TY - JOUR
T1 - Psychosis Recovery Orientation in Malawi by Improving Services and Engagement (PROMISE) protocol
AU - Lawrie, Stephen
AU - Hanlon, Charlotte
AU - Manda-Taylor, Lucinda
AU - Knapp, Martin
AU - Pickersgill, Martyn
AU - Stewart, Robert C
AU - Ahrens, Jen
AU - Allardyce, Judith
AU - Amos, Action
AU - Bauer, Annette
AU - Breuer, Erica
AU - Chasweka, Dennis
AU - Chidzalo, Kate
AU - Gondwe, Saulos
AU - Jain, Sumeet
AU - Kokota, Demoubly
AU - Kulisewa, Kazione
AU - Liwimbi, Olive
AU - MacBeth, Angus
AU - Mkandawire, Thandiwe
AU - Sefasi, Anthony
AU - Sibande, Wakumanya
AU - Udedi, Michael
AU - Umar, Eric
N1 - Funding Information:
Funding: This study is funded by Wellcome Trust (www.wellcome.org) under grant number 223615/ Z/21/Z. The Principal Investigator is Professor Stephen Lawrie (SL). Charlotte Hanlon (CH) receives support through the National Institute for Health and Care Research (NIHR) with a RIGHT grant (NIHR200842) and an NIHR global health research group on homelessness and mental health in Africa (HOPE; NIHR134325). The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care, England. CH is also funded by the Wellcome Trust through grants 222154/Z20/Z (SCOPE). Martin Pickersgill (MP) contributions are additionally supported through the AHRC [AH/W011417/1], MRC [MR/S035818/1], and Wellcome Trust [209519/Z/17/A]. Robert Stewart (RS) and Angus MacBeth (AMB) are supported by MRC GCRF MR/ S035818/1. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Publisher Copyright:
Copyright: © 2023 Lawrie et al.
PY - 2023/11/14
Y1 - 2023/11/14
N2 - Malawi has a population of around 20 million people and is one of the world's most economically deprived nations. Severe mental illness (largely comprising psychoses and severe mood disorders) is managed by a very small number of staff in four tertiary facilities, aided by clinical officers and nurses in general hospitals and clinics. Given these constraints, psychosis is largely undetected and untreated, with a median duration of untreated psychosis (DUP) of around six years. Our aim is to work with people with lived experience (PWLE), caregivers, local communities and health leaders to develop acceptable and sustainable psychosis detection and management systems to increase psychosis awareness, reduce DUP, and to improve the health and lives of people with psychosis in Malawi. We will use the UK Medical Research Council guidance for developing and evaluating complex interventions, including qualitative work to explore diverse perspectives around psychosis detection, management, and outcomes, augmented by co-design with PWLE, and underpinned by a Theory of Change. Planned deliverables include a readily usable management blueprint encompassing education and community supports, with an integrated care pathway that includes Primary Health Centre clinics and District Mental Health Teams. PWLE and caregivers will be closely involved throughout to ensure that the interventions are shaped by the communities concerned. The effect of the interventions will be assessed with a quasi-experimental sequential implementation in three regions, in terms of DUP reduction, symptom remission, functional recovery and PWLE / caregiver impact, with quality of life as the primary outcome. As the study team is focused on long-term impact, we recognise the importance of having embedded, robust evaluation of the programme as a whole. We will therefore evaluate implementation processes and outcomes, and cost-effectiveness, to demonstrate the value of this approach to the Ministry of Health, and to encourage longer-term adoption across Malawi.
AB - Malawi has a population of around 20 million people and is one of the world's most economically deprived nations. Severe mental illness (largely comprising psychoses and severe mood disorders) is managed by a very small number of staff in four tertiary facilities, aided by clinical officers and nurses in general hospitals and clinics. Given these constraints, psychosis is largely undetected and untreated, with a median duration of untreated psychosis (DUP) of around six years. Our aim is to work with people with lived experience (PWLE), caregivers, local communities and health leaders to develop acceptable and sustainable psychosis detection and management systems to increase psychosis awareness, reduce DUP, and to improve the health and lives of people with psychosis in Malawi. We will use the UK Medical Research Council guidance for developing and evaluating complex interventions, including qualitative work to explore diverse perspectives around psychosis detection, management, and outcomes, augmented by co-design with PWLE, and underpinned by a Theory of Change. Planned deliverables include a readily usable management blueprint encompassing education and community supports, with an integrated care pathway that includes Primary Health Centre clinics and District Mental Health Teams. PWLE and caregivers will be closely involved throughout to ensure that the interventions are shaped by the communities concerned. The effect of the interventions will be assessed with a quasi-experimental sequential implementation in three regions, in terms of DUP reduction, symptom remission, functional recovery and PWLE / caregiver impact, with quality of life as the primary outcome. As the study team is focused on long-term impact, we recognise the importance of having embedded, robust evaluation of the programme as a whole. We will therefore evaluate implementation processes and outcomes, and cost-effectiveness, to demonstrate the value of this approach to the Ministry of Health, and to encourage longer-term adoption across Malawi.
UR - http://www.scopus.com/inward/record.url?scp=85178502292&partnerID=8YFLogxK
U2 - 10.1371/journal.pone.0293370
DO - 10.1371/journal.pone.0293370
M3 - Article
C2 - 38032862
SN - 1932-6203
VL - 18
SP - e0293370
JO - PLoS ONE
JF - PLoS ONE
IS - 11 November
M1 - e0293370
ER -
