Impaired psychosocial functioning in patients with SMI is multifactorial: adverse medication reactions (parkinsonism, obesity), and treatment setting (in-or outpatient) may influence functional recovery (9)(10)(11)(12)(13). For example, the medication side effect parkinsonism is associated with poor vocational performance (11), while some studies show positive results for community-based rehabilitation versus in-hospital treatment in patients with SMI (12)(13)(14).…”

Individualized Rehabilitation Programme in a Schizophrenic Patient: A Case Report

“…Günlük işlevsellik düzeyi ve yaşam kalitesi düşüktür. [1,2] Hastaların sağlıklı yaşam davranışları edinmesi ve sürdürmesi zordur, fiziksel sağlık sorunları sık görülür, ayrıca tedavide kullanılan psikotrop ilaçların yan etkileri hastaların yaşamına yeni sorunlar ekleyebilir. [3,4] Dolayısı ile rehabilitasyon programında kronik ruhsal hastaların sağlığı biyopsikososyal açıdan bütüncül olarak ele alınmalıdır.…”