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Cited by 156Schizophrenia research and treatmentMental Health Treatment and AccessPsychiatric care and mental health services

The development of a lay health worker delivered collaborative community based intervention for people with schizophrenia in India

Open access
Balaji, Madhumitha, Chatterjee, Sudipto, Koschorke, Mirja, Rangaswamy, Thara, Chavan, Animish, Dabholkar, Hamid, Dakshin, Lilly, Kumar, Pratheesh +3 more·2012·BMC Health Services Research
DOI 10.1186/1472-6963-12-42PMC PMC3312863
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Abstract

Background: Care for schizophrenia in low and middle income countries is predominantly facility based and led by specialists, with limited use of non-pharmacological treatments. Although community based psychosocial interventions are emphasised, there is little evidence about their acceptability and feasibility. Furthermore, the shortage of skilled manpower is a major barrier to improving access to these interventions. Our study aimed to develop a lay health worker delivered community based intervention in three sites in India. This paper describes how the intervention was developed systematically, following the MRC framework for the development of complex interventions. Methods: We reviewed the lierature on the burden of schizophrenia and the treatment gap in low and middle income countries and the evidence for community based treatments, and identified intervention components. We then evaluated the acceptability and feasibility of this package of care through formative case studies with individuals with schizophrenia and their primary caregivers and piloted its delivery with 30 families. Results: Based on the reviews, our intervention comprised five components (psycho-education; adherence management; rehabilitation; referral to community agencies; and health promotion) to be delivered by trained lay health workers supervised by specialists. The intervention underwent a number of changes as a result of formative and pilot work. While all the components were acceptable and most were feasible, experiences of stigma and discrimination were inadequately addressed; some participants feared that delivery of care at home would lead to illness disclosure; some participants and providers did not understand how the intervention related to usual care; some families were unwilling to participate; and there were delivery problems, for example, in meeting the targeted number of sessions. Participants found delivery by health workers acceptable, and expected them to have knowledge about the subject matter. Some had expectations regarding their demographic and personal characteristics, for example, preferring only females or those who are understanding/friendly. New components to address stigma were then added to the intervention, the collaborative nature of service provision was strengthened, a multi-level supervision system was developed, and delivery of components was made more flexible. Criteria were evolved for the selection and training of the health workers based on participants' expectations. Conclusions: A multi-component community based intervention, targeting multiple outcomes, and delivered by trained lay health workers, supervised by mental health specialists, is an acceptable and feasible intervention for treating schizophrenia in India.

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  • The Chaudoir et al. framework is particularly helpful for task-sharing because it explicitly includes the characteristics of providers, which have been found to influence implementation and intervention outcomes.

    “The Chaudoir et al. [35] framework is particularly helpful for task-sharing because it explicitly includes the characteristics of the providers, which have been found to influence implementation and intervention (i.e., client and service) outcomes [10, 36–38].”

    From Barriers and facilitators to implementation of evidence-based task-sharing mental health interventions in low- and middle-income countries: a systematic review using implementation science frameworks (2022) · cites this paper as [10]

    The Abstract Results and Background’s Intervention development section report that participants’ preferences about lay health workers’ gender, knowledge, and personal qualities informed worker selection and training. The paper also links workers’ local-community ties and rapport-building to families’ acceptance of the service. It does not establish that provider characteristics influenced client outcomes; the statement about what the Chaudoir framework includes is attributed to a different citation. (LLM, conf=0.84)

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  • For people with severe mental disorders, the key factors facilitating effectiveness include psycho-education interventions; adherence management; rehabilitation; referral to community agencies; and health promotion.

    “For people with severe mental disorders the key factors facilitating effectiveness are rather similar and include: psycho-education interventions; adherence management; rehabilitation; referral to community agencies; and health promotion 44 .”

    From Integrated care for people with long-term mental and physical health conditions in low-income and middle-income countries (2019) · cites this paper as [44]

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Authors
Balaji, M., Chatterjee, S., Koschorke, M., Rangaswamy, T., Chavan, A., Dabholkar, H., Dakshin, L., Kumar, P., John, S., Thornicroft, G., & Patel, V.
Affiliations
  • Sangath (IN)
  • London School of Hygiene & Tropical Medicine (GB)
  • Schizophrenia Research Foundation (IN)
  • King's College London (GB)
Corresponding author
Patel, Vikram
ORCID
Venue
BMC Health Services Research
Publisher
Springer Science and Business Media LLC
Published
2012-02-16
Volume
12
Issue
1
Pages
42-42
ISSN
1472-6963 (ISSN-L)
DOI
10.1186/1472-6963-12-42
PMC
PMC3312863
OpenAlex
W2146617657
Cited by
156
References
31
Citations by year
2026: 3 · 2025: 9 · 2024: 4 · 2023: 7 · 2022: 6 · 2021: 36 · 2020: 14 · 2019: 19 · 2018: 8 · 2017: 14 · 2016: 8 · 2015: 12 · 2014: 10 · 2013: 4 · 2012: 2
FWCI
6.40
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Health Services Research (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
  • Minerva Access (University of Melbourne) (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
  • Research Portal (King's College London) (submittedVersion)
  • Greater South Information System
Funders
  • South London and Maudsley NHS Foundation Trust
  • Wellcome Trust (084355, 091834, 084355/Z/07/Z)
  • National Institute for Health and Care Research (NF-SI-0611-10053)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
Keywords
schizophrenia, lay health workers, intervention development, feasibility and acceptability, stigma and discrimination, family caregivers, medication adherence, psychoeducation, psychiatric rehabilitation, health worker training and supervision, treatment gap, India
MeSH terms
Community Health Workers, Developing Countries, Female, Humans, India, Interviews as Topic, Male, Pilot Projects, Schizophrenia, Schizophrenic Psychology, Staff Development, Program Evaluation, Program Development, Caregivers, Patient Satisfaction, Social Stigma

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