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. 2023 Jul 14;13(7):e072471.
doi: 10.1136/bmjopen-2023-072471.

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

Saeed Farooq  1   2 , Saima Sheikh  3 , Lisa Dikomitis  4 , Mian Mukhtar Ul Haq  5 , Abdul Jalil Khan  6 , Noor Sanauddin  7 , Malik Wajid Ali  8 , Johar Ali  7 , Muhammad Firaz Khan  5 , Imran Chaudhry  9   10 , Nusrat Husain  11 , Muhammad Gul  12 , Muhammad Irfan  13   14 , Gabrielle Andrews  12 , Prachi Kaistha  15 , Syed Muhammad Uzair Shah  7 , Ishfaq Azeemi  7 , Shumaila Hamid  6 , Aaliya Minhaz  16 , Christian Mallen  3 , Martyn Lewis  3
Affiliations

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

Saeed Farooq et al. BMJ Open. .

Abstract

Objectives: In 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.

Methods: To prevent the consequences of long DUP in adolescents in LMICs, we aim to develop and pilot test a culturally appropriate and context-bespoke intervention. Traditional HEalers working with primary care and mental Health for early interventiOn in Psychosis 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 dissemination: Ethical 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 number: ISRCTN75347421.

Keywords: Child & adolescent psychiatry; EPIDEMIOLOGIC STUDIES; MEDICAL EDUCATION & TRAINING; MENTAL HEALTH; PUBLIC HEALTH; Schizophrenia & psychotic disorders.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
The HOPE flow diagram. DUP, duration of untreated psychosis; MhGAP, Mental Health Gap Action Programme; RCT, randomised controlled trial; THE HOPE, Traditional HEalers working with primary care and mental Health for early interventiOn in Psychosis in young pErsons.
Figure 2
Figure 2
Patient flow and assessments in THE HOPE trial. FEP, first-episode psychosis; PCPs, primary care physicians; PIS, participants’ information sheet; THE HOPE, Traditional HEalers working with primary care and mental Health for early interventiOn in Psychosis in young pErsons; TSH, traditional and spiritual healer.
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