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. 2022 Aug 15;8(5):e156.
doi: 10.1192/bjo.2022.539.

Perceived sustainability of psychosocial treatment in low- and middle-income countries in South-Eastern Europe

Emina Ribic  1 , Hana Sikira  1 , Alma Dzubur Kulenovic  1 , Tamara Pemovska  2 , Manuela Russo  3 , Nikolina Jovanovic  4 , Tamara Radojicic  5 , Selman Repisti  5 , Miloš Milutinović  6 , Biljana Blazevska  6 , Jon Konjufca  7 , Fjolla Ramadani  8 , Stefan Jerotic  9 , Bojana Savic  10
Affiliations

Perceived sustainability of psychosocial treatment in low- and middle-income countries in South-Eastern Europe

Emina Ribic et al. BJPsych Open. .

Abstract

Background: DIALOG+ is an evidence-based, generic, cost-saving and easily deliverable psychosocial intervention, adaptable to clinicians' personal manner of interaction with patients. It was implemented in mental health services in five low- and middle-income countries in South-Eastern Europe during a 12-month randomised-controlled trial (IMPULSE) to improve the effectiveness of out-patient treatment for people with psychotic disorders.

Aims: To investigate barriers and facilitators to the perceived sustainability of DIALOG+ that has been successfully implemented as a part of the IMPULSE project.

Method: Three months after the IMPULSE trial's end, perceived sustainability of the DIALOG+ intervention was assessed via a short survey of clinicians and patients who took part in the trial. Quantitative data collected from the survey were analysed using descriptive statistics; content analysis assessed qualitative survey data. The views and experiences of key informants (patients, clinicians and healthcare policy influencers) regarding the sustainability and scale-up of DIALOG+ were further explored through semi-structured interviews. These data were explored using framework analysis.

Results: Clinicians mostly appreciated the comprehensiveness of DIALOG+, and patients described DIALOG+ meetings as empowering and motivating. The barrier most commonly identified by key informants was availability of financial resources; the most important facilitators were the clinically relevant structure and comprehensiveness of the DIALOG+ intervention.

Conclusions: Participants showed a willingness to sustain the implementation of DIALOG+. It is important to maintain collaboration with healthcare policy influencers to improve implementation of DIALOG+ across different levels of healthcare systems and ensure availability of resources for implementing psychosocial interventions such as DIALOG+.

Keywords: Schizophrenia; bipolar affective disorders; low- and middle-income countries; psychosocial interventions; qualitative research.

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