Community-based Rehabilitation Workers Research Articles

Health-related quality of life and associated factors among primary caregivers of children with cerebral palsy, in Bahir Dar and Gondar cities, Ethiopia, 2022.

Caring for a child with cerebral palsy (CP) could negatively affect the Health-Related Quality of Life (HRQOL) of the mothers who are usually the primary caregivers. To the best of our 'knowledge, there is a dearth of information on the HRQOL of primary caregivers of children with CP in Ethiopia. Therefore, this study aimed to investigate caregivers' HRQOL and factors associated with it in Gondar and Bahir Dar Cities, Northwest Ethiopia, 2022. A community-based cross-sectional study was conducted among primary caregivers of Children with CP from April 20 to June 20, 2022, in Gondar and Bahir Dar cities. Convenience sampling was used to get study participants. Data were collected by trained health extension and community-based rehabilitation workers. The collected data were coded, cleaned, entered into EPI data, and exported to Stata-16 for analysis. A generalized linear model was employed to show the relationship between dependent and independent variables. A P-value≤0.05 was considered statistically significant at a 95% confidence interval. In this study, HRQOL among primary caregivers of children with CP was 28.72(±13.38) and 23.26(±12.37) in the physical summary score (PSC) and mental summary score (MSC) respectively. Age 17-30yeas (p-value = 0.03), unable to read and write (p = 0.01), privately employed (p = 0.01) and government employed (p = 0.02), monthly income<1000 Ethiopian Birr (ETB) (p = 0.01), insufficient sleeping (p = 0.001), others relationship(p = 0.001), have three and above children (p = 0.001), others house composition (p = 0.003), have no helpers (p = 0.001) and third birth order of child (p = 0.03) were all factors associated with HRQOL in PSC. On the other hand, income<1000ETB (p = 0.05), insufficient sleeping (p = 0.001), others in relation to the child (p = 0.001), others in house composition (p = 0.03), dyskinetic CP (p = 0.01) and ataxic CP (p = 0.001) were all factors associated with HRQOL of caregivers in MSC components. The HRQOL among primary caregivers of children with CP in Bahir Dar and Gondar cities was low. Age, monthly income, educational status, sleeping status, relationship and house composition, number of living children, birth order of child, helpers, and type of CP were all significantly associated with HRQOL of primary caregivers of children with CP.

Assessing the usefulness of an mHealth strategy to support implementation of multi-faceted adaptive feeding interventions by community-based rehabilitation workers

ABSTRACT To assess the usefulness of an mHealth strategy to support assimilation of adaptive feeding interventions into daily practices of community-based rehabilitation (CBR) workers. The mHealth strategy was evaluated in a 4-week field test. At baseline, all participants received a 1-hour, hands-on training on adaptive feeding techniques. The intervention group (n = 12) subsequently received smartphones pre-loaded with training and demonstration videos; control group members (n = 12) did not. All were instructed to recommend adaptive feeding interventions to families on their caseload when appropriate. Both groups received weekly calls to monitor progress and discussed their experiences in post-study focus groups. The intervention group saw over twice the number of families with a child with cerebral palsy compared to the control group. For intervention group members, on-demand access to the videos increased their overall usefulness in everyday practice, enhanced their self-confidence, clarified their recommendations, and increased credibility with caregivers. In contrast, control group members implemented the adaptive feeding strategies less frequently and less confidently. mHealth strategies are a promising option for supporting geographically dispersed CBR workers implementing multi-faceted assistive technology interventions. The portability of video content reinforced learning, increased implementation of the adaptive feeding interventions, and enhanced communication with consumer.

"Like a doctor, like a brother": Achieving competence amongst lay health workers delivering community-based rehabilitation for people with schizophrenia in Ethiopia.

