Institute of Public Health & Social Sciences, Khyber Medical University, Pakistan Khyber Medical University Peshawar, Peshawar, Pakistan.
Kent and Medway Medical School, University of Kent and Canterbury Christ Church University, Canterbury, United Kingdom.
PLoS One. 2022 Aug 29;17(8):e0273286. doi: 10.1371/journal.pone.0273286. eCollection 2022.
To explore the perceptions and experiences of schizophrenia from patients, their care givers, health care providers, spiritual and traditional healers to develop a community-based intervention for improving treatment adherence for people with schizophrenia in Pakistan.
This qualitative study involved four focus group discussions (FGD) with a total of 26 participants: patients and carers (n = 5), primary care staff (n = 7), medical technicians (n = 8) and traditional and spiritual healers (n = 6). The participants were selected using purposive sampling method. FGDs were audio-recorded and transcribed. A thematic analysis was applied to the data set.
The themes identified were (i) Schizophrenia is not merely a biomedical problem: participants believed that poverty and an inferiority complex resulting from social disparity caused schizophrenia and contributed to non-adherence to medications; (ii) Spiritual healing goes hand in hand with the medical treatment: participants regarded spiritual and traditional treatment methods as an inherent part of schizophrenia patients' well-being and rehabilitation; (iii) Services for mental illness: mental health is not covered under primary health in a basic health unit: participants believed that the lack of services, training and necessary medication in primary care are major issues for treating schizophrenia in community; (iv) Barriers to community-based interventions: primary care staff believed that multiple pressures on staff, lack of incentives, non-availability of medication and lack of formal referral pathways resulted in disintegration of dealing with schizophrenia patients in primary care facilities.
The study has identified a number of barriers and facilitators to developing and delivering a psychosocial intervention to support people living with schizophrenia in Pakistan. In particular, the importance of involving spiritual and traditional healers was highlighted by our diverse group of stakeholders.
探索来自患者、照顾者、医疗保健提供者、精神和传统治疗师的精神分裂症的认知和体验，为改善巴基斯坦精神分裂症患者的治疗依从性开发基于社区的干预措施。
本定性研究采用目的抽样法选择了共 26 名参与者进行了 4 次焦点小组讨论（FGD）：患者和照顾者（n=5）、初级保健人员（n=7）、医疗技术人员（n=8）和传统及精神治疗师（n=6）。FGD 进行了录音和转录。对数据集进行了主题分析。
确定的主题包括：（i）精神分裂症不仅仅是一个生物医学问题：参与者认为贫困和社会差异导致的自卑感导致了精神分裂症，并导致对药物治疗的不依从；（ii）精神治疗与医疗治疗齐头并进：参与者认为精神和传统治疗方法是精神分裂症患者健康和康复的固有组成部分；（iii）精神疾病服务：基层卫生单位不提供精神健康服务：参与者认为初级保健中缺乏服务、培训和必要的药物是社区治疗精神分裂症的主要问题；（iv）基于社区的干预障碍：初级保健人员认为工作人员面临多重压力、缺乏激励、药物供应不足以及缺乏正式转诊途径，导致初级保健设施中处理精神分裂症患者的工作瓦解。
本研究确定了在巴基斯坦为支持精神分裂症患者开发和提供心理社会干预措施的一些障碍和促进因素。特别是，我们的不同利益相关者强调了让精神和传统治疗师参与的重要性。
