Z Factor: Drama as a tool to tackle mental health stigma: study design and protocol for community and public engagement in rural Zimbabwe.

Tamaryn Palmer,Nicola Wright,Eileen O'Regan,Denford Gudyanga,Melody Maremera,Walter Mangezi,Nefasi Mlambo,Charity Shonai

doi:10.12688/wellcomeopenres.16262.1

Abstract

Background: Mental health is slowly gaining global significance as a key health issue, yet the stigma attached to psychosis is still a major problem. There has been little in-depth exploration of sustainable, cost-effective, and replicable community engagement strategies that address mental health myths and stigma, which are major barriers to early health-seeking behaviours. In low-income countries such as Zimbabwe, cultural and spiritual beliefs are at the centre of most mental health explanatory models, perpetuating an environment where mental health conversations are a cultural taboo. Mental health interventions should be accompanied by creative, evidence-based community engagement, ensuring that interventions are suitable for local settings and giving communities a voice in directing their health initiatives. Methods: Z Factor aimed to engage young adults and their support networks across a variety of socioeconomic groups in a rural district of Zimbabwe through their participation in an inter-ward five-staged drama competition. The focus was on psychosis, with subcategories of initial presentation/detection, seeking help/pathway to care, and the road to recovery/treatment. Each drama group's composition included a young adult and a typical support network seeking treatment from the service provider of choice. Dramas were to act as discussion starters, paving the way toward broader and deeper psychosis treatment discussions among rural communities and gaining insight into service user expectations from health research. Conclusions: Outcomes of the pilot community engagement project will be instrumental in improving understanding community perceptions about psychosis treatment and recovery in rural Zimbabwe and increasing community awareness about psychosis, as well as paving the way for initiating service provider collaboration to promote early detection and encouraging early health-seeking behaviours. The above outcomes will also inform the design of models for more responsive community and public engagement initiatives in similar low resource settings in Zimbabwe and beyond.

Highlights

Mental health is slowly gaining global significance as a key health issue (Keyes, 2007; World Health Organization, 2004)
Neither has there been an in-depth exploration of sustainable, cost-effective and replicable community engagement strategies that address mental health myths and stigma as a major barrier to early health-seeking behaviours
In low income and resource-constrained countries such as Zimbabwe, cultural and spiritual beliefs are at the centre of most mental health explanatory models (Refugee Review Tribunal AUSTRALIA, 2009)

Summary

Introduction

Mental health is slowly gaining global significance as a key health issue (Keyes, 2007; World Health Organization, 2004) This has not, resulted in a significant decrease in the stigma attached to psychosis, especially in low-income countries (Kemp et al, 2019). In low income and resource-constrained countries such as Zimbabwe, cultural and spiritual beliefs are at the centre of most mental health explanatory models (Refugee Review Tribunal AUSTRALIA, 2009) This perpetuates an environment in which public conversations about mental health are the equivalent of a cultural taboo (Patel et al, 1995; Wintersteen et al, 1995). There has been little in-depth exploration of sustainable, cost-effective, and replicable community engagement strategies that address mental health myths and stigma, which are major barriers to early health-seeking behaviours. Dramas were to act as discussion starters, paving the way toward broader and deeper psychosis treatment discussions among rural communities and gaining insight

Methods

Results

Conclusion