There are gaps in our understanding of how non-specialists, such as lay health workers, can achieve core competencies to deliver psychosocial interventions in low- and middle-income countries. We conducted a 12-month mixed-methods study alongside the Rehabilitation Intervention for people with Schizophrenia in Ethiopia (RISE) pilot study. We rated a total of 30 role-plays and 55 clinical encounters of ten community-based rehabilitation (CBR) lay workers using an Ethiopian adaptation of the ENhancing Assessment of Common Therapeutic factors (ENACT) structured observational rating scale. To explore factors influencing competence, six focus group discussions and four in-depth interviews were conducted with 11 CBR workers and two supervisors at three time-points. We conducted a thematic analysis and triangulated the qualitative and quantitative data. There were improvements in CBR worker competence throughout the training and 12-month pilot study. Therapeutic alliance competencies (e.g., empathy) saw the earliest improvements. Competencies in personal factors (e.g., substance use) and external factors (e.g., assessing social networks) were initially rated lower, but scores improved during the pilot. Problem-solving and giving advice competencies saw the least improvements overall. Multimodal training, including role-plays, field work and group discussions, contributed to early development of competence. Initial stigma towards CBR participants was reduced through contact. Over time CBR workers occupied dual roles of expert and close friend for the people with schizophrenia in the programme. Competence was sustained through peer supervision, which also supported wellbeing. More intensive specialist supervision was needed. It is possible to equip lay health workers with the core competencies to deliver a psychosocial intervention for people with schizophrenia in a low-income setting. A prolonged period of work experience is needed to develop advanced skills such as problem-solving. A structured intervention with clear protocols, combined with peer supervision to support wellbeing, is recommended for good quality intervention delivery. Repeated ENACT assessments can feasibly and successfully be used to identify areas needing improvement and to guide on-going training and supervision.

Comprehensive Needs Assessment to Ensure Appropriate Rehabilitation Training for Community-Based Workers and Caregivers in India.

Rehabilitation researchers and occupational therapy practitioners frequently conduct projects that involve the provision of services or the dissemination of knowledge in low- and middle-income countries (LMICs); however, the needs assessment process underlying these transcultural projects is often underreported. To identify a comprehensive set of feeding-related training needs that reflect the culture, resources, and service delivery practices in the West Bengal region of India and that will be used to develop video-based training modules that are contextually relevant and support decentralized training of community-based rehabilitation workers and caregivers of children with cerebral palsy (CP). Mixed methods design using focus groups and observations. Community setting in rural, suburban, and urban locations in West Bengal, India. Caregivers of children with CP and community-based rehabilitation workers with experience working with children with CP. Focus groups and in-home mealtime observations. Several findings suggest training priorities that were not anticipated. Caregivers commonly fed children by means of hand feeding while sitting on the floor. Children were fed a limited variation of food consistencies, often in positions of neck hyperextension. Water was frequently used to stimulate swallowing. Caregivers struggled to help children with oral hygiene practices after meals. A thorough needs assessment yielded insights that can favorably alter the trajectory of transcultural service and research projects. For occupational therapists who provide advice on practice, continuing education, or research in a transcultural project, the findings underscore the value of engaging local stakeholders and using firsthand observation. The rigorous, multistakeholder needs assessment process described herein can serve as a road map for researchers and occupational therapy practitioners conducting transcultural projects in LMICs.

A Situational Mapping Overview of Training Programmes for Community-Based Rehabilitation Workers in Southern Africa: Strategies for Strengthening Accessible Rural Rehabilitation Practice.

In 2018, the United Nations global report showed that people with disabilities, who make up 15% of the worlds' population, have poorer health and rehabilitation access (SDG 3). Without improving the needed person-centered health and rehabilitation services at household level, SDG 3 cannot be achieved. This includes addressing human resource shortages through training multi-skilled community based rehabilitation workers (CRWs) to build rural workforce capacity and enhance the lives of people with disabilities, particularly in LMICs where the need is higher but resources are lower. However, to date, there is no documentation and analysis of existing training and its scope for this workforce in LMICs. A situational mapping overview was undertaken to review the current status of rural rehabilitation training programs offered in Southern Africa for CRWs. CRWs are rehabilitation personnel, based in the home/community, who are not professionals (without a bachelor qualification) but render non-institutional rehabilitation and inclusive development in communities, under the supervision of rehabilitation practitioners. Information on these programs was obtained using a two-step process. Firstly, a descriptive list of university courses for rehabilitation workers offered in the Southern African countries was collected via an internet and literature search. Secondly, detailed information about the disability and rural rehabilitation courses was collected from the respective institutions and their designated websites. There are six training courses targeted at CRWs or disability practitioners with a disability focus being offered at universities in Southern Africa, five of these in South Africa and one in Zimbabwe. Additionally, four training courses are offered as online/open resources by global organizations and are self-directed with no accreditation. While other key competencies feature, none of these programmes' learning outcomes make direct reference to the rural practice context and its complexities in relation to disability and poverty. The situational mapping overview shows limited training targeted at CRWs in Southern Africa, to effectively facilitate rural rehabilitation, poverty reduction and social inclusion. There is a need for an articulated community-orientated rural training to respond to the unmet needs. This may require a different set of competencies and assessment standards for trainees as well as additional competencies for their supervisors and mentors.

