Impact of incentivizing ASHAs on the outcome of persons with severe mental illness in a rural South Indian community amidst the COVID-19 pandemic

Sivakumar, Thanapal; Basavarajappa, Chethan; Philip, Mariamma; Kumar, Channaveerachari Naveen; Thirthalli, Jagadisha; Parthasarathy, R.

doi:10.1016/j.ajp.2022.103388

Cited by 4 publications

(7 citation statements)

References 13 publications

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“…CHW interventions were heterogeneous across the 15 studies. Interventions included a low literacy checklist to maintain access to prenatal care during the COVID-19 pandemic in Guatemala and CHW training in COVID-19 in Thailand, India, Nepal [ 36 , 38 , 42 , 44 , 47 ]. There were CHW interventions that leveraged previously established CHW programmes to respond to the COVID-19 pandemic in hard-to-reach communities in Peru and India [ 37 , 43 ].…”

Section: Resultsmentioning

confidence: 99%

“…There were CHW interventions that leveraged previously established CHW programmes to respond to the COVID-19 pandemic in hard-to-reach communities in Peru and India [ 37 , 43 ]. Other CHW interventions sought to expand COVID-19 testing in India and strengthen linkages to abortion and mental health services during the COVID-19 pandemic in Pakistan and India [ 39 , 40 , 42 ]. In addition, rural CHWs strengthened COVID-19 prevention by influencing health behaviour in rural Bangladesh [ 46 ].…”

Section: Resultsmentioning

confidence: 99%

“…Shaikh et al reported on abortion outcomes during the COVID-19 pandemic in Pakistan [ 40 ]. Sivakumar et al reported on disability from mental illness, mental illness severity and self-induced stigma in rural India during the COVID-19 pandemic [ 42 ].…”

Section: Resultsmentioning

confidence: 99%

“…In India, mental health outcomes improved after continued linkage to mental health services through rural CHWs during the COVID-19 pandemic. As a result of this rural CHW intervention, there were statistically significant improvements in disability from mental illness, mental illness severity, and self-stigma due to mental illness compared to baseline measures: the mean WHO Disability Assessment Schedule 2.0 score was reduced from 16/100 at baseline to 12/100 at the second follow-up visit [ p = 0.001] [ 42 ]. Because of the heterogeneity in outcome measures across studies, a pooled analysis of effect measures was not possible.…”

Section: Resultsmentioning

confidence: 99%

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The effectiveness of rural community health workers in improving health outcomes during the COVID-19 pandemic: a systematic review

Kaseje,

Ranganathan,

Magadi

et al. 2024

Global Health Action

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Background Rural community health workers [CHWs] play a critical role in improving health outcomes during non-pandemic times, but evidence on their effectiveness during the COVID-19 pandemic is limited. There is a need to focus on rural CHWs and rural health systems as they have limited material and human resources rendering them more vulnerable than urban health systems to severe disruptions during pandemics. Objectives This systematic review aims to describe and appraise the current evidence on the effectiveness of rural CHWs in improving access to health services and health outcomes during the COVID-19 pandemic in low-and middle-income countries [LMICs]. Methods We searched electronic databases for articles published from 2020 to 2023 describing rural CHW interventions during the COVID-19 pandemic in LMICs. We extracted data on study characteristics, interventions, outcome measures, and main results. We conducted a narrative synthesis of key results. Results Fifteen studies from 10 countries met our inclusion criteria. Most of the studies were from Asia [10 of 15 studies]. Study designs varied and included descriptive and analytical studies. The evidence suggested that rural CHW interventions led to increased household access to health services and may be effective in improving COVID-19 and non-COVID-19 health outcomes. Overall, however, the quality of evidence was poor due to methodological limitations; 14 of 15 studies had a high risk of bias. Conclusion Rural CHWs may have improved access to health services and health outcomes during the COVID-19 pandemic in LMICs but more rigorous studies are needed during future pandemics to evaluate their effectiveness in improving health outcomes in different settings and to assess appropriate support required to ensure their impact at scale.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

The effectiveness of rural community health workers in improving health outcomes during the COVID-19 pandemic: a systematic review

