Patients’ and healthcare professionals’ perspectives on a community-based intervention for schizophrenia in Pakistan: A focus group study

Abstract

Objective To explore the perceptions and experiences of schizophrenia from patients, their care givers, health care providers, spiritual and traditional healers to develop a community-based intervention for improving treatment adherence for people with schizophrenia in Pakistan. Methods This qualitative study involved four focus group discussions (FGD) with a total of 26 participants: patients and carers (n = 5), primary care staff (n = 7), medical technicians (n = 8) and traditional and spiritual healers (n = 6). The participants were selected using purposive sampling method. FGDs were audio-recorded and transcribed. A thematic analysis was applied to the data set. Results The themes identified were (i) Schizophrenia is not merely a biomedical problem: participants believed that poverty and an inferiority complex resulting from social disparity caused schizophrenia and contributed to non-adherence to medications; (ii) Spiritual healing goes hand in hand with the medical treatment: participants regarded spiritual and traditional treatment methods as an inherent part of schizophrenia patients’ well-being and rehabilitation; (iii) Services for mental illness: mental health is not covered under primary health in a basic health unit: participants believed that the lack of services, training and necessary medication in primary care are major issues for treating schizophrenia in community; (iv) Barriers to community-based interventions: primary care staff believed that multiple pressures on staff, lack of incentives, non-availability of medication and lack of formal referral pathways resulted in disintegration of dealing with schizophrenia patients in primary care facilities. Conclusion The study has identified a number of barriers and facilitators to developing and delivering a psychosocial intervention to support people living with schizophrenia in Pakistan. In particular, the importance of involving spiritual and traditional healers was highlighted by our diverse group of stakeholders.

Traditional healers working with primary care and mental health for early intervention in psychosis in young persons: protocol for the feasibility cluster randomised controlled trial

“…8 This is consistent with a systematic review showing predominantly supernatural explanatory models of illness for psychosis in LMICs. 9 Research with TSHs in Pakistan [10][11][12] has identified that the following terms are used for identifying people suffering from psychosis: influence of jinn, saya (influence or shadow), 'strong spell or under the control of spirits' lewanay (insane) and 'superstitious'. This is consistent with previous literature.…”

“…The Open access information gained from ethnographic and qualitative studies will inform the contents, format and methodology for training TSHs. Based on our experience of working with traditional healers in the STOPS+ Programme, 10 the training will mainly focus on the following topics: overcoming barriers to working with psychiatric services, symptoms and signs of FEP and differentiating these from normal behaviours expected in adolescence, attitudes and behaviours towards people with psychosis, avoiding harmful practices, respecting individual autonomy, preventing gender-based discrimination and information about referral pathways.…”

Including families in schizophrenia treatment: a systematic review

“…In this case, lack of access to mental health services is an important issue. In addition, Schizophrenia tends to seek treatment than the general population [4]- [7].…”