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. 2018 Aug 3;18(1):250.
doi: 10.1186/s12888-018-1818-4.

Community-based rehabilitation intervention for people with schizophrenia in Ethiopia (RISE): a 12 month mixed methods pilot study

Laura Asher  1   2 , Charlotte Hanlon  3   4 , Rahel Birhane  3 , Alehegn Habtamu  3 , Julian Eaton  5   6 , Helen A Weiss  7 , Vikram Patel  8 , Abebaw Fekadu  3   9   10 , Mary De Silva  11
Affiliations

Community-based rehabilitation intervention for people with schizophrenia in Ethiopia (RISE): a 12 month mixed methods pilot study

Laura Asher et al. BMC Psychiatry. .

Abstract

Background: Community-based rehabilitation (CBR), or community-based inclusive development, is an approach to address the complex health, social and economic needs of people with schizophrenia in low and middle-income countries. Formative work was undertaken previously to design a culturally appropriate CBR intervention for people with schizophrenia in Ethiopia. The current study explored the acceptability and feasibility of CBR in practice, as well as how CBR may improve functioning among people with schizophrenia.

Methods: This mixed methods pilot study took place in rural Ethiopia between December 2014 and December 2015. Ten people with schizophrenia who were unresponsive to treatment with medication alone, and their caregivers, participated in CBR. CBR was led by lay workers with five weeks training and involved home visits (education, family intervention and support returning to work) and community mobilisation. Theory of change was used to guide the pilot evaluation. Qualitative and quantitative data were collected at baseline, six months and 12 months. Forty in-depth interviews and two focus group discussions were conducted with 31 individuals comprising people with schizophrenia, caregivers, CBR workers, supervisors, health officers and community members.

Results: The RISE CBR intervention may have a positive impact on functioning through the pathways of enhanced family support, improved access to health care, increased income and improved self-esteem. CBR was acceptable to CBR workers, community leaders and health officers. Some CBR workers found it challenging to accept the choices of people with schizophrenia. These concerns were felt to be resolvable with supplementary training for CBR workers. The intervention was feasible but further evaluation is needed on a larger scale.

Conclusion: In low and middle-income countries, CBR may be an acceptable and feasible adjuvant approach to facility-based care for people with schizophrenia. However, contextual factors, including poverty and inaccessible anti-psychotic medication, remain substantial challenges. There were indications that CBR can impact on functioning but the RISE trial will determine effectiveness.

Keywords: Community based inclusive development; Community based rehabilitation; Community health services; Developing countries; Ethiopia; Feasibility studies; Psychiatric rehabilitation; Psychotic disorders; Schizophrenia.

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Conflict of interest statement

Ethical approval was obtained from the London School of Hygiene and Tropical Medicine (LSHTM) Research Ethics Committee and the Addis Ababa University College of Health Sciences Institutional Review Board. Written consent was sought from each participant. If a person with schizophrenia was deemed by the recruiting psychiatric nurse not to have capacity to consent, permission was sought from the caregiver and assent from the person with schizophrenia. Individuals were not recruited if they expressed unwillingness to participate. Where the participant was unable to write, a thumb impression was recorded, along with the signature of a witness.

The authors declare that they have no competing interests.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Parallel convergent mixed methods model
Fig. 2
Fig. 2
Pre-pilot theory of change
Fig. 3
Fig. 3
Post-pilot theory of change
See this image and copyright information in PMC

References

    1. Kebede D, Alem A, Shibre T, Negash A, Deyassa N, Beyero T, Medhin G. Short-term symptomatic and functional outcomes of schizophrenia in Butajira, Ethiopia. Schizophr Res. 2005;78(2–3):171–185. doi: 10.1016/j.schres.2005.05.028. - DOI - PubMed
    1. Marwaha S, Johnson S, Bebbington P, Stafford M, Angermeyer MC, Brugha T, Azorin JM, Kilian R, Hansen K, Toumi M. Rates and correlates of employment in people with schizophrenia in the UK, France and Germany. Br J Psychiatry. 2007;191:30–37. doi: 10.1192/bjp.bp.105.020982. - DOI - PubMed
    1. Tsigebrhan R, Shibre T, Medhin G, Fekadu A, Hanlon C. Violence and violent victimization in people with severe mental illness in a rural low-income country setting: a comparative cross-sectional community study. Schizophr Res. 2014;152(1):275–282. doi: 10.1016/j.schres.2013.10.032. - DOI - PubMed
    1. Asher L, Fekadu A, Teferra S, De Silva M, Pathare S, Hanlon C. “I cry every day and night, I have my son tied in chains”: physical restraint of people with schizophrenia in community settings in Ethiopia. Glob Health. 2017;13(1):47. doi: 10.1186/s12992-017-0273-1. - DOI - PMC - PubMed
    1. Fekadu A, Medhin G, Kebede D, Alem A, Cleare AJ, Prince M, Hanlon C, Shibre T. Excess mortality in severe mental illness: 10-year population-based cohort study in rural Ethiopia. Br J Psychiatry. 2015;206(4):289–296. doi: 10.1192/bjp.bp.114.149112. - DOI - PubMed

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