Methods and madness : researching community health workers' perceptions of mental illness in Khayelitsha and Nyanga
Master Thesis
1993
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University of Cape Town
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This dissertation explores the use of qualitative methods to research community health workers' (CHWs) perceptions of mental health problems in Khayelitsha and Nyanga, two peri-urban Black townships in the Cape Town area. Since the historic WHO-UNICEF meeting at Alma-Ata in 1978, there has been widespread interest in the concept of CHW s as the ideal work force for advancing the principles of the primary health care (PH C) approach. In seeking to transform the structure and delivery of mental health care in South Africa within the confines of limited financial and human resources, policy makers are shifting attention to the integration of mental health care within a PHC framework. Fundamental to the PHC agenda, as conceptualised at Alma-Ata, is health care that is based on appropriate technologies and that encourages effective community participation in making decisions about health issues. In the past few decades, anthropological perspectives gained from cross-cultural research into health beliefs and practices have made valuable contributions to the planning and implementation ofPHC programmes. In the field of medical anthropology, hermeneutically orientated approaches play an important role in advocacy, whereby the patient's perspective on illness and the meaning of illness is brought to the fore in an attempt to provide more patient-centred care. In this research, CHW s were interviewed to gain insight into the scope of primary mental health care, as perceived by them, and prevailing beliefs and practices surrounding mental health problems. Unstructured individual interviews were conducted with 20 CHW s working in community-based PHC projects in Khayelitsha and Nyanga to elicit their personal accounts of mental health problems in their geographical communities. This material was used to construct five vignette descriptions of mental health problems in the CHWs' own words. Kleinman's explanatory model approach was used in structured individual interviews to access CHW s' understandings of mental illness. Questions related to naming the problem; theories of illness causation; coping with the problem; and decision-making as regards treatment options. Focus group interviews were held with the participants of two of the CHW projects to explore their feelings about involvement in mental health care. This micro-level analysis was accompanied by the perspectives of critically-interpretive medical anthropology which shifts attention beyond the individual cultural construction of illness to the political and economic factors affecting the social organisation of health care. Within the PHC setting, the critical perspective entails challenging constraints to the attainment of health for all as a result of inequities in the distribution of power and wealth; barriers to achieving community participation in health issues; and inequitable access to basic primary health needs by the most disadvantaged.
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Binedell, J. 1993. Methods and madness : researching community health workers' perceptions of mental illness in Khayelitsha and Nyanga. University of Cape Town.