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Equitable access to integrated primary mental healthcare for people with severe mental disorders in Ethiopia: a formative study
BACKGROUND: The provision of mental healthcare through integration into primary care is expected to improve access to care, but not all population groups may benefit equally. The aim of this study was to inform delivery of a new primary care-based mental health service in rural Ethiopia by identifyi...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4962424/ https://www.ncbi.nlm.nih.gov/pubmed/27460038 http://dx.doi.org/10.1186/s12939-016-0410-0 |
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author | Hailemariam, Maji Fekadu, Abebaw Selamu, Medhin Medhin, Girmay Prince, Martin Hanlon, Charlotte |
author_facet | Hailemariam, Maji Fekadu, Abebaw Selamu, Medhin Medhin, Girmay Prince, Martin Hanlon, Charlotte |
author_sort | Hailemariam, Maji |
collection | PubMed |
description | BACKGROUND: The provision of mental healthcare through integration into primary care is expected to improve access to care, but not all population groups may benefit equally. The aim of this study was to inform delivery of a new primary care-based mental health service in rural Ethiopia by identifying potential barriers to equitable access to mental healthcare and strategies to overcome them. METHODS: A qualitative study was conducted as formative work for the PRogramme for Improving Mental healthcarE (PRIME), a project supporting delivery of mental healthcare integrated into primary care in a rural district in south central Ethiopia. In-depth interviews (n = 21) were carried out with stakeholders selected purposively from mental health service users, caregivers, community leaders and healthcare administrators. A focus group discussion (n = 12) was conducted with community health extension workers. Framework analysis was employed using an adapted version of the access framework developed for use in contexts of livelihood insecurity, which considers (1) availability, (2) accessibility and affordability. and (3) acceptability and adequacy dimensions of access. RESULTS: Primary care-based mental healthcare was considered as a positive development, and would increase availability, accessibility and affordability of treatments. Low levels of community awareness, and general preference for traditional and religious healing were raised as potential challenges to the acceptability of integrated mental healthcare. Participants believed integrated mental healthcare would be comprehensive and of satisfactory quality. However, expectations about the effectiveness of treatment for mental disorders were generally low. Threats to equitable access to mental healthcare were identified for perinatal women, persons with physical disability, those living in extreme poverty and people with severe and persistent mental disability. CONCLUSION: Establishing an affordable service within reach, raising awareness and financial support to families from low socioeconomic backgrounds were suggested to improve equitable access to mental healthcare by vulnerable groups including perinatal women and people with disabilities. Innovative approaches, such as telephone consultations with psychiatric nurses based in nearby towns and home outreach need to be developed and evaluated. |
format | Online Article Text |
id | pubmed-4962424 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-49624242016-07-28 Equitable access to integrated primary mental healthcare for people with severe mental disorders in Ethiopia: a formative study Hailemariam, Maji Fekadu, Abebaw Selamu, Medhin Medhin, Girmay Prince, Martin Hanlon, Charlotte Int J Equity Health Research BACKGROUND: The provision of mental healthcare through integration into primary care is expected to improve access to care, but not all population groups may benefit equally. The aim of this study was to inform delivery of a new primary care-based mental health service in rural Ethiopia by identifying potential barriers to equitable access to mental healthcare and strategies to overcome them. METHODS: A qualitative study was conducted as formative work for the PRogramme for Improving Mental healthcarE (PRIME), a project supporting delivery of mental healthcare integrated into primary care in a rural district in south central Ethiopia. In-depth interviews (n = 21) were carried out with stakeholders selected purposively from mental health service users, caregivers, community leaders and healthcare administrators. A focus group discussion (n = 12) was conducted with community health extension workers. Framework analysis was employed using an adapted version of the access framework developed for use in contexts of livelihood insecurity, which considers (1) availability, (2) accessibility and affordability. and (3) acceptability and adequacy dimensions of access. RESULTS: Primary care-based mental healthcare was considered as a positive development, and would increase availability, accessibility and affordability of treatments. Low levels of community awareness, and general preference for traditional and religious healing were raised as potential challenges to the acceptability of integrated mental healthcare. Participants believed integrated mental healthcare would be comprehensive and of satisfactory quality. However, expectations about the effectiveness of treatment for mental disorders were generally low. Threats to equitable access to mental healthcare were identified for perinatal women, persons with physical disability, those living in extreme poverty and people with severe and persistent mental disability. CONCLUSION: Establishing an affordable service within reach, raising awareness and financial support to families from low socioeconomic backgrounds were suggested to improve equitable access to mental healthcare by vulnerable groups including perinatal women and people with disabilities. Innovative approaches, such as telephone consultations with psychiatric nurses based in nearby towns and home outreach need to be developed and evaluated. BioMed Central 2016-07-26 /pmc/articles/PMC4962424/ /pubmed/27460038 http://dx.doi.org/10.1186/s12939-016-0410-0 Text en © The Author(s). 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Hailemariam, Maji Fekadu, Abebaw Selamu, Medhin Medhin, Girmay Prince, Martin Hanlon, Charlotte Equitable access to integrated primary mental healthcare for people with severe mental disorders in Ethiopia: a formative study |
title | Equitable access to integrated primary mental healthcare for people with severe mental disorders in Ethiopia: a formative study |
title_full | Equitable access to integrated primary mental healthcare for people with severe mental disorders in Ethiopia: a formative study |
title_fullStr | Equitable access to integrated primary mental healthcare for people with severe mental disorders in Ethiopia: a formative study |
title_full_unstemmed | Equitable access to integrated primary mental healthcare for people with severe mental disorders in Ethiopia: a formative study |
title_short | Equitable access to integrated primary mental healthcare for people with severe mental disorders in Ethiopia: a formative study |
title_sort | equitable access to integrated primary mental healthcare for people with severe mental disorders in ethiopia: a formative study |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4962424/ https://www.ncbi.nlm.nih.gov/pubmed/27460038 http://dx.doi.org/10.1186/s12939-016-0410-0 |
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