Operational challenges in the implementation of an anti-stigma campaign in rural Andhra Pradesh, India.

Published on Oct 8, 2021in Journal of Public Health2.341
· DOI :10.1093/PUBMED/FDAB314
Sudha Kallakuri8
Estimated H-index: 8
(The George Institute for Global Health),
Amanpreet Kaur2
Estimated H-index: 2
(The George Institute for Global Health)
+ 1 AuthorsPallab K. Maulik38
Estimated H-index: 38
(The George Institute for Global Health)
BACKGROUND Despite of literature available on mental health-related stigma interventions, little is reported about the operational challenges faced during the planning, implementation and evaluation phases. METHODS The Systematic Medical Appraisal, Referral and Treatment Mental Health Project was implemented in 42 villages of the West Godavari district in India. Andersen's Behavioural Model for Health Services Use was adopted to understand the factors influencing anti-stigma campaign delivery and the strategies identified to overcome these challenges. RESULTS The challenges faced during the planning and implementation phase included distance and time taken for travel by the field staff, inadequate mental health services and infrastructure within communities, engagement of community with the field staff and community's poor mental health literacy and knowledge. Strategies used to overcome these challenges were regular engagement with community stakeholders, understanding mental health literacy levels and seeking inputs from the community regarding campaign design, organizing live drama shows at community's preferred time and place and screening of recorded drama video clips where lives shows were difficult. The evaluation phase posed challenges such as non-availability of key stakeholders and inadequate time and funding to evaluate the entire study population. CONCLUSION The reported findings can help in planning and scaling up of the anti-stigma campaign in large trials in similar settings.
#1Hosein Azizi (Tabriz University of Medical Sciences)H-Index: 6
#2Ali Fakhari (Tabriz University of Medical Sciences)H-Index: 14
Last. Mohammad Mirzapour (Tabriz University of Medical Sciences)H-Index: 2
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BACKGROUND Suicidal management and prevention in communities, especially in its first stages, is an effective intervention for the health systems. However, in numerous societies most cases go undetected. Primary Health Care (PHC) is an effective place for the management of Suicide Prevention Programs (SPP). In Malekan County, a health community assessment found suicide as the most important health problem. A regional SPP was performed for suicide prevention during 2014-2017. METHODS This study w...
#1A S SzostekH-Index: 1
#2P BoucherH-Index: 1
Last. Ségolène Gaillard (French Institute of Health and Medical Research)H-Index: 12
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BACKGROUND Arterial hypotension induced by general anesthesia is commonly identified as a risk factor of morbidity, especially neurological, after cardiac or noncardiac surgery in adults and children. Intraoperative hypotension is observed with sevoflurane anesthesia in children, in particular in neonates, infants younger than 6 months, and preterm babies. Ephedrine is commonly used to treat intraoperative hypotension. It is an attractive therapeutic, due to its dual action on receptors alpha an...
#1Mercian Daniel (The George Institute for Global Health)H-Index: 2
#2Pallab K. Maulik (The George Institute for Global Health)H-Index: 38
Last. David Peiris (The George Institute for Global Health)H-Index: 29
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BACKGROUND Around 1 in 7 people in India are impacted by mental illness. The treatment gap for people with mental disorders is as high as 75-95%. Health care systems, especially in rural regions in India, face substantial challenges to address these gaps in care, and innovative strategies are needed. METHODS We hypothesise that an intervention involving an anti-stigma campaign and a mobile-technology-based electronic decision support system will result in reduced stigma and improved mental healt...
BACKGROUND Globally, mental health problems are a growing public health concern. Resources and services for mental disorders are disproportionately low compared to disease burden. In order to bridge treatment gaps, The Systematic Medical Appraisal, Referral and Treatment (SMART) Mental Health Project was implemented across 12 villages in West Godavari district of the southern Indian state of Andhra Pradesh. This paper reports findings from a process evaluation of feasibility and acceptability of...
#1Pallab K. MaulikH-Index: 38
Last. Anushka Patel (UNSW: University of New South Wales)H-Index: 75
view all 6 authors...
BACKGROUND: Although around 10% of Indians experience depression, anxiety, or alcohol use disorders, very few receive adequate mental health care, especially in rural communities. Stigma and limited availability of mental health services contribute to this treatment gap. The Systematic Medical Appraisal Referral and Treatment Mental Health project aimed to address this gap. OBJECTIVE: This study aimed to evaluate the effectiveness of an intervention in increasing the use of mental health service...
AimsThis systematic review compiled evidence on interventions to reduce mental health-related stigma in primary health care (PHC) in low- and middle-income countries (LMICs). Studies targeting PHC staff (including non-professionals) were included. Primary outcomes were stigmatising attitudes and discriminatory behaviours. METHODS: Data collection included two strategies. First, previous systematic reviews were searched for studies that met the inclusion criteria of the current review. Second, a ...
#1Pallab K. Maulik (University of Oxford)H-Index: 38
#2Siddhardha Devarapalli (University of Oxford)H-Index: 8
Last. Graham ThornicroftH-Index: 124
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BACKGROUND: Stigma related to mental health and lack of trained mental health professionals is a major cause for an increased treatment gap, particularly in rural India. The Systematic Medical Appraisal, Referral and Treatment (SMART) Mental Health project delivered a complex intervention involving task sharing, an anti-stigma campaign and use of technology-based, decision-support tools to empower primary care workers to identify and manage depression, anxiety, stress and suicide risk.AimsThe ai...
#1Snehil Gupta (AIIMS: All India Institute of Medical Sciences)H-Index: 3
#2Rajesh Sagar (AIIMS: All India Institute of Medical Sciences)H-Index: 66
India was one of the major World Health Organization (WHO) member countries to launch its National Mental Health Programme (NMHP) in 1982 in accordance with WHO's recommendations to deliver mental health services to the people under the framework of general health care system in the community. NMHP underwent major strategic revisions over its course, starting from setting a district as the unit for program planning and implementation under the District Mental Health Program (DMHP) to incorporati...
#1Pallab K. Maulik (UNSW: University of New South Wales)H-Index: 38
#2Sudha KallakuriH-Index: 8
Last. Siddhardha DevarapalliH-Index: 8
view all 3 authors...
Background: There are large gaps in the delivery of mental health care in low- and middle-income countries such as India, and the problems are even more acute in rural settings due to lack of resources, remoteness, and lack of infrastructure, amongst other factors. The Systematic Medical Appraisal Referral and Treatment (SMART) Mental Health Project was conceived as a mental health services delivery model using technology-based solutions for rural India. This paper reports on the operational str...
#1Abha Tewari (The George Institute for Global Health)H-Index: 8
#2Sudha Kallakuri (The George Institute for Global Health)H-Index: 8
Last. Pallab K. Maulik (The George Institute for Global Health)H-Index: 38
view all 6 authors...
Background Availability of basic mental health services is limited in rural areas of India. Health system and individual level factors such as lack of mental health professionals and infrastructure, poor awareness about mental health, stigma related to help seeking, are responsible for poor awareness and use of mental health services. We implemented a mental health services delivery model that leveraged technology and task sharing to facilitate identification and treatment of common mental disor...
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