Improving adherence in mental health service users with severe mental illness in South Africa: a pilot randomized controlled trial of a treatment partner and text message intervention vs. treatment as usual

Abstract

ObjectivesMedication non-adherence is a significant problem in treatment of severe mental disorders and is associated with poor clinical outcomes and increased demand on services. Task-shifting interventions incorporating mobile health may improve adherence in mental health service users in low- and middle-income countries. Seventy-seven participants were recruited from a psychiatric hospital in Cape Town, with 42 randomized to receive the intervention and 35 to treatment as usual. Intervention pairs underwent treatment-partner contracting and psychoeducation, and received monthly text message reminders of clinic appointments. Primary outcomes were intervention acceptability and feasibility. Secondary outcome for efficacy were adherence to clinic visit; relapse; quality of life; symptomatic relief and medication adherence.ResultsTreatment partner and psychoeducation components were acceptable and feasible. The text message component was acceptable but not feasible in its current form. Efficacy outcomes favoured the intervention but did not reach statistical significance. A treatment-partner intervention is acceptable and feasible in a low- and middle-income setting. Work is needed to ensure that additional components of such interventions are tailored to the local context. Appropriately powered efficacy studies are needed. Trial Registration PACTR PACTR201610001830190, Registered 21 October 2016 (Retrospectively registered)Electronic supplementary materialThe online version of this article (10.1186/s13104-017-2915-z) contains supplementary material, which is available to authorized users.

Taking steps towards deinstitutionalizing mental health care within a low and middle-income country: A cross-sectional study of service user needs in the Republic of Moldova

“…Moreover, from the Central and Eastern European context, Winkler and colleagues report an EQ-5D index for quality of life between 77 and 80 among Czech mental health care service users suffering from a psychosis (Winkler, Koeser, et al, 2018). In South Africa, service users with severe mental disorders reported a quality of life (EQ-5D VAS) of 84 (out of 100), which is higher than service users in the current sample (Sibeko et al, 2017). In sum, service users in other studies using the same tool to assess quality of life and with similar mental health systems in transition to that of Moldova report a higher quality of life than in our sample, indicating that services can make steps towards further improvements in quality of life of service users.…”

Global mental health and schizophrenia

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Feasibility of implementing a behavioral economics mobile health platform for individuals with behavioral health conditions

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