Abayneh Sisay, Lempp Heidi, Kohrt Brandon A, Alem Atalay, Hanlon Charlotte
College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa University, WHO Collaborating Centre in Mental Health Research and Capacity Building, Addis Ababa, Ethiopia.
Madda Walabu University College of Education and Behavoural Studies, Bale Robe, Ethiopia.
Int J Ment Health Syst. 2022 Jul 11;16(1):33. doi: 10.1186/s13033-022-00545-8.
Little is known about actual involvement or how to achieve service user and caregiver in mental health systems strengthening in low-and middle-income countries. This study describes the processes and explores involvement experiences of participants in a pilot study of a new model of service user involvement in mental health system strengthening in a rural district in southern Ethiopia.
We applied a case study design using participatory action research (PAR). The PAR process comprised of three stages, each with iterative activities of plan, act, observe and reflect. Two stakeholder groups, a Research Advisory Group (RAG) and Research Participant Group (RPG), were established and collaborated in the PAR process. Data collection involved process documentation of meetings and activities: attendances, workshop minutes, discussion outputs, reflective notes, participatory observation of sessions, and in-depth interviews with 12 RPG members. We analyzed the process data descriptively. Thematic analysis was used for qualitative data. Triangulation and synthesis of findings was carried out to develop the case study.
The stakeholder groups identified their top research priorities, developed an intervention and action plan and made a public presentation of preliminary findings. Key mechanisms used for inclusive participation included capacity building and bringing together diverse stakeholders, anchoring the study in established strong community involvement structures, and making use of participatory strategies and activities during the PAR process. Four themes were developed about experiences of involvement in PAR: (i) expectations and motivation, (ii) experiences of the dynamics of the PAR process, (iii) perceived impacts of involvement in the PAR process, and (iv) implementation challenges and future directions.
This case study demonstrated the feasibility and acceptability of implementing a complex model of service-user involvement in mental health system strengthening in a resource constrained setting. More needs to be done to embed service-user involvement into routines of the primary healthcare system, alongside sustained support and strengthening multi-stakeholder collaboration at multiple levels.
在低收入和中等收入国家，关于精神卫生系统加强过程中服务使用者和照料者的实际参与情况以及如何实现这种参与，人们了解甚少。本研究描述了埃塞俄比亚南部一个农村地区在加强精神卫生系统过程中采用新的服务使用者参与模式的试点研究中的过程，并探讨了参与者的参与经历。
我们采用了基于参与式行动研究（PAR）的案例研究设计。PAR过程包括三个阶段，每个阶段都有计划、行动、观察和反思的迭代活动。建立了两个利益相关者群体，即研究咨询小组（RAG）和研究参与者小组（RPG），并在PAR过程中进行合作。数据收集包括会议和活动的过程记录：出席情况、研讨会记录、讨论成果、反思笔记、会议的参与观察以及对12名RPG成员的深入访谈。我们对过程数据进行了描述性分析。定性数据采用了主题分析。对研究结果进行三角互证和综合以形成案例研究。
利益相关者群体确定了他们的首要研究重点，制定了干预和行动计划，并对初步研究结果进行了公开汇报。用于包容性参与的关键机制包括能力建设、汇聚不同利益相关者、将研究扎根于已建立的强大社区参与结构以及在PAR过程中采用参与式策略和活动。关于参与PAR的经历形成了四个主题：（i）期望和动机，（ii）PAR过程动态的经历，（iii）参与PAR过程的感知影响，以及（iv）实施挑战和未来方向。
本案例研究证明了在资源有限的环境中实施复杂的服务使用者参与精神卫生系统加强模式的可行性和可接受性。还需要做更多工作，将服务使用者参与纳入初级卫生保健系统的日常工作中，同时在多个层面持续提供支持并加强多利益相关者合作。
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