Howard University, Department of Psychology, Washington, DC, USA.
University of Ibadan, College of Medicine, Centre for Child and Adolescent Mental Health, Ibadan, Nigeria; University College Hospital, Department of Child & Adolescent Psychiatry, Ibadan, Nigeria.
Soc Sci Med. 2021 Jun;279:113972. doi: 10.1016/j.socscimed.2021.113972. Epub 2021 May 7.
If child and adolescent psychiatric (CAP) services were accessible in lower-middle-income countries (LMIC) such as Nigeria, what individual and socio-cultural factors would influence caregivers' willingness to use these services when they are needed?
To address this question, we conducted structured interviews with a stratified random sampling of 442 adult caregivers of children aged 5 to 19-years who lived within 10 km of an established CAP outpatient service in Ibadan, Nigeria.
Based on structural equation modeling, our cross-sectional findings indicated that caregivers were generally willing to use the accessible outpatient CAP service for a narrow range of overtly disruptive and developmentally atypical child behavior. However, their decisions were not influenced by their recognition of child and adolescent mental health (CAMH) conditions, competing life stressors, caregiver wellness, nor stigma as we had initially hypothesized. Rather caregivers pragmatically considered a range of approaches to address CAMH concerns. Post-hoc hypotheses confirmed that caregivers' beliefs about etiology and treatment effectiveness for CAMH conditions shaped their help-seeking decisions and stigmatization of CAP services. Specifically, caregivers who attributed CAMH conditions to physical causes regarded biomedical interventions as the most effective treatment while spiritual interventions were deemed to be the least effective.
Taken together our results suggested that caregivers were receptive and willing to use outpatient psychiatric services for their children. However, their beliefs about the etiology and treatment effectiveness of CAMH conditions shaped how they intended to engage the services. These findings underscored the importance of scaling up a broader spectrum of accessible complementary CAMH intervention and prevention services in Nigeria that extend beyond indigenous or biomedical models. In doing so caregivers will come.
如果儿童和青少年精神病学（CAP）服务在尼日利亚等中低收入国家（LMIC）普及，那么在需要时，哪些个人和社会文化因素会影响照顾者使用这些服务的意愿？
为了回答这个问题，我们对 442 名居住在尼日利亚伊巴丹一个成熟的 CAP 门诊服务 10 公里范围内的 5 至 19 岁儿童的成年照顾者进行了分层随机抽样的结构访谈。
基于结构方程建模，我们的横断面研究结果表明，照顾者通常愿意使用可及的门诊 CAP 服务来治疗明显的破坏性行为和发育异常行为。然而，他们的决定并不受他们对儿童和青少年心理健康（CAMH）状况的认识、竞争生活压力、照顾者的健康状况或我们最初假设的污名化的影响。相反，照顾者务实考虑了一系列方法来解决 CAMH 问题。事后假设证实，照顾者对 CAMH 状况的病因和治疗效果的信念影响了他们的寻求帮助决策和对 CAP 服务的污名化。具体而言，将 CAMH 状况归因于身体原因的照顾者认为生物医学干预是最有效的治疗方法，而精神干预被认为是最无效的。
总的来说，我们的研究结果表明，照顾者愿意接受并愿意为他们的孩子使用门诊精神病服务。然而，他们对 CAMH 状况的病因和治疗效果的信念影响了他们打算如何使用这些服务。这些发现强调了在尼日利亚扩大普及范围更广的、可及的补充 CAMH 干预和预防服务的重要性，这些服务不仅限于本土或生物医学模式。通过这样做，照顾者会来的。
