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Establishing views of traditional healers and biomedical practitioners on collaboration in mental health care in Zanzibar: a qualitative pilot study.

ABSTRACT: Background:This qualitative pilot study aimed to establish views of traditional and biomedical practitioners towards collaboration between the two sectors on the treatment of people with mental illness in Zanzibar, Tanzania. Methods:Six traditional healers (known as "waganga" in Swahili) and six nurses working in government secondary mental health services were invited to participate in a series of focus group discussions (FGDs). Two sets of FGDs took place approximately seven weeks apart. In each set, FGDs were conducted with traditional healers only, nurses only, and finally nurses and traditional healers together. FGDs were conducted in Swahili, audio-recorded and then translated to English by an independent translator and coded thematically using NVivo software. Results:All participants expressed that they were in favour of collaboration between traditional and biomedical practitioners on mental healthcare. Opinions varied regarding what form this collaboration should take. For many nurses and healers, there was acknowledgement of the role of the other group in providing treatment for people with mental illness, with support for the idea of bi-directional referrals between the two sectors. For some nurses, the value of collaboration would be purely in the education of traditional healers in the recognition of mental illness, with subsequent referral to biomedical services. For some traditional healers, the idea of collaboration seemed to appeal in part because of a perceived opportunity to learn additional skills from biomedical practitioners. Both categories of participant expressed a belief that patients possessed by a jinn (a spirit) or those that had been bewitched needed treatment by traditional healers. On the other hand, those with what participants considered to be "mental illness" needed treatment at the hospital clinic. However, some nurses felt that that traditional healers might be able to provide helpful treatment for mental illness, as well as those suspected to be affected by jinn or witchcraft. There was agreement on the need to establish clear referral pathways between the two service providers. The creation of an office for traditional healers at the hospital was an area where there was disagreement among participants. Conclusions:We conclude that there is a positive view of collaboration among traditional healers and nurses who participated, and a willingness to work towards actual collaboration. The results suggest that views vary as to what form this collaboration should take, with opinions differing between nurses, as well as between traditional healers. Additional work is needed in order to further explore the nature of potential collaboration and extend the research to the wider population of traditional and biomedical practitioners in Zanzibar, to include primary health care workers.

SUBMITTER: Solera-Deuchar L

PROVIDER: S-EPMC6950788 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Early identification and management of mental illness in childhood and adolescence helps to avert debilitating mental illness in adulthood but the attention given to Child and Adolescent Mental Health (CAMH) has until recently been low. Traditional healers are often consulted by patients with mental illness and in Uganda, up to 60% of patients attending traditional healers have moderate to severe mental illness. Poor access to CAMH care in Uganda creates a treatment gap that could be met through enhanced collaboration between traditional healers and biomedical health systems. The aim of this study was to explore traditional healers' views on their collaboration with biomedical health systems so as to inform the implementation of strategies to improve access to CAMH services in Uganda.In-depth interviews with 20 purposively selected traditional healers were conducted in November 2015. A semi-structured interview guide was used to explore: 1) The experiences of traditional healers with mental ill-health in children and adolescents; 2) their willingness to collaborate with the formal health system; and 3) their perception of clinicians' willingness to collaborate with them. Interviews were conducted in local languages and tape recorded. Data were analysed using thematic analysis.Traditional healers described several experiences managing children and adolescents with mental illness, which they ascribed to spiritual and physical causes. The spiritual explanations were a consequence of unhappy ancestral spirits, modern religions and witchcraft, while physical causes mentioned included substance abuse and fevers. No traditional healer had received a patient referred to them from a medical clinic although all had referred patients to clinics for non-mental health reasons. Traditional healers expressed distrust in biomedical health systems and believed their treatments were superior to medical therapies in alleviating mental suffering. They expressed willingness to collaborate with biomedical providers. However, traditional healers believe clinicians disregard them and would not be willing to collaborate with them.Potential for collaboration between traditional healers and biomedical health systems for improving access to CAMH services in Uganda exists, but is undermined by mutual mistrust and competition between traditional healers and clinicians.

Project description:BACKGROUND:Involvement of traditional health practitioners (THPs) in the form of collaboration with the formal health care system is suggested to improve the pathways to mental health care in Kenya, yet understanding of the current traditional practice and THPs' perspectives is lacking. The aim of this study was to explore the views of THPs with respect to their mental health practice. METHODS:This study qualitatively explored the views of THPs, using four focus group discussions (FDGs) each consisting of 8-10 traditional and faith healers, resulting in a total of 36 participants. Thematic content analysis using a grounded theory approach was performed using QSR NVivo 10. Emerging topics were identified and examined by re-reading the transcripts several times and constantly re-sorting the material. RESULTS:Four themes that reflect THPs' mental health practice perspectives emerged as follows: 1) Categorization of mental illness; 2) Diagnostics in traditional mental health practice; 3) Treatments and challenges in current traditional mental health practice; and 4) Solutions to improve traditional mental health practice. CONCLUSIONS:These themes provide insight into the perspectives of Kenyan traditional and faith healers on their mental health practice, in an attempt to offer a meaningful contribution to the debate on collaboration between informal and formal health care providers in improving mental health services in Kenya. Furthermore, the presented challenges and solutions can inform policy makers in their task to improve and scale up mental health services in resource-poor areas in Kenya. Addressing these issues would be a first step towards understanding the solid foundation of traditional medicine that is necessary before collaboration can be successfully attempted. Further research is also recommended to assess patients' needs and explore potential forms of collaboration, in order to achieve sustainable improvement in the mental health care pathways for patients.

Project description:BackgroundLoneliness is an important public health problem with established adverse effects on physical and mental health. Although people with psychosis often experience high levels of loneliness, relatively little is known about the relationship between loneliness and early psychosis. Potential interventions to address loneliness might be easier to implement early in the illness when social networks and social skills may be more intact than at a later stage. We investigated the views of mental health practitioners about the context and causes of loneliness in people with early psychosis, and about potential interventions.MethodsSemi-structured face-to-face interviews were conducted with mental health practitioners (n = 20). Participants were purposively recruited from four early intervention services for first-episode psychosis in the UK. Interviews were transcribed verbatim and thematic analysis was conducted.ResultsParticipants believed that the majority of service users with early psychosis experience feelings of loneliness. They often saw socially isolated and disconnected clients and believed them to be lonely, but rarely discussed loneliness explicitly in clinical interactions. A combination of symptoms, stigma and negative sense of self were believed to underpin loneliness. Participants could not identify any specific current interventions delivered by their services for tackling loneliness, but thought some routinely provided interventions, including social groups and psychological treatments, could be helpful. They favoured making a wider range of loneliness interventions available and believed that community agencies beyond mental health services should be involved to make these effective and feasible to deliver. They suggested social participation interventions without an explicit mental health focus as potentially promising and valued a co-produced approach to intervention development.ConclusionsThis study suggests that loneliness is not routinely discussed in early intervention services, and a targeted strategy for tackling it is lacking. Co-produced, individualised community approaches, and interventions that target symptoms, stigma and negative self-schemas might be beneficial in alleviating loneliness for people with early psychosis. Empirical research is needed to develop and test such interventions.

Project description:BackgroundSnakebite is a neglected tropical disease (NTD) affecting rural and remote populations globally, who are additionally burdened by poverty and the lack of effective healthcare systems. Delayed healthcare and use of traditional treatments are very frequent. The purpose of our study was to explore perceptions of snakes, impact of snakebite, and knowledge and opinions of different snakebite treatments with the aim of identifying opportunities for improving snakebite management.MethodsThis is a qualitative descriptive study based on semi-structured interviews with 21 snakebite victims and 4 traditional healers in 4 villages of Akonolinga health district, Center Region, Cameroon. Analysis focused on describing participants' perceptions of snakes, the impact of snakebite on the victims' lives, and their opinions of different treatment options.ResultsRespondents were fearful of snakes and knowledgeable about envenoming symptoms and treatments. The experience of snakebite led to increased vigilance and avoidance behaviours, which sometimes resulted in financial loss for the victims. A range of traditional treatments were described, including tourniquets, black-stone application and medicinal plant decoctions. However, opinions were ambivalent regarding their efficacy, depending especially on previous personal experiences. Still, traditional treatments were said to be more available and cheaper than hospital care, and in particular, than antivenom. Nevertheless, most victims preferred hospital treatment if the financial and transportation barriers were lifted. Both snakebite victims and traditional healers were of the opinion that collaboration between health services and traditional healers could help to improve snakebite management and outcomes.ConclusionOur study shows that snakebite victims are in favour of using antivenom for the treatment of snakebite and would welcome better access to it. However, its current unavailability and high cost pushes them to turn to traditional treatments. On the other hand, traditional healers are in favour of collaborating with health facilities. These results are very encouraging for the improvement of snakebite management in Cameroon along the lines of the WHO Snakebite Envenoming Strategy for Prevention and Control: ensuring access to safe and effective treatment, and increasing partnership and coordination between communities, traditional healers, and conventional caregivers.

Project description:IntroductionHealthcare seekers around the globe use more than one healthcare system, with most using the traditional and the Western approaches concurrently. To date, little collaboration between the two systems has taken place within the mental health space compared with other areas of medicine. In order to inform integrating plans for traditional health practitioners and biomedical health practitioners in the South African mental health system, it is important to know which models of collaboration are used in other medical settings and contexts. This study aims to document global evidence on collaboration practices between traditional health practitioners and biomedical professionals when working with various health conditions.Methods and analysisThis scoping review will be guided by an improved Arksey and O'Malley framework, the 2010 Levac et al methodological framework and the 2017 Joanna Briggs Institute guidelines. A systematic literature search will be carried out using seven different databases, EMBASE, PubMed, LILACS MEDLINE, APA PsycArticles, CINAHL Plus, Academic Search Complete and Scopus, in addition to the WHO repository, bibliographical search engines, and Open Access Theses and Dissertations. Moreover, the references of relevant publications between January 1978 and March 2020 will be scanned. Two reviewers will independently screen articles for eligibility based on the predetermined inclusion and exclusion criteria. Thematic analysis and descriptive numerical analysis will be performed using ATLAS.ti V.8 and Excel software, respectively. The results for this review will be presented using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis: Extension for Scoping Review.Ethics and disseminationThis study will not require ethics approval because publicly available material will be used. Study findings will be published in an open-access journal and be presented to other key health system stakeholders and academic research gatherings.

Project description:BACKGROUND: Common mental health problems are mainly treated in primary care settings and collaboration with mental health services is needed. Prior to re-organisation of the mental health care offer in a geographical area, a study was organized: 1) to evaluate GPs' opinions on their day-to-day practice with Patients with Mental Health Problems (PMHP) and on relationships with Mental Health Professionals (MHPro); 2) to identify factors associated with perceived need for collaboration with MHPro and with actual collaboration. METHODS: All GPs in the South Yvelines area in France (n = 492) were informed of the implementation of a local mental health program. GPs interested in taking part (n = 180) were invited to complete a satisfaction questionnaire on their practice in the field of Mental Health and to include prospectively all PMHP consultants over an 8-day period (n = 1519). For each PMHP, data was collected on demographic and clinical profile, and on needs (met v. unmet) for collaboration with MHPro. RESULTS: A majority of GPs rated PMHP as requiring more care (83.4%), more time (92.3%), more frequent consultations (64.0%) and as being more difficult to refer (87.7%) than other patients. A minority of GPs had a satisfactory relationship with private psychiatrists (49.5%), public psychiatrists (35%) and social workers (27.8%). 53.9% had a less satisfactory relationship with MHPro than with other physicians. Needs for collaboration with a MHPro were more often felt in caring for PMHP who were young, not in employment, with mental health problems lasting for more than one year, with a history of psychiatric hospitalization, and showing reluctance to talk of psychological problems and to consult a MHPro. Needs for collaboration were more often met among PMHP with past psychiatric consultation or hospitalization and when the patient was not reluctant to consult a MHPro. Where needs were not met, GP would opt for the classic procedure of mental health referral for only 31.3% of their PMHP. CONCLUSION: GPs need targeted collaboration with MHPro to support their management of PMHP, whom they are willing to care for without systematic referral to specialists as the major therapeutic option.

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Establishing views of traditional healers and biomedical practitioners on collaboration in mental health care in Zanzibar: a qualitative pilot study.

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