\u201cWe can\u2019t handle things we don\u2019t know about\u201d: perceived neurorehabilitation challenges for Malawian paediatric cerebral malaria survivors

BackgroundWe sought to identify perceptions of neurorehabilitation challenges for paediatric cerebral malaria (CM) survivors post-hospital discharge at Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi.MethodsAn exploratory approach was used to qualitatively investigate the perceived neurorehabilitation challenges for paediatric CM survivors. Data were collected through semi-structured in-depth interviews (IDIs) and focus group discussions (FGDs). Eighteen data-gathering sessions were conducted with 38 total participants, including 3 FGDs with 23 primary caregivers, 11 IDIs with healthcare workers at QECH, and 4 IDIs with community-based rehabilitation workers (CRWs).ResultsFGDs revealed that caregivers lack important knowledge about CM and fear recurrence of CM in their children. Post-CM children and families experience substantial stigma and sociocultural barriers to integrating into their community and accessing neurorehabilitative care. At a community-level, rehabilitation infrastructure, including trained staff, equipment, and programmes, is extremely limited. Rehabilitation services are inequitably accessible, and community-based rehabilitation remains largely unavailable.ConclusionsThere is an urgent need to establish further training of rehabilitation personnel at all levels and to build accessible rehabilitation infrastructure in Malawi for post-CM patients. Additional work is required to expand this study across multiple regions for a holistic understanding of neurorehabilitation needs.

From Community-Based Rehabilitation (CBR) Services to Inclusive Development. A Study on Practice, Challenges, and Future Prospects of CBR in Gedeo Zone (Southern Ethiopia)

The purpose of this article is to explain the practice, challenges and future prospects of community-based rehabilitation (CBR) in Gedeo zone, a district of nearly one million inhabitants in the south of Ethiopia. The study used a mixed methods design. The quantitative part of the study involved 138 parents and care givers selected by convenient sampling technique. In addition, a total of 22 (seven female and 15 male) research participants were purposively selected from various categories: one head of zone labor and social affairs, three heads of district labor and social affairs, three representatives of associations of PWDs, 11 parents, two CBR heads, and two CBR social workers. Questionnaires and interviews were used as tools of data collection. The data were analyzed using both descriptive and thematic analysis. The finding indicated that there was no well-established CBR service provision for PWDs in Gedeo zone to ensure full participation and successful adjustment in the community. The article also revealed that a lack of trained manpower, following the charity model of CBR, and a failure to understand the modern essence of CBR were some of the major challenges that hindered the implementation of CBR service in Gedeo zone. Based on the findings, we recommend the establishment of rehabilitation centers in combination with community services in various districts of the zone. Community-based rehabilitation requires centers with skilled staff, able to empower local people in the community to develop inclusive structures. Furthermore, we suggest that the practice of CBR in Gedeo zone should empower CBR workers in community-based inclusive development.

Community participation of families of children with profound intellectual and multiple disabilities in South Africa.

Families struggle to support family members with profound intellectual and multiple disabilities (PIMD), especially in low resourced settings where formal services may not be available. The adapted Family Community Participation survey, measuring perceptions of community participation, was administered to 67 primary caregivers of children with PIMD in Cape Town by community-based rehabilitation workers. Families were most satisfied going to religious activities and getting together with family and friends. They were most dissatisfied with doing activities together in public and working or volunteering outside the home. Barriers to participation included negative attitudes, insufficient money and unavailability of community activities. Transportation, safety and security were additional challenges. Participants advocate awareness raising, community support and provision of services to address barriers to community participation. Families should be consulted on community issues to integrate their specific family needs into the overall needs of the community.

