■在西非,治疗师的数量大大超过训练有素的心理健康专业人员。患有严重精神疾病(SMI)的人经常在“祈祷营”中被治疗师看到,在那里他们也可能遭受侵犯人权的行为。我们开发了M&M,一项为期8周的双管齐下的干预措施,包括(1)智能手机提供的工具包,旨在让治疗师接受简短的心理社会干预,并鼓励他们维护人权(M-Healer应用程序),和(2)为患者提供药物的来访护士(移动护士)。
■我们检查了可行性,可接受性,安全,以及M&M干预在现实世界祈祷营环境中的初步有效性。
■我们在加纳的一个祈祷营与SMI和治疗师的人进行了M&M的单臂现场试验。为治疗师提供了安装了M-Healer的智能手机,并由实践促进者培训以使用数字工具包。并行,一名研究护士参观了他们的祈祷营,为他们的病人服用药物。临床评估人员在治疗前(基线)对SMI参与者实施研究措施,治疗中期(4周)和治疗后(8周)。
■17名参与者被登记,大多数(n=15,88.3%)被保留。参与者的平均年龄为44.3(SD13.9)岁,其中59%(n=10)为男性。14名(82%)参与者被诊断为精神分裂症,2名(18%)被诊断为双相情感障碍。对四名治疗师进行了使用M-Healer的培训。平均而言,他们自我发起的应用程序每周使用31.9(SD28.9)次。治疗者平均观看了19.1(SD21.2)个视频,响应1.5(SD2.4)提示,并每周使用该应用程序5.3(SD2.7)天。Pre-postanalysisdiscoveredasignificantandpassiallymeaningreductioninpsychiatricsympticlesseverity(BriefPsychiatricRatingScalegards52.3to30.9;BriefSymptomInvestoryscoreradsrange76.4to27.9),心理困扰(Talbieh短暂困扰清单得分范围为37.7至16.9),羞耻(Shamer量表其他评分范围为41.9至28.5),和污名(简短的内化污名精神疾病量表评分范围为11.8至10.3)。我们记录了链接天数的显着减少(1.6至0.5)和强制禁食天数的减少趋势(2.6至0.0,P=.06)。我们没有发现患者报告的与治疗师的工作联盟(工作联盟清单)的显着事后变化,抑郁症状严重程度(患者健康问卷-9),生活质量(雷曼精神病患者生活质量访谈),关于药物的信念(关于药物的信念问卷-一般危害分量表),或其他侵犯人权的行为。没有大的副作用,违反健康和安全规定,或在试验过程中发生严重不良事件.
■并购干预被证明是可行的,可接受,安全,临床上很有前途。初步调查结果表明,M-Healer工具包可能改变了祈祷营中治疗师的行为,从而减少了侵犯人权的行为。
UNASSIGNED: In West Africa, healers greatly outnumber trained mental health professionals. People with serious mental illness (SMI) are often seen by healers in \"prayer camps\" where they may also experience human rights abuses. We developed \"M&M,\" an 8-week-long dual-pronged intervention involving (1) a smartphone-delivered toolkit designed to expose healers to brief psychosocial interventions and encourage them to preserve human rights (M-Healer app), and (2) a visiting nurse who provides medications to their patients (Mobile Nurse).
UNASSIGNED: We examined the feasibility, acceptability, safety, and preliminary effectiveness of the M&M intervention in real-world prayer camp settings.
UNASSIGNED: We conducted a single-arm field trial of M&M with people with SMI and healers at a prayer camp in Ghana. Healers were provided smartphones with M-Healer installed and were trained by practice facilitators to use the digital toolkit. In parallel, a study nurse visited their prayer camp to administer medications to their patients. Clinical assessors administered study measures to participants with SMI at pretreatment (baseline), midtreatment (4 weeks) and post treatment (8 weeks).
UNASSIGNED: Seventeen participants were enrolled and most (n=15, 88.3%) were retained. Participants had an average age of 44.3 (SD 13.9) years and 59% (n=10) of them were male. Fourteen (82%) participants had a diagnosis of schizophrenia and 2 (18%) were diagnosed with bipolar disorder. Four healers were trained to use M-Healer. On average, they self-initiated app use 31.9 (SD 28.9) times per week. Healers watched an average of 19.1 (SD 21.2) videos, responded to 1.5 (