Supervised treatment in outpatients for schizophrenia plus (STOPS+): protocol for a cluster randomised trial of a community-based intervention to improve treatment adherence and reduce the treatment gap for schizophrenia in Pakistan

Shepherd, Thomas A.; Ul‐Haq, Zia; Ul-Haq, Mian Mukhtiar; Khan, Muhammad Firaz; Afridi, Adil; Dikomitis, Lisa; Robinson, Michelle; Lewis, Martyn; Rahman, Atıf; Dziedzic, Krysia; Saeed, Umaima; Awan, Naila Riaz; Mallen, Christian; Farooq, Saeed

doi:10.1136/bmjopen-2019-034709

Cited by 5 publications

(11 citation statements)

References 42 publications

(29 reference statements)

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“…This qualitative study provided the STOPS+ research team valuable insights for developing our intervention and following essential components of STOPS+ intervention were developed in the light of these findings [ 15 ]. The complete details of intervention are as follows: (1) Supervision by a trained family member for dispensing and administering medication: The family member will dispense medication, observe that is has been taken correctly and record this information on a simple sheet of paper designed and used in the previous STOPS trial.…”

Section: Discussionmentioning

confidence: 99%

“…(3) Monitoring the availability of essential psychotropic medication and their side effects: A kit to monitor the supply of medication will be used to monitor the availability and supply of psychotropic medication. This will consist of (a) a cupboard dedicated specifically for the storage of psychotropic medication, (b) a tracking sheet used to monitor the stock levels and (c) a simple checklist for monitoring side effects of antipsychotics [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…The Primary Health Care (PHC) facilities are provided by a network of Basic Health Units (BHUs), Civil Dispensaries (CDs) and Rural Health Centres (RHCs) [ 18 ]. Each PHC is staffed by Primary Care Physicians (PCPs) and Multipurpose PHC Technicians (MTs) [ 15 ]. MTs are trained in providing basic health services to the community and to assist PCPs with treating patients in the PHC facilities located within the community [ 15 , 19 ].…”

Section: Methodsmentioning

confidence: 99%

“…Each PHC is staffed by Primary Care Physicians (PCPs) and Multipurpose PHC Technicians (MTs) [ 15 ]. MTs are trained in providing basic health services to the community and to assist PCPs with treating patients in the PHC facilities located within the community [ 15 , 19 ].…”

Section: Methodsmentioning

confidence: 99%

“…The scaled-up intervention, called Supervised Treatment in Outpatients for Schizophrenia Plus (STOPS+), involves primary care and community stakeholders, while overcoming barriers for implementation in the real world and adopting a whole system approach. The protocol evaluating the STOPS+ in cluster Randomized Controlled Trial (RCT) is described elsewhere [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

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Primary-level worker interventions for the care of people living with mental disorders and distress in low- and middle-income countries