Sustainable support solutions for community-based rehabilitation workers in refugee camps: piloting telehealth acceptability and implementation

BackgroundThe lack of training and education of Community-Based Rehabilitation (CBR) workers poses one of the most significant barriers to receiving effective occupational, physical and speech therapy for individuals with disabilities in Low-to-Middle Income Countries (LMIC), especially in countries with significant refugee populations. The aim of this study was to successfully implement a telehealth support system for CBR workers, evaluate the feasibility and acceptability of this intervention’s implementation among CBR workers in the CBR setting, and further identify strategies to address the deficit of skilled rehabilitation workers in LMIC through technological intervention.MethodsThis pilot study included CBR workers and CBR managers to inform feasibility, acceptability, and sustainable implementation. The RE-AIM and Dynamic Sustainability Framework were incorporated to guide procedural design, survey development, data collection, data evaluation, and increase success of telehealth implementation. CBR workers participate in trainings, telehealth sessions, surveys and focus groups to inform feasibility and acceptability. CBR Managers participated in focus groups to inform feasibility and sustainable implementation. NVIVO 12 Software was utilized to develop themes from CBR worker and CBR manager responses.ResultsFindings from this study demonstrate the need for additional training support for CBR workers in CBR settings throughout the entire treatment process. The telehealth system demonstrated successful short-term implementation across several domains of feasibility. Telehealth utilization was also proven acceptable, appropriate and necessary. Cultural beliefs, CBR worker training, and CBR Center infrastructure pose the most significant barriers to implementation of telehealth technologies in CBR Centers. CBR workers and managers confirmed the demand for future telehealth-based support systems, strengthening effort towards sustainability and scale-up.ConclusionsTelehealth can be utilized to support CBR workers that serve vulnerable and marginalized populations, and in turn improve the global health status among refugee populations by reducing inequitable access to quality health care. The results support the need for further research to rigorously evaluate effectiveness of telehealth interventions to support CBR workers.

Management of Undergraduate Community-Based Rehabilitation Programmes in the Philippines: A Cross-Sectional Survey

Purpose: The survey aimed to identify common strengths and weaknesses regarding the characteristics, management and implementation of Community-Based Rehabilitation (CBR) training in the undergraduate curriculum of Schools of Physical Therapy in the Philippines, and make recommendations for improvement. Method: A survey was conducted with the academic heads of CBR departments in 10 Physical Therapy schools. The institutions were selected through cluster sampling according to regional location. Nine of these were private institutions. Data was collected through a 24-item self-assessment survey distributed to the heads of the participating colleges /departments. Results: A number of strengths and weaknesses were identified. The strengths were: all schools had a 1 to 2-month clinical CBR course integrated into their undergraduate curriculum; CBR courses were supported by a course syllabus, learning outcomes, student assessment and clinical training manual; 80% of institutions had implementing policies and guidelines governing management of the CBR programme(s); at least one physiotherapist was involved in the management of the CBR programme(s); and, CBR activities were delivered in coordination with key stakeholders management, with emphasis on delivery of physical therapy services, disability prevention, health education, participation of persons with disabilities and community awareness. The weaknesses were: no head/programme coordinator for 30% of CBR programmes; 40% did not have clinical coordinators as designated management positions in the CBR programme; only 50% of academic staff received formal CBR training, of which 80% was provided through CBR summits and professional interaction with other physical therapists; and, only 50% of schools adopted a multidisciplinary approach to service delivery which was focused on the Health domain of the CBR Matrix. Conclusion: The CBR component of the undergraduate physical therapy curriculum in the Philippines can be improved. A shift in the teaching to transdisciplinary care and inter-professional learning is recommended. Regular review of the CBR indicators should be done by the schools, including the key stakeholders. Challenges for CBR implementation were recruitment of community volunteers as CBR workers, availability of indigenous resources and finances to support CBR activities, and family participation in the rehabilitation of a relative with a disability. Each school should determine whether current human resources and training are adequate. Schools must be encouraged to jointly identify common problems in CBR education and share solutions.

