Collaboration With People With Lived Experience of Mental Illness to Reduce Stigma and Improve Primary Care Services: A Pilot Cluster Randomized Clinical Trial.

Journal: JAMA network open

Volume: 4

Issue: 11

Year of Publication: 2022

Affiliated Institutions:  Department of Psychiatry and Behavioral Sciences, The George Washington University, Washington, DC. Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal. Duke Global Health Institute, Duke University, Durham, North Carolina. Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland. Juggernaut Mindset, Kathmandu, Nepal. Campbell Family Mental Health Research Institute, Centre of Addiction and Mental Health, Toronto, Ontario, Canada. Center for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom. Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.

Abstract summary 

Collaboration with people with lived experience of mental illness (PWLE), also referred to as service users, is a growing priority to reduce stigma and improve mental health care.To examine feasibility and acceptability of conducting an antistigma intervention in collaboration with PWLE during mental health training of primary care practitioners (PCPs).This pilot cluster randomized clinical trial was conducted from February 7, 2016, to August 10, 2018, with assessors, PCPs, and patients blinded to group assignment. The participants were PCPs and primary care patients diagnosed with depression, psychosis, or alcohol use disorder at primary care facilities (the cluster unit of randomization) in Nepal. Statistical analysis was performed from February 2020 to February 2021.In the control group, PCPs were trained on the World Health Organization Mental Health Gap Action Programme-Intervention Guide (mhGAP-IG). In the Reducing Stigma Among Healthcare Providers (RESHAPE) group, the mhGAP-IG trainings for PCPs were cofacilitated by PWLE who presented recovery testimonials through photographic narratives.Prespecified feasibility and acceptability measures were adequacy of randomization, retention rates, intervention fidelity, data missingness, and safety. Outcome measures for PCPs included the Social Distance Scale (SDS), accuracy of diagnoses of mental illness in standardized role-plays using the Enhancing Assessment of Common Therapeutic factors tool (ENACT), and accuracy of diagnosis with actual patients. The primary end point was 16 months posttraining.Among the overall sample of 88 PCPs, 75 (85.2%) were men and 67 (76.1%) were upper caste Hindus; the mean (SD) age was 36.2 (8.8) years. Nine of the PCPs (10.2%) were physicians, whereas the remaining 79 PCPs (89.8%) were health assistants or auxiliary health workers. Thirty-four facilities were randomized to RESHAPE or the control group. All eligible PCPs participated: 43 in RESHAPE and 45 in the control group, with 76.7% (n = 33) and 73.3% (n = 33) retention at end line, respectively. Due to PCP dropout, 29 facilities (85.3%) were included in end line analysis. Of 15 PWLE trained as cofacilitators, 11 (73.3%) participated throughout the 3 months of PCP trainings. Among PCPs, mean SDS changes from pretraining to 16 months were -10.6 points (95% CI, -14.5 to -6.74 points) in RESHAPE and -2.79 points (-8.29 to 2.70 points) in the control group. Role-play-based diagnoses with ENACT were 78.1% (25 of 32) accurate in RESHAPE and 66.7% (22 of 33) in the control group. Patient diagnoses were 72.5% (29 of 40) accurate by PCPs in RESHAPE compared with 34.5% (10 of 29) by PCPs in the control group. There were no serious adverse events.This pilot cluster randomized clinical trial found that procedures were feasible and acceptable for PCPs to be trained by PWLE. These pilot results will help inform a full trial to evaluate benefits of collaboration with PWLE during training of PCPs to reduce stigma and improve diagnostic accuracy.ClinicalTrials.gov Identifier: NCT02793271.

Authors & Co-authors:  Kohrt Brandon A BA Jordans Mark J D MJD Turner Elizabeth L EL Rai Sauharda S Gurung Dristy D Dhakal Manoj M Bhardwaj Anvita A Lamichhane Jagannath J Singla Daisy R DR Lund Crick C Patel Vikram V Luitel Nagendra P NP Sikkema Kathleen J KJ

Study Outcome 

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Statistics
Citations :  Semrau M, Alem A, Abdulmalik J, et al. . Developing capacity-building activities for mental health system strengthening in low- and middle-income countries for service users and caregivers, service planners, and researchers. Epidemiol Psychiatr Sci. 2018;27(1):11-21. doi:10.1017/S2045796017000452
Authors :  13
Identifiers
Doi : e2131475
SSN : 2574-3805
Study Population
Men
Mesh Terms
Adult
Other Terms
Study Design
Randomized Control Trial,Case Control Trial,Cross Sectional Study
Study Approach
Country of Study
Publication Country
United States