Background
Methods
Study design
Setting
Participants
Inclusion criteria | Stakeholder groups | ||
---|---|---|---|
Service users | Caregivers | Health professionals | |
Health professional who directly provides healthcare to service-users | X | ||
Have a psychiatrist-confirmed diagnosis of the WHO mental health Gap Action Program (mhGAP)‘priority’ mental health conditions: psychosis or epilepsy or alcohol use disorder or depression | X | ||
Immediate caregiver to the service-users and closely involved in care | X | ||
Adult(18+ years) | X | X | X |
Considered by themselves, by healthcare providers, and by the family to have improved in capacity to participate/functioning and with stable mental health conditions | X | ||
Working or receiving/had received healthcare services from primary healthcare at the Sodo district for at least for six months | X | X | X |
Participant has time available and is willing to be involved in the training, or share their own recovery stories | X | X | X |
Overview of the training program
Theoretical lens
Development of the training program
Training delivery
Evaluation of the training program
Quantitative assessment
Demographic data
Feasibilityand acceptability of the training program
Evaluation of understanding
Qualitative assessments
Exit interviews
Follow-up in-depth interviews
Data analysis
Quantitative data
Qualitative data
Rigor
Results
Participant characteristics
Characteristics | Service users | Caregivers | Health professionals |
---|---|---|---|
Gender | |||
Male | 6 | 5 | 15 |
Female | 6 | 7 | 3 |
Age (years) | |||
20–25 | 2 | 0 | 2 |
26–30 | 0 | 3 | 4 |
31–35 | 3 | 2 | 6 |
36–40 | 1 | 2 | 4 |
41+ | 6 | 5 | 2 |
Educational attainment | |||
Non-literate | 4 | 7 | 0 |
Informal Education | 2 | 2 | 0 |
Primary School | 6 | 1 | 0 |
Secondary School | 0 | 2 | 0 |
Diploma | 0 | 0 | 5 |
First degree | 0 | 0 | 13 |
Years of work experience or caring or living with mental health condition | |||
1-5 years | 5 | 5 | 3 |
6-10 years | 3 | 3 | 8 |
11-15 years | 1 | 0 | 1 |
16+years | 3 | 4 | 6 |
Training program feasibility and acceptability
Feasibility
Indicators | Service uses | Caregivers | Health professionals |
---|---|---|---|
Indicators of feasibility | |||
Participants invited to participate in the training | 12 | 12 | 20 |
Participants enrolled in training | 12 | 12 | 18 |
Participants attended all the sessions | 12 | 11 | 18 |
Participants completed the sessions | 12 | 12 | 18 |
Indicators of acceptability | |||
Number of participants who reported that their expectations had been fulfilled: | |||
Strongly agree | 10 | 11 | 12 |
Agree | 2 | 1 | 6 |
Number of participants who reported that the training of high standard: | |||
Strongly agree | 9 | 11 | 11 |
Agree | 3 | 1 | 7 |
I attended all the training attentively with interest. The time schedule was good and it did not waste our time. (SU20, Exit interview)
I attended all the 10 days, previously I used to feel health problems all the days, but there was no problem during the training. I saw changes [health] in this regard. (SU3, Exit interview)
Sometimes I was delayed getting transportation and when there was rain we did not get transport, but there was nothing else. (CG20, follow-up interview)
The training was very nice, but the time was very short. If the time was longer we could have discussed many points. The trainer covered a lot of key points in [a] very short time. (HP13, Response to open-ended questions)
Acceptability
I am very happy about the training; the issues discussed were very important. The recommendations and solutions raised during the training should be changed into practice involving all stakeholders (HP6, Response to open-ended questions)
The training contained many useful topics. It helps to learn how to properly use medication, and how to teach other people. It helps to clearly learn from others’ stories, for example about how to avoid alcohol use and factors that worsen mental illness. (CG 22, Exit interview)
This training was provided for 12 service users and 12 caregivers. They should share the knowledge to many people. The training program should be supported by governmental and non-government organizations to reach many people. For example, if teachers participate in the training, the lesson can reach many people. (CG12. Follow-up interviews)
The service users actively participated by capturing and describing photos and this made the training very clear to understand. This training included many things and was unusual. There were photographs, videos, and people with the mental health conditions shared their experiences throughout the training. I liked it very much. (CG 24, Exit interview)
The PhotoVoice was helpful to express idea easily. It nicely helped me to express my ideas. I am very happy talking about my experiences to others. (SU21, Exit interview)
Perceived outcomes of the training programme
Improved understanding/knowledge
I understood: | Phases | N | Mean | St.d | |
---|---|---|---|---|---|
1 | Why service users and caregivers wanted to be involved in mental health systems strengthening | After | 18 | 4.9 | 0.32 |
Before | 3.3 | 0.97 | |||
2 | The value of service users and caregivers’ involvement in mental health system strengthening | After | 18 | 4.9 | 0.32 |
Before | 3.3 | 1.09 | |||
3 | How to involve service user and caregivers in the different aspects of mental health system strengthening | After | 18 | 4.7 | 0.49 |
Before | 2.8 | 1.06 | |||
4 | How to collaborate with service users and caregivers for mental health system strengthening | After | 18 | 4.8 | 0.43 |
Before | 3.3 | 1.09 | |||
