Introduction
Understanding psychotherapy in a low-resource health services context
Mental Health Services in Kenya
Extending a naturalistic design to study effectiveness of existing psychotherapies
Aim and objectives
Methods
Integrating practice-based research to understand dissemination and implementation challenges
Setting and procedure
Participants
Variable | Category | Frequency (N = 345) | Percentage % |
---|---|---|---|
Clinic | KNH | 155 | 48.8 |
MPH | 180 | 52.2 | |
Therapist | Mental health workers | 225 | 65.2 |
Interns | 112 | 32.5 | |
Missing data
| 8 | 2.3 | |
Sex of the client | Male | 249 | 72.2 |
Female | 94 | 27.2 | |
Missing data
| 2 | 0.6 | |
Age of the client | Mean; SD; range | 28.9; 9.9; 18–60 | |
Age category, years | 18–27 | 194 | 56.2 |
28–37 | 78 | 22.6 | |
> 37 | 73 | 21.2 | |
Previous therapy | Yes | 55 | 15.9 |
No | 284 | 82.3 | |
Missing data
| 6 | 1.7 | |
Current psychotropic prescription | Yes | 171 | 49.6 |
No | 155 | 44.9 | |
Missing data
| 19 | 5.5 | |
Primary diagnosis | Addictions | 188 | 54.8 |
Psychosis | 60 | 17.5 | |
Depression | 58 | 16.9 | |
Anxiety/stress | 41 | 11.9 | |
Interpersonal problems | 22 | 6.4 | |
Physical problems | 22 | 6.4 | |
Work/academic | 22 | 6.4 | |
Other problems | 22 | 6.4 | |
Self-esteem | 17 | 5.0 | |
Trauma/abuse | 16 | 4.7 | |
Personality problems | 15 | 4.4 | |
Living welfare | 12 | 3.5 | |
Eating disorders | 11 | 3.2 | |
Bereavement/loss | 08 | 2.3 |
Therapists
Measures
Statistical analysis
Results
Age and gender of patients
Patient attendance
Therapeutic foci
Overall improvement in clinical outcome
Coefficient | se | z |
p
| 95% CI | ||
---|---|---|---|---|---|---|
Intercept | 11.78 | 1.10 | 10.68 | < 0.001 | 9.61 | 13.94 |
Time | − 0.94 | 0.64 | − 1.46 | 0.144 | − 2.20 | 0.32 |
Patient support centre | 2.45 | 2.28 | 1.08 | 0.282 | − 2.01 | 6.91 |
Clinic 24 | − 2.96 | 2.53 | − 1.17 | 0.242 | − 7.92 | 2.00 |
Mathare hospital | − 0.97 | 1.29 | − 0.75 | 0.453 | − 3.49 | 1.56 |
Patient support centre × time | − 0.61 | 1.49 | − 0.41 | 0.681 | − 3.53 | 2.31 |
Clinic 24 × time | − 1.13 | 1.48 | − 0.77 | 0.444 | − 4.02 | 1.76 |
Mathare hospital × time | 0.23 | 0.70 | 0.32 | 0.746 | − 1.15 | 1.60 |
Intern |
3.24
|
0.90
|
3.60
| < 0.001 |
1.48
|
5.00
|
Intern × time | − 1.20 |
0.51
| − 2.35 |
0.019
| − 2.20 | − 0.20 |
Client_Age | − 0.01 | 0.05 | − 0.18 | 0.861 | − 0.11 | 0.09 |
Client_Age × time |
0.08
|
0.03
|
3.02
|
0.003
|
0.03
|
0.14
|
Female |
2.62
|
1.00
|
2.61
|
0.009
|
0.65
|
4.58
|
Female × time | − 0.91 | 0.54 | − 1.68 | 0.093 | − 1.97 | 0.15 |
Previous_Therapy | 1.87 | 1.07 | 1.74 | 0.082 | − 0.23 | 3.97 |
Previous_Therapy × time | − 0.70 | 0.63 | − 1.12 | 0.261 | − 1.93 | 0.52 |
Current_Prescription | 0.85 | 0.89 | 0.96 | 0.338 | − 0.89 | 2.60 |
Current_Prescription × time | − 0.07 | 0.45 | − 0.15 | 0.883 | − 0.94 | 0.81 |
Addictions | − 0.18 | 1.04 | − 0.18 | 0.859 | − 2.22 | 1.85 |
Addictions × time | − 0.24 | 0.57 | − 0.42 | 0.674 | − 1.36 | 0.88 |
Psychosis | − 0.35 | 1.09 | − 0.32 | 0.746 | − 2.49 | 1.78 |
Psychosis × time | 0.55 | 0.58 | 0.95 | 0.341 | − 0.59 | 1.70 |
Depression |
2.75
|
1.11
|
2.48
|
0.013
|
0.57
|
4.93
|
Depression × time | − 1.15 | 0.62 | − 1.87 | 0.062 | − 2.36 | 0.06 |
Anxiety | 2.03 | 1.28 | 1.59 | 0.113 | − 0.48 | 4.53 |
Anxiety × time | − 0.29 | 0.67 | − 0.44 | 0.661 | − 1.61 | 1.02 |
Random-effects parameters | Estimate | se | 95% CI | |||
---|---|---|---|---|---|---|
Time | 2.22 | 1.00 | 0.92 | 5.37 | ||
Intercept | 37.05 | 7.20 | 25.32 | 54.22 | ||
Covariance time/intercept | − 5.47 | 2.48 | − 10.33 | − 0.61 | ||
Residual | 21.99 | 1.66 | 18.97 | 25.49 |