Development of a psychological intervention for people with bipolar disorder in rural Ethiopia

TY - JOUR

T1 - Development of a psychological intervention for people with bipolar disorder in rural Ethiopia

AU - Demissie, Mekdes

AU - Hanlon, Charlotte

AU - Ng, Lauren

AU - Mayston, Rosie

AU - Abayneh, Sisay

AU - Fekadu, Abebaw

N1 - Funding Information: This work was supported through the DELTAS Africa Initiative (grant DEL-15-01). The DELTAS Africa Initiative is an independent funding scheme of the African Academy of Sciences’ Alliance for Accelerating Excellence in Science in Africa (AESA), and is supported by the New Partnership for Africa's Development Planning and Coordinating Agency (NEPAD Agency), with funding from the Wellcome Trust (grant DEL-15-01) and the UK Government. The views expressed in this publication (manual) are those of the authors and not necessarily those of AAS, NEPAD Agency, Wellcome Trust or the UK Government. Addis Ababa University also supported this study financially. None of the funding bodies had a role in study design, data collection and analysis, decision to publish or preparation of the manuscript. The authors acknowledge the contributions of all stakeholders participated in the qualitative study, mental health expert workshop and the ToC workshops. We would like to thank Sodo District Health Office and PRIME project field coordinators who invested their time and effort in facilitating the workshops. Publisher Copyright: © 2021 The Author(s). Published by Cambridge University Press on behalf of the Royal College of Psychiatrists.

PY - 2021/9/14

Y1 - 2021/9/14

N2 - Background Evidence from high- A nd middle-income countries indicates that psychological interventions (PSIs) can improve the well-being of people with bipolar disorder. However, there is no evidence from low-income countries. Cultural and contextual adaptation is recommended to ensure that PSIs are feasible and acceptable when transferred to new settings, and to maximise effectiveness. Aims To develop a manualised PSI for people with bipolar disorder in rural Ethiopia. Method We used the Medical Research Council framework for the development and evaluation of complex interventions and integrated a participatory theory-of-change (ToC) approach. We conducted a mental health expert workshop (n = 12), four independent ToC workshops and a final workshop with all participants. The four independent ToC workshops comprised people with bipolar disorder and caregivers (n = 19), male community leaders (n = 8), female community leaders (n = 11) and primary care workers (n = 21). Results During the workshops, participants collaborated on the development of a ToC roadmap to achieve the shared goal of improved quality of life and reduced family burden for people with bipolar disorder. The developed PSI had five sessions: Needs assessment and goal-setting; psychoeducation about bipolar disorder and its causes; treatment; promotion of well-being, including sleep hygiene and problem-solving techniques; and behavioural techniques to reduce anxiety and prevent relapse. Participants suggested that the intervention sessions be linked with patients' monthly scheduled healthcare follow-ups, to reduce economic barriers to access. Conclusions We developed a contextually appropriate PSI for people with bipolar disorder in rural Ethiopia. This intervention will now be piloted for feasibility and acceptability before its wider implementation.

AB - Background Evidence from high- A nd middle-income countries indicates that psychological interventions (PSIs) can improve the well-being of people with bipolar disorder. However, there is no evidence from low-income countries. Cultural and contextual adaptation is recommended to ensure that PSIs are feasible and acceptable when transferred to new settings, and to maximise effectiveness. Aims To develop a manualised PSI for people with bipolar disorder in rural Ethiopia. Method We used the Medical Research Council framework for the development and evaluation of complex interventions and integrated a participatory theory-of-change (ToC) approach. We conducted a mental health expert workshop (n = 12), four independent ToC workshops and a final workshop with all participants. The four independent ToC workshops comprised people with bipolar disorder and caregivers (n = 19), male community leaders (n = 8), female community leaders (n = 11) and primary care workers (n = 21). Results During the workshops, participants collaborated on the development of a ToC roadmap to achieve the shared goal of improved quality of life and reduced family burden for people with bipolar disorder. The developed PSI had five sessions: Needs assessment and goal-setting; psychoeducation about bipolar disorder and its causes; treatment; promotion of well-being, including sleep hygiene and problem-solving techniques; and behavioural techniques to reduce anxiety and prevent relapse. Participants suggested that the intervention sessions be linked with patients' monthly scheduled healthcare follow-ups, to reduce economic barriers to access. Conclusions We developed a contextually appropriate PSI for people with bipolar disorder in rural Ethiopia. This intervention will now be piloted for feasibility and acceptability before its wider implementation.

KW - behavioural intervention

KW - individual therapy

KW - Psychoeducation

KW - relapse prevention

KW - theory of change approach

UR - http://www.scopus.com/inward/record.url?scp=85117191443&partnerID=8YFLogxK

U2 - 10.1192/bjo.2021.999

DO - 10.1192/bjo.2021.999

M3 - Article

AN - SCOPUS:85117191443

SN - 2056-4724

VL - 7

JO - BJPsych Open

JF - BJPsych Open

IS - 5

M1 - e168

ER -