5 | What kinds of contributions service users and their caregivers can make to improve mental care in my district (Sodo district) | After | 42 | 4.6 | 0.59 |
Before | 3.0 | 1.08 | |||
6 | About the international protections (and protections within Ethiopia) for the rights of people with mental health problems | After | 42 | 4.3 | 0.67 |
Before | 2.9 | 1.30 | |||
7 | The experiences of people with mental health conditions in Sodo district | After | 42 | 4.3 | 0.75 |
Before | 2.7 | 1.27 | |||
8 | The levels of service user and caregiver involvement in mental health system strengthening | After | 42 | 4.3 | 0.75 |
Before | 2.8 | 1.17 | |||
9 | Myths and facts about mental illness | After | 42 | 4.6 | 0.59 |
Before | 3.4 | 1.23 | |||
10 | Types of mental health related stigma and discriminations | After | 42 | 4.6 | 0.55 |
Before | 3.3 | 1.05 | |||
11 | Impacts of mental health related stigma and discrimination | After | 42 | 4.6 | 0.54 |
Before | 3.4 | 1.08 | |||
12 | Strategies to reduce mental health related stigma and discrimination | After | 42 | 4.6 | 0.58 |
Before | 3.0 | 1.19 | |||
13 | Types of mental health problems | After | 42 | 4.7 | 0.47 |
Before | 3.6 | 1.08 | |||
14 | Treatments that can help people with mental health problems | After | 42 | 4.6 | 0.54 |
Before | 3.6 | 1.15 | |||
15 | Definition of service user | After | 42 | 4.7 | 0.48 |
Before | 3.2 | 1.09 | |||
16 | Definition of caregiver | After | 42 | 4.6 | 0.50 |
Before | 3.5 | 1.17 | |||
17 | Definition of involvement in mental health system | After | 42 | 4.6 | 0.55 |
Before | 3.3 | 1.13 | |||
18 | How I can contribute to improve mental care in my district (Sodo district) | After | 24 | 4.1 | 0.68 |
Before | 2.9 | 1.04 | |||
19 | How I can contribute to the development of mental health policy and law development in Ethiopia | After | 24 | 4.2 | 0.66 |
Before | 2.9 | 1.19 |
The training gave us sufficient knowledge about mental illness, medication use and stigma and discrimination. I got good knowledge when I heard their advice (participants sharing lived experiences) and the way they talk. (SU16, Exit interview)
The training had a lot of benefit. When participants presented their experiences of living with mental illness, this becomes a good experience and advice for us [participants]. When they [service users] talk we [participants] were happy. Just when they speak about their past experiences and how well they are doing now it gives hope service user. (CG15, Follow-up interviews)
Sense of empowerment
...they (health professionals) were very happy, clapped their hands for us, and they told us to help us [service users and caregivers] if we faced any problem even at night. (CG20, Follow-up interview)
I am very happy having a freedom to discuss with others and sharing my experience about my previous situation. I feel like I rebirth and feel like my age is just like a child. Previously I have suffered a lot … when that time passes and I become to this stage, this is rebirth for me. I am happy. (SU 17, Exit interview)
Perceived social benefits
We were stigmatized and discriminated by community, no one used to visit us, including our neighbours, and we did not go to other peoples’ homes. After we started participation in this training many people started greeting us. My relatives who used to reject me are now accepting me. People started treating us as human beings. We have hope. God knows the future. (CG7, Exit interview)
In my family no one was looking for me because of my illness. They were wishing my death; no one used to give me even free rain water and considered me as useless. My husband is very nice person and he encouraged me and after my involvement in the training my family started visiting me. (SU11, Exit interview)
The training showed us many good things. I am communicating with my family very well now and they are also asking me to share my ideas with them. They are also accepting my ideas. (SU1, Exit interview)
There are many people who stigmatise and discriminate against people with mental illness. They lack understanding about mental illness and people with mental illness. We should provide awareness to all people. (SU 11, Exit interview)
The training process brings people to deeply connect with each other. Our (service users) coming and discussing together enabled us to establish a service users association, and hope that it [association] will be the best association in the Sodo district and the entire country. (CG12, Exit interview)
Perceived therapeutic benefits
The man (service user) used to be in bed and feeling pain all day; and I was not able to attend meeting even at my neighbourhood. I am very happy for attending this training. The man is effectively taking his medication. The man was a difficult person, but after the training [he] has showed improvement. He started meeting people and participation in social activities. He is started looking for and feeding cattle. The training gives hope. (CG2, Exit interview)
This training was more than taking medication, helpful to change the mind and giving hope about the future. Thanks to God we are here to get involved here. We used to chain her all the days just like a sheep and goat. I remember many people visited and took her photo while she was chained. (CG7, Exit interview)
When both of us (service user and caregiver) go to health facility, we don’t feel shameful and [can] freely talk about her (service user) mental health condition without fear. I ask for timely service without waiting for long. They (health professionals) are also serving us with good manner and respect. (CG10, Exit interview)