College of Health Sciences, School of Medicine, Department of Psychiatry, WHO Collaborating Centre in Mental Health Research and Capacity Building, Addis Ababa University, Addis Ababa, Ethiopia.
Madda Walabu University College of Education and Behavoural Studies, Robe, Ethiopia.
BMC Health Serv Res. 2022 Jul 8;22(1):880. doi: 10.1186/s12913-022-08290-x.
Increased service user involvement is recommended to improve weak mental health systems in low-and middle-income countries (LMICs). However, involvement is rarely implemented and interventions to support involvement are sparse. In this study we evaluated the acceptability, feasibility and perceived outcomes of an empowerment and training program for service users and health professionals to facilitate service user involvement in mental health system strengthening in rural Ethiopia.
REducing Stigma among HealthcAreProvidErs (RESHAPE) is a training curriculum for service users, their caregivers and aspirational health workers, which uses PhotoVoice methodology, to prepare them in participation of mental health systems strengthening in LMICs. We delivered the RESHAPE training augmented with empowerment content developed in Ethiopia. The interactive face-to-face training was delivered to service users and caregivers (over 10 days), and health professionals (1 day) separately. The study was an uncontrolled, convergent mixed-methods design. The quantitative data consisted of process data, satisfaction questionnaire, and a retrospective pre-test survey. Qualitative data included exit and follow-up in-depth interviews with the service users. Descriptive statistics were performed for quantitative data, and qualitative data were thematically analysed. The findings were integrated through triangulation for convergent themes following analysis.
Twelve service users, 12 caregivers and 18 health professionals were enrolled, and completed the training. Participants valued the content and delivery process; the standard of the training program met their expectations and participation led to positive gains in understanding about mental illness, stigma, service-user involvement and human rights. The qualitative findings identified positive impacts, including increased self-confidence, sense of empowerment, social - and perceived therapeutic benefits.
We found that the RESHAPE training with added content for Ethiopia, delivered using the PhotoVoice methodology, is feasible, acceptable and of value to develop and implement training programmes which can empower service users to be involved in mental health system strengthening in this setting. Further study to assess the impact on health systems strengthening is warranted.
增加服务使用者的参与被建议用来改善中低收入国家（LMICs）中薄弱的心理健康系统。然而，参与度很少得到实施，支持参与的干预措施也很少。在这项研究中，我们评估了一项针对服务使用者和卫生专业人员的赋权和培训计划的可接受性、可行性和感知效果，以促进服务使用者参与埃塞俄比亚农村地区的心理健康系统强化。
减少卫生保健提供者的污名（RESHAPE）是一个针对服务使用者、他们的照顾者和有抱负的卫生工作者的培训课程，它使用照片声音方法，让他们为参与中低收入国家的心理健康系统强化做好准备。我们提供了增强了埃塞俄比亚开发的赋权内容的RESHAPE 培训。面对面的互动培训分别针对服务使用者和照顾者（10 天以上）和卫生专业人员（1 天）进行。该研究采用非对照、收敛混合方法设计。定量数据包括过程数据、满意度问卷和回顾性预测试调查。定性数据包括对服务使用者的退出和后续深入访谈。对定量数据进行了描述性统计，对定性数据进行了主题分析。通过分析得出收敛主题的三角测量法整合了发现。
12 名服务使用者、12 名照顾者和 18 名卫生专业人员参加了培训并完成了培训。参与者对内容和交付过程表示赞赏；培训计划的标准符合他们的期望，参与带来了对精神疾病、污名、服务使用者参与和人权的理解的积极提高。定性发现确定了积极的影响，包括增强自信、赋权感、社会和感知治疗效益。
我们发现，在埃塞俄比亚使用照片声音方法提供的具有附加内容的 RESHAPE 培训是可行的、可接受的和有价值的，可以开发和实施培训计划，使服务使用者有能力参与该环境中的心理健康系统强化。需要进一步研究来评估对卫生系统强化的影响。