Expanding Global Rehabilitation Services through International Academic-Community Partnerships.

Background:More than one billion people worldwide live with a disability, yet rehabilitation professionals are scarce in low- and middle-income countries. Attempts to expand access to rehabilitation services have encountered barriers on multiple levels: limited resources on the systemic level, hierarchies on the professional level, and cultural stigma on the community level.Objectives:We sought to determine if an academic-community partnership could overcome multiple levels of barriers to expand services for people with disabilities.Methods:Toward an All-Inclusive Jordan incorporates community-based rehabilitation with prelicensure health professions education to address the three primary levels of barriers to rehabilitation services in low- and middle-income countries. The yearlong curriculum includes formal training, research, and advocacy with graduate students from the United States and health professions students and community members in Palestinian refugee camps near Amman, Jordan.Findings:After two cycles of the program, 14 Jordanian volunteers have partnered with 20 graduate students from the United States. They have delivered over 300 direct rehabilitation sessions, conducted ten workshops with mothers of children with disabilities, and trained 12 community-based rehabilitation workers in the refugee camps.Conclusions:The academic-community partnership model builds on the evidence base for the success of community-based rehabilitation services in low- and middle-income countries. Its components address barriers on multiple levels to create a sustainable expansion of services to people with disabilities.

Development of training manuals for community disability workers

BACKGROUND: People with disability (PWD) living in the community often require ongoing assistance for self-care and for continuing rehabilitation maintenance programs. While awareness material is easily available, training for volunteers working with disabled population and family members of PWD is hard to come by. AIM: The aim of this study was to develop resource material for training of disability workers, community-based rehabilitation (CBR) workers, and school teachers in rural areas in specific areas. METHODOLOGY: Using standard guidelines, training manuals were prepared under five specific categories to train CBR volunteers to undertake routine maintenance exercise programs and functional training strategies. These manuals were translated into Kannada, and in stepwise process fieldworkers, school teachers and CBR workers were trained. Revisions were made based on feedback received from stakeholders. RESULTS: Five manuals pertaining to specific areas have been prepared and tested. CONCLUSION: The training manuals developed for CBR workers are available in English and Kannada and were found to be useful by the target population in this preliminary study.

Physiotherapy Guideline for Children with Supracondylar Fracture of Humerus for Hospital Setting of Low-Income Countries: Clinical Commentary

Background: This clinical commentary is aimed to intended to evidence based physiotherapy assessment and treatment of children with supracondylar humerus fracture and post fracture complication that could be used for physiotherapists working in university hospital setting and a base line, information resource and a quick reference for physiotherapists, and community based rehabilitation workers, nurses, orthopedist and pediatrician in the management of children with supracondylar humerus fracture and to prevent its complications. Findings: The purpose of this clinical commentary is to summaries simple assessment tools based on international classification of functioning and disability and simples’ physiotherapy intervention program for children with supracondylar humeral fracture. It is very important to establish an appropriate clinical guideline for physical rehabilitation based on setting resource. Implication: Evidence based at the same time simple and cost-effective assessment, referral imputes and physical therapy treatment protocol can be more beneficial and easier to implement in resource limited pediatric care settings.

Prioritizing Local Needs and Culture When Developing Rehabilitation Training Materials For Use in Another Country

Identify key training needs and cultural considerations to guide development of video-based training on adaptive feeding strategies for use by community-based rehabilitation (CBR) workers and caregivers of children with cerebral palsy (CP) in West Bengal, India.

Community-based rehabilitation workers' perspectives of wheelchair provision in Uganda: A qualitative study.