Kaseje,

Ranganathan,

Magadi

et al. 2024

Global Health Action

View full text Add to dashboard Cite

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“…We suggest incentivizing ASHA workers to identify new PwMIs and for continued engagement with mentally ill patients, as it has been proven successful. 42 …”

Section: Discussionmentioning

confidence: 99%

Perspectives of Community Nurses on Treatment Engagement of Persons with Severe Mental Illnesses (PwSMI): A Qualitative Study from South India

Somanathan,

Gandhi,

Sivakumar

et al. 2023

Indian Journal of Psychological Medicine

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Background: There is increasing evidence of the need for treatment engagement between Persons with Severe Mental Illnesses (PwSMIs) and Mental Health Professionals (MHPs). This therapeutic process involves collaborative work between patients and MHPs, which improves the condition. Community nurses are uniquely positioned to facilitate this process as they act as the focal point of interaction between patients and the health system. Methods: This qualitative study explored the community nurses’ experiences in treatment engagement with PwSMI through eight group interviews of 35 community nurses from District Mental Health Programs (DMHPs) across Karnataka (South India) from February 2020 to March 2020. The audio recordings of the interviews were transcribed and coded to arrive at themes and subthemes. Results: The major themes identified were factors influencing treatment engagement, strategies to tackle treatment nonengagement, and challenges in dealing with nonengagement. The reasons for nonengagement were lack of insight and lack of knowledge of sociocultural, logistic, and treatment-related factors. The DMHP teams contacted patients through phone calls, home visits, and liaisons with health workers and intervened with them through education and depot injections. The major challenges were difficulty conducting home visits, distances, the unavailability of medications, and the need for adequate infrastructure and human resources. Conclusion: Community nurses address a few factors of nonengagement, such as insight, sociocultural factors, and treatment-related factors. Addressing the systemic challenges and adequate training of nurses in intervening in the dropped-out PwSMIs would help to reduce the treatment gap.

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Outcome of Wage and Self-employment intervention for Persons with Severe Mental Illness availing Rural Community-based Rehabilitation Project: Experience from South India

Sivakumar,

Reddy K,

Jagannathan

et al. 2024

Preprint

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Background: The World Health Organization advocates Community-Based Rehabilitation (CBR) for resource-constrained settings. There is a need for evidence-based models of employment for persons with severe mental illness (referred to as patients) from such settings. Aims: To facilitate and study the employment outcome of patients aged 18-50 years, availing a rural CBR project in South India. Methods: Of 98 consented patients, only three men chose wage employment, and eighty-nine chose self-employment. Patients seeking wage employment were offered training and job placement in the nearest metropolitan city. Ten patients were offered loans for self-employment as revolving funds without collateral through the family federation of persons with mental illness. The patients and families were followed up for ten months after recruitment into intervention. The AIMS-SEEP tool assessed the impact on families that availed of loans. Results: All three men who chose wage employment in the city discontinued it. Two of ten families did not use it for the intended purpose, and one loan was written off. Seven families chose sheep rearing, and one bought a tailoring machine. Self-employment was a secondary source of income for families and was used for food, clothes, school expenses, health-related costs, household items, and debt repayment. The attendance at monthly meetings of the family federation has more than tripled since loans were issued. Families reported no adverse effects due to the intervention. Only three out of eight families had repaid the loan completely at the end of ten months. Reasons cited for delay in loan repayment were hospital expenses for a sick family member and children's school expenses. Conclusion: In impoverished rural areas, patients and their families prefer self-employment locally over shifting to the city for wage employment. Suggestions for implementing livelihood interventions in other resource-constrained settings are discussed. Families must own the initiative to ensure its sustainability.

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Impact of incentivizing ASHAs on the outcome of persons with severe mental illness in a rural South Indian community amidst the COVID-19 pandemic

Cited by 4 publications

References 13 publications

The effectiveness of rural community health workers in improving health outcomes during the COVID-19 pandemic: a systematic review

The effectiveness of rural community health workers in improving health outcomes during the COVID-19 pandemic: a systematic review

Perspectives of Community Nurses on Treatment Engagement of Persons with Severe Mental Illnesses (PwSMI): A Qualitative Study from South India

Outcome of Wage and Self-employment intervention for Persons with Severe Mental Illness availing Rural Community-based Rehabilitation Project: Experience from South India

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