Ginneken

Chin

Lim

et al. 2021

Cochrane Database of Systematic Reviews

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Background Community‐based primary‐level workers (PWs) are an important strategy for addressing gaps in mental health service delivery in low‐ and middle‐income countries. Objectives To evaluate the effectiveness of PW‐led treatments for persons with mental health symptoms in LMICs, compared to usual care. Search methods MEDLINE, Embase, CENTRAL, ClinicalTrials.gov, ICTRP, reference lists (to 20 June 2019). Selection criteria Randomised trials of PW‐led or collaborative‐care interventions treating people with mental health symptoms or their carers in LMICs. PWs included: primary health professionals (PHPs), lay health workers (LHWs), community non‐health professionals (CPs). Data collection and analysis Seven conditions were identified apriori and analysed by disorder and PW examining recovery, prevalence, symptom change, quality‐of‐life (QOL), functioning, service use (SU), and adverse events (AEs). Risk ratios (RRs) were used for dichotomous outcomes; mean difference (MDs), standardised mean differences (SMDs), or mean change differences (MCDs) for continuous outcomes. For SMDs, 0.20 to 0.49 represented small, 0.50 to 0.79 moderate, and ≥0.80 large clinical effects. Analysis timepoints: T1 (<1 month), T2 (1‐6 months), T3 ( >6 months) post‐intervention. Main results Description of studies 95 trials (72 new since 2013) from 30 LMICs (25 trials from 13 LICs). Risk of bias Most common: detection bias, attrition bias (efficacy), insufficient protection against contamination. Intervention effects *Unless indicated, comparisons were usual care at T2. “Probably”, “may”, or “uncertain” indicates "moderate", "low," or "very low" certainty evidence. Adults with common mental disorders (CMDs) LHW‐led interventions a. may increase recovery (2 trials, 308 participants; RR 1.29, 95%CI 1.06 to 1.56); b. may reduce prevalence (2 trials, 479 participants; RR 0.42, 95%CI 0.18 to 0.96); c. may reduce symptoms (4 trials, 798 participants; SMD ‐0.59, 95%CI ‐1.01 to ‐0.16); d. may improve QOL (1 trial, 521 participants; SMD 0.51, 95%CI 0.34 to 0.69); e. may slightly reduce functional impairment (3 trials, 1399 participants; SMD ‐0.47, 95%CI ‐0.8 to ‐0.15); f. may reduce AEs (risk of suicide ideation/attempts); g. may have uncertain effects on SU. Collaborative‐care a. may increase recovery (5 trials, 804 participants; RR 2.26, 95%CI 1.50 to 3.43); b. may reduce prevalence although the actual effect range indicates it may have little‐or‐no effect (2 trials, 2820 participants; RR 0.57, 95%CI 0.32 to 1.01); c. may slightly red...

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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

Farooq,

Sheikh,

Dikomitis

et al. 2023

BMJ Open

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ObjectivesIn low/middle-income countries (LMICs), more than half of patients with first-episode psychosis initially seek treatment from traditional and religious healers as their first care. This contributes to an excessively long duration of untreated psychosis (DUP). There is a need for culturally appropriate interventions to involve traditional and spiritual healers to work collaboratively with primary care practitioners and psychiatrists through task-shifting for early detection, referral and treatment of first episode of psychosis.MethodsTo prevent the consequences of long DUP in adolescents in LMICs, we aim to develop and pilot test a culturally appropriate and context-bespoke intervention.TraditionalHEalers working with primary care and mentalHealth for early interventiOn inPsychosis in young pErsons (THE HOPE) will be developed using ethnographic and qualitative methods with traditional healers and caregivers. We will conduct a randomised controlled cluster feasibility trial with a nested qualitative study to assess study recruitment and acceptability of the intervention. Ninety-three union councils in district Peshawar, Pakistan will be randomised and allocated using a 1:1 ratio to either intervention arm (THE HOPE) or enhanced treatment as usual and stratified by urban/rural setting. Data on feasibility outcomes will be collected at baseline and follow-up. Patients, carers, clinicians and policymakers will be interviewed to ascertain their views about the intervention. The decision to proceed to the phase III trial will be based on prespecified stop–go criteria.Ethics and disseminationEthical approval has been obtained from Keele University Ethical Review Panel (ref: MH210177), Khyber Medical University Ethical Review Board (ref: DIR/KMU-EB/IG/001005) and National Bioethics Committee Pakistan (ref no. 4-87/NBC-840/22/621). The results of THE HOPE feasibility trial will be reported in peer-reviewed journals and academic conferences and disseminated to local stakeholders and policymakers.Trial registration numberISRCTN75347421.

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Supervised treatment in outpatients for schizophrenia plus (STOPS+): protocol for a cluster randomised trial of a community-based intervention to improve treatment adherence and reduce the treatment gap for schizophrenia in Pakistan

Cited by 5 publications

References 42 publications

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

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

Primary-level worker interventions for the care of people living with mental disorders and distress in low- and middle-income countries

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

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