BackgroundThe challenges of wheelchair provision and use in less resourced settings are the focus of global efforts to enhance wheelchair service delivery. The shortage of professional wheelchair service providers in these settings necessitates the collaboration of multiple stakeholders, including community-based rehabilitation (CBR) workers, whose role needs to be further understood.ObjectivesThe aim of this study was to determine what CBR workers in three areas of Uganda perceived as (1) the challenges with wheelchair provision and use, (2) the factors contributing to these challenges, (3) the role they themselves can potentially play and (4) what facilitators they need to achieve this.MethodThis qualitative study in the transformative paradigm comprised focus group discussions to gather perceptions from 21 CBR workers in three areas of Uganda, each with an operational wheelchair service, participant observations and field notes. Thematic analysis of data was implemented.ResultsCommunity-based rehabilitation workers’ perceptions of challenges were similar while perceived causes of challenges differed as influenced by location, historical and current wheelchair availability and the CBR workers’ roles. Their main responsibilities included assistance in overcoming barriers to access the service, transfer of skills and knowledge related to wheelchairs, follow-up of users for wheelchair-related problem-solving, and user and community empowerment.ConclusionCommunity-based rehabilitation workers can contribute in various ways to wheelchair service delivery and inclusion of wheelchair users; however, their capabilities are not consistently applied. Considering the diversity of contextual challenges, CBR workers’ range of responsive approaches, knowledge of networks and ability to work in the community make their input valuable. However, to optimise their contribution, specific planning for their training and financial needs and effective engagement in the wheelchair services delivery system are essential.Keywordswheelchairs; less resourced settings; community-based rehabilitation; wheelchair service provision; service steps; Uganda; empowerment; inclusion; assistive device.

Training Needs of Community-based Rehabilitation Workers for the Effective Implementation of CBR Programmes

Purpose : This review investigates the training needs of Community-Based Rehabilitation (CBR) workers that would enable them to effectively facilitate CBR programmes. Emphasis was placed on identifying: (a) the skills that CBR workers require (b) the training currently available for them, and (c) the gaps in current training. Method : A scoping review was conducted using on-line database searches (Medline, Embase, Cinahl, PsycInfo, Global Health) for English articles from 2006 onwards. A combination of keywords related to CBR, personnel, and training were applied. Hand searches of reference lists and the DCID journal were also conducted. Grey literature related to training, from the World Health Organisation (WHO), CBR Regional Networks and organisations affiliated with CBR were included as secondary data. Thirty-three articles and thirty-five sources from the grey literature were included. Data was organised under the three objectives outlined above – i.e., required skills, available training and training gaps. Results : CBR workers represent a diverse group requiring a broad range of skills. A new cadre of mid-level workers is also necessary to effectively implement the CBR guidelines. There is currently no standardised training for CBR workers and training varies widely, depending on context. CBR workers require further training in various clinical, social, management, communication, and cultural competence skills across the spectrum of the CBR Matrix, and specifically in empowering persons with disabilities and facilitating community development. They also need to develop critical reasoning, creativity, and compassion. Conclusion : A standardised approach to training CBR workers would be beneficial to ensure basic standards and quality services, to allow meaningful comparison and evaluation across contexts, to recognise the role of mid-level CBR workers, and to strengthen the workforce. Further research is required to determine minimal competencies, define the roles of various CBR workers, and evaluate the effectiveness of training.

Job satisfaction among Community-Based Rehabilitation (CBR) workers in caring for disabled persons in the east coast region of Peninsular Malaysia

BackgroundJob satisfaction influences staff retention, motivation, and performance in providing services. A considerable amount of published studies has reported on the job satisfaction level of healthcare workers, but to date, very few studies focused on Community-Based Rehabilitation (CBR) workers. This study aimed to explore the job satisfaction level among Community-Based Rehabilitation (CBR) workers and associated factors related to their overall job satisfaction.MethodsA one-year survey was conducted in three states of the east coast region of Peninsular Malaysia involving 204 CBR workers selected through universal sampling method where all CBR staff who fulfilled the inclusion criteria were selected as participants. Self-completed questionnaires consisted of 20 association factors on six-point Likert scale responses were distributed. Total mean satisfaction level and mean associated factors were reported in this study.ResultsThe results showed that the majority of the participants were between 20 and 40 years old (72%), female (96%), Malay (99%) and had 1–5 years of working experience. The mean total satisfaction score was 79.8 ± SD = 7.85. The highest mean satisfaction level for the associated factor was 4.6 ± SD = 0.59 with about 95% of the participants were satisfied that “CBR programme is a challenging work”, while the lowest satisfaction level for associated factor was on “salary of community-based rehabilitation staff is acceptable”, with mean score of 2.3 ± SD = 0.97 with about 59% of the participants felt dissatisfied. The results of this study determined that the highest dissatisfied factors among CBR workers were on salary.ConclusionThese findings provided useful information for policymakers to evaluate this issue for a sustainable CBR programme in the future.Trial registrationThis study has been registered for trial as ‘retrospective registered’ in the Australian New Zealand Clinical Trials Registry (ANZCTR) (registration no.: ACTRN 12618001101279) on 5th October 2018.

