Implementation of first episode psychosis intervention in India – A case study in a low-and middle-income country
Open accessAbstract
First Episode Psychosis (FEP) is a serious mental illness affecting adolescents and young persons. While many effective interventions are available, there has not been much research to understand the implementation of such interventions in India and other low- and middle-income countries (LMIC). We studied the implementation of an FEP intervention program in a specialist mental health facility in Chennai, India, using a well-established framework for doing so, the Consolidated Framework for Implementation Research (CFIR). We conducted 27 in-depth interviews with the service users (15 persons with FEP and 12 family caregivers of persons with FEP). We also conducted a focus group discussion with 8 service providers and in-depth interviews with 7 other service providers including those in the service management. A thematic analysis approach was used to identify emerging themes. First, we found CFIR effectively accommodated implementation challenges evident in LMICs; that is, it is transferable to LMIC settings. Second, we highlight barriers to implementation that include cost, limited human resources, cultural and professional hierarchy, divergence from evidence-based guidelines, and lack of awareness and stigma in the wider community. Third, we highlight facilitators for implementation such as, leadership engagement, the need for change that was recognized within the service, cosmopolitan perspectives derived from clinicians' local and international collaborative experiences and expertise, compatibility of the intervention with the existing systems within the organization, accommodating the needs of the service users, and rapport developed by the service with the service users. Fourth, we propose a model of service delivery incorporating a task-sharing approach for first episode psychosis in resource restricted settings based on the feedback from the stakeholders.
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A relatively understudied phenomenon in Indian settings is the exploration of initial experiences and understandings of illness and treatment from the perspective of both patients and caregivers.
“A relatively understudied phenomenon in Indian settings is the exploration of initial experiences and understandings of illness and treatment from the perspective of both patients and caregivers, though there are rare exceptions from Central and South India (Dutta et al., 2019, Vaitheswaran et al., 2021).”
From Qualitative study to explore the perspectives and mental health experiences of first episode psychosis patients and their caregivers in North India (2024) · cites this paper as Vaitheswaran et al., 2021
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- Authors
- Vaitheswaran, S., Currie, G., Dhandapani, V. R., Mohan, G., Rangaswamy, T., & Preet Singh, S.
- Affiliations
- Schizophrenia Research Foundation (IN)
- University of Warwick (GB)
- Corresponding author
- Vaitheswaran, Sridhar
- Venue
- SSM - Mental Health
- Publisher
- Elsevier BV
- Published
- 2021-12
- Volume
- 1
- Pages
- 100018
- ISSN
- 2666-5603 (ISSN-L)
- PMC
- PMC8654684
- OpenAlex
- W3196842701
- Cited by
- 13
- References
- 61
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 3 · 2023: 3
- FWCI
- 1.69
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- SSM - Mental Health (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- National Institute for Health Research
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- first-episode psychosis, implementation research, Consolidated Framework for Implementation Research, task sharing, low- and middle-income countries, mental health service delivery, barriers and facilitators, stigma, family caregivers, service user perspectives, leadership engagement, resource-limited settings
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