Service user involvement in mental health system strengthening in a rural African setting: qualitative study

 

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dc.contributor.author Abayneh, Sisay
dc.contributor.author Lempp, Heidi
dc.contributor.author Alem, Atalay
dc.contributor.author Alemayehu, Daniel
dc.contributor.author Eshetu, Tigist
dc.contributor.author Lund, Crick
dc.contributor.author Semrau, Maya
dc.contributor.author Thornicroft, Graham
dc.contributor.author Hanlon, Charlotte
dc.date.accessioned 2017-05-23T13:21:41Z
dc.date.available 2017-05-23T13:21:41Z
dc.date.issued 2017-05-18
dc.identifier.citation Abayneh, S., Lempp, H., Alem, A., Alemayehu, D., Eshetu, T., Lund, C., ... & Hanlon, C. (2017). Service user involvement in mental health system strengthening in a rural African setting: qualitative study. BMC psychiatry, 17(1), 187.
dc.identifier.uri http://dx.doi.org/10.1186/s12888-017-1352-9
dc.identifier.uri http://hdl.handle.net/11427/24387
dc.description.abstract Background: It is essential to involve service users in efforts to expand access to mental health care in integrated primary care settings in low- and middle-income countries (LMICs). However, there is little evidence from LMICs to guide this process. The aim of this study was to explore barriers to, and facilitators of, service user/caregiver involvement in rural Ethiopia to inform the development of a scalable approach. Methods: Thirty nine semi-structured interviews were carried out with purposively selected mental health service users (n = 13), caregivers (n = 10), heads of primary care facilities (n = 8) and policy makers/planners/service developers (n = 8). The interviews were audio-recorded and transcribed in Amharic, and translated into English. Thematic analysis was applied. Results: All groups of participants supported service user and caregiver involvement in mental health system strengthening. Potential benefits were identified as (i) improved appropriateness and quality of services, and (ii) greater protection against mistreatment and promotion of respect for service users. However, hardly any respondents had prior experience of service user involvement. Stigma was considered to be a pervasive barrier, operating within the health system, the local community and individuals. Competing priorities of service users included the need to obtain adequate individual care and to work for survival. Low recognition of the potential contribution of service users seemed linked to limited empowerment and mobilization of service users. Potential health system facilitators included a culture of community oversight of primary care services. All groups of respondents identified a need for awareness-raising and training to equip service users, caregivers, service providers and local community for involvement. Empowerment at the level of individual service users (information about mental health conditions, care and rights) and the group level (for advocacy and representation) were considered essential, alongside improved, accessible mental health care and livelihood interventions. Conclusion: As Ethiopia increases access to mental health care, a fundamental barrier to service user involvement is beginning to be addressed. Our study identified further barriers that need to be tackled, including a supportive political climate, and receptiveness amongst stakeholders. The findings will inform the development of a model of service user involvement, which will be piloted and evaluated.
dc.language.iso en
dc.publisher BioMed Central
dc.source BMC Psychiatry
dc.source.uri https://bmcpsychiatry.biomedcentral.com/
dc.subject.other Qualitative study
dc.subject.other Mental health
dc.subject.other Ethiopia
dc.subject.other Service user and carer involvement
dc.title Service user involvement in mental health system strengthening in a rural African setting: qualitative study
dc.type Journal Article
dc.date.updated 2017-05-21T03:31:22Z
dc.rights.holder The Author(s).
uct.type.publication Research en_ZA
uct.type.resource Article en_ZA
dc.publisher.institution University of Cape Town
dc.publisher.faculty Faculty of Health Sciences en_ZA
dc.publisher.department Department of Psychiatry and Mental Health en_ZA
uct.type.filetype Text
uct.type.filetype Image
dc.identifier.apacitation Abayneh, S., Lempp, H., Alem, A., Alemayehu, D., Eshetu, T., Lund, C., ... Hanlon, C. (2017). Service user involvement in mental health system strengthening in a rural African setting: qualitative study. <i>BMC Psychiatry</i>, http://hdl.handle.net/11427/24387 en_ZA
dc.identifier.chicagocitation Abayneh, Sisay, Heidi Lempp, Atalay Alem, Daniel Alemayehu, Tigist Eshetu, Crick Lund, Maya Semrau, Graham Thornicroft, and Charlotte Hanlon "Service user involvement in mental health system strengthening in a rural African setting: qualitative study." <i>BMC Psychiatry</i> (2017) http://hdl.handle.net/11427/24387 en_ZA
dc.identifier.vancouvercitation Abayneh S, Lempp H, Alem A, Alemayehu D, Eshetu T, Lund C, et al. Service user involvement in mental health system strengthening in a rural African setting: qualitative study. BMC Psychiatry. 2017; http://hdl.handle.net/11427/24387. en_ZA
dc.identifier.ris TY - Journal Article AU - Abayneh, Sisay AU - Lempp, Heidi AU - Alem, Atalay AU - Alemayehu, Daniel AU - Eshetu, Tigist AU - Lund, Crick AU - Semrau, Maya AU - Thornicroft, Graham AU - Hanlon, Charlotte AB - Background: It is essential to involve service users in efforts to expand access to mental health care in integrated primary care settings in low- and middle-income countries (LMICs). However, there is little evidence from LMICs to guide this process. The aim of this study was to explore barriers to, and facilitators of, service user/caregiver involvement in rural Ethiopia to inform the development of a scalable approach. Methods: Thirty nine semi-structured interviews were carried out with purposively selected mental health service users (n = 13), caregivers (n = 10), heads of primary care facilities (n = 8) and policy makers/planners/service developers (n = 8). The interviews were audio-recorded and transcribed in Amharic, and translated into English. Thematic analysis was applied. Results: All groups of participants supported service user and caregiver involvement in mental health system strengthening. Potential benefits were identified as (i) improved appropriateness and quality of services, and (ii) greater protection against mistreatment and promotion of respect for service users. However, hardly any respondents had prior experience of service user involvement. Stigma was considered to be a pervasive barrier, operating within the health system, the local community and individuals. Competing priorities of service users included the need to obtain adequate individual care and to work for survival. Low recognition of the potential contribution of service users seemed linked to limited empowerment and mobilization of service users. Potential health system facilitators included a culture of community oversight of primary care services. All groups of respondents identified a need for awareness-raising and training to equip service users, caregivers, service providers and local community for involvement. Empowerment at the level of individual service users (information about mental health conditions, care and rights) and the group level (for advocacy and representation) were considered essential, alongside improved, accessible mental health care and livelihood interventions. Conclusion: As Ethiopia increases access to mental health care, a fundamental barrier to service user involvement is beginning to be addressed. Our study identified further barriers that need to be tackled, including a supportive political climate, and receptiveness amongst stakeholders. The findings will inform the development of a model of service user involvement, which will be piloted and evaluated. DA - 2017-05-18 DB - OpenUCT DO - 10.1186/s12888-017-1352-9 DP - University of Cape Town J1 - BMC Psychiatry LK - https://open.uct.ac.za PB - University of Cape Town PY - 2017 T1 - Service user involvement in mental health system strengthening in a rural African setting: qualitative study TI - Service user involvement in mental health system strengthening in a rural African setting: qualitative study UR - http://hdl.handle.net/11427/24387 ER - en_ZA


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