Abstract
BackgroundCommunity-based rehabilitation (CBR) is a multi-sectoral strategy to improve the functioning and quality of life of people with disabilities. The RISE (Rehabilitation Intervention for people with Schizophrenia in Ethiopia) trial will evaluate the effectiveness of CBR for people with schizophrenia in Ethiopia. Nevertheless, the components of CBR that are both feasible and likely to prove effective in low and middle-income countries such as Ethiopia are unclear.MethodsIn this study intervention development work was undertaken to design a CBR intervention that is acceptable and feasible in the local context. The development work consisted of five phases. 1: Identify potential components of CBR for schizophrenia, 2: Situational analysis, 3: Determine feasibility of CBR (Theory of Change workshops with experts and local stakeholders), 4: Determine acceptability of CBR (16 in-depth interviews and five focus group discussions with people with schizophrenia, caregivers, health workers and community leaders) and 5: Synthesise results to finalise intervention. A Theory of Change map was constructed showing the causal pathway for how we expect CBR to achieve its impact.ResultsPeople with schizophrenia in rural Ethiopia experience family conflict, difficulty participating in work and community life, and stigma. Stakeholders perceived CBR to be acceptable and useful to address these problems. The focus of CBR will be on the individual developing the skills and confidence to perform their previous or desired roles and activities. To ensure feasibility, non-health professionals will be trained to deliver CBR and provide supervision, rather than mental health specialists. Novel components of CBR for schizophrenia included family intervention and dealing with distressing symptoms. Microfinance was excluded due to concerns about stress and exploitation. Community mobilisation was viewed as essential to ensure the effectiveness and sustainability of CBR.ConclusionExtensive formative research using a variety of methods has enabled the design of a culturally appropriate CBR intervention for people with schizophrenia that is acceptable and feasible.
Highlights
Many people with schizophrenia experience severe and chronic illness; in Ethiopia 38% had episodic symptoms and 19% had continuous symptoms over a 10-year period whilst 11.8% had complete remission after one episode [1]
People with schizophrenia in rural Ethiopia experience family conflict, difficulty participating in work and community life, and stigma
Extensive formative research using a variety of methods has enabled the design of a culturally appropriate Community-based rehabilitation (CBR) intervention for people with schizophrenia that is acceptable and feasible
Summary
Many people with schizophrenia experience severe and chronic illness; in Ethiopia 38% had episodic symptoms and 19% had continuous symptoms over a 10-year period whilst 11.8% had complete remission after one episode [1]. The majority of people with schizophrenia in low and middle income countries (LMIC) do not have access to adequate care; in Ethiopia, the treatment gap is 90% [7]. The WHO’s mental health Gap Action Programme (mhGAP) recommends that schizophrenia management should include psychosocial interventions, including community-based rehabilitation (CBR), where available, evidence from LMIC settings is limited [15, 16]. CBR echoes the ethos of psychosocial rehabilitation, drawing on recovery values, whilst reflecting the particular needs of low-income settings [17]. Community-based rehabilitation (CBR) is a multi-sectoral strategy to improve the functioning and quality of life of people with disabilities. The components of CBR that are both feasible and likely to prove effective in low and middle-income countries such as Ethiopia are unclear
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