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Empowerment training to support service user involvement in mental health system strengthening in rural Ethiopia: a mixed-methods pilot study

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Sisay Abayneh, Heidi Lempp, Sauharda Rai, Eshetu Girma, Medhanit Getachew, Atalay Alem, Brandon A. Kohrt, Charlotte Hanlon

Original languageEnglish
Article number880
Pages (from-to)880
Number of pages1
JournalBMC Health Services Research
Issue number1
Published8 Jul 2022

Bibliographical note

Funding Information: The field work of this study was financially supported by the Psychiatry Research Trust, the Institute of Psychiatry, Psychology and Neuroscience at King’s College London, OPAL project and US National Institute of Mental Health (Grant#: R21MH111280) and Addis Ababa University. None of the funding bodies had a role in study design, data collection and analysis, decision to publish or preparation of the manuscript. The opinions and views expressed in this article are solely those of the authors and do not reflect the official positions of any of these institutions. Publisher Copyright: © 2022, The Author(s).

King's Authors


BACKGROUND: Increased service user involvement is recommended to improve weak mental health systems in low-and middle-income countries (LMICs). However, involvement is rarely implemented and interventions to support involvement are sparse. In this study we evaluated the acceptability, feasibility and perceived outcomes of an empowerment and training program for service users and health professionals to facilitate service user involvement in mental health system strengthening in rural Ethiopia. METHODS: REducing Stigma among HealthcAreProvidErs (RESHAPE) is a training curriculum for service users, their caregivers and aspirational health workers, which uses PhotoVoice methodology, to prepare them in participation of mental health systems strengthening in LMICs. We delivered the RESHAPE training augmented with empowerment content developed in Ethiopia. The interactive face-to-face training was delivered to service users and caregivers (over 10 days), and health professionals (1 day) separately. The study was an uncontrolled, convergent mixed-methods design. The quantitative data consisted of process data, satisfaction questionnaire, and a retrospective pre-test survey. Qualitative data included exit and follow-up in-depth interviews with the service users. Descriptive statistics were performed for quantitative data, and qualitative data were thematically analysed. The findings were integrated through triangulation for convergent themes following analysis. RESULTS: Twelve service users, 12 caregivers and 18 health professionals were enrolled, and completed the training. Participants valued the content and delivery process; the standard of the training program met their expectations and participation led to positive gains in understanding about mental illness, stigma, service-user involvement and human rights. The qualitative findings identified positive impacts, including increased self-confidence, sense of empowerment, social - and perceived therapeutic benefits. CONCLUSIONS: We found that the RESHAPE training with added content for Ethiopia, delivered using the PhotoVoice methodology, is feasible, acceptable and of value to develop and implement training programmes which can empower service users to be involved in mental health system strengthening in this setting. Further study to assess the impact on health systems strengthening is warranted.

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