Using Mobile Devices to Support Training of Community-Based Rehabilitation Workers in India Who Provide Services to Children With Cerebral Palsy

Abstract Date Presented 4/20/2018 Increased use of mobile devices in developing countries may provide an effective medium for ongoing training and support for community-based rehabilitation workers. This study found that ongoing smartphone access enabled CBR workers in rural India to view video modules and confidently share strategies with families of children with cerebral palsy. Primary Author and Speaker: Sutanuka Bhattacharjya Additional Authors and Speakers: James Lenker

Community-Based Mental Health Intervention Skills: Task Shifting in Low- and Middle-Income Settings

There is a global need to provide human resources for health in low- and middle-income countries. To increase access to care, task shifting has been implemented in community-based rehabilitation (CBR) programs where skills and responsibilities are transferred to local people with shorter and more focused training. Through realist review and synthesis, this research aimed to consolidate the literature when considering (a) what skills CBR workers are reportedly using and/or being trained in relating to mental health, (b) how different settings affect how these task shifting programs work, and (c) the evidence of effectiveness when community health workers come from within the community itself. A total of 11 databases (PubMed, ABI/Inform Global, CINAHL, Cochrane, Emerald, Google Scholar, PsycINFO, SAGE, Science Direct, Scopus, and Web of Science) were systematically searched for specific terms relating to mental health, CBR, and low- and middle-income country. A total of 27 publications were identified as fitting the criteria (4 qualitative, 20 quantitative including 10 randomized controlled trials, and 3 noninvestigatory editorials). Core skills have been identified along with themes that affect how programs work in particular contexts. The use of task shifting in this area may be a potentially viable option for increasing access to mental health care. This resulted in the development of a theory to explain the outcomes being observed. When Task-shifting mental health intervention skills collaboration, harnessing resources available within the community, and the provision of ongoing supervision interact to influence awareness gains, social bonding, the building of trust, and the development of skills and understanding within the community itself. This effects intervention buy-in, overall effectiveness and sustainability, mental health symptoms and local empowerment. These findings can be considered when developing training programs for CBR mental health workers, as well as policy and intervention program design.

Involvement of people with schizophrenia in decision-making in rural Ethiopia: a qualitative study

BackgroundThe involvement of people with psychosocial disabilities in decision-making is a fundamental component of a person-centred and recovery-oriented model of care, but there has been little investigation of this approach in low- and middle-income countries. The aim of this study was to explore the involvement of people with schizophrenia in decision-making relating to their care in rural Ethiopia.MethodsA qualitative study was conducted in rural Ethiopia as part of the Rehabilitation Intervention for people with Schizophrenia in Ethiopia (RISE) project, involving two focus group discussions (n = 10) with community-based rehabilitation workers, and 18 in-depth interviews with people with schizophrenia, caregivers, health officers, supervisors and a community-based rehabilitation worker. Thematic analysis was used to examine major themes related to involvement in decision-making in this specific setting.ResultsInvolvement of people with schizophrenia in decision-making in this rural Ethiopian setting was limited and coercive practices were evident. People with schizophrenia tended to be consulted about their care only when they were considered clinically ‘recovered’. Caregivers typically had a prominent role in decision-making, but they also acquiesced to the views of health care professionals. People with schizophrenia and caregivers were often unable to execute their desired choice due to inaccessible and unaffordable treatment.ConclusionsCommunity-based rehabilitation, as a model of care, may give opportunities for involvement of people with schizophrenia in decision-making. In order to increase involvement of people with schizophrenia in rural Ethiopia there needs to be greater empowerment of service users, wider availability of treatment choices and a facilitating policy environment. Further studies are needed to explore concepts of person-centred care and recovery across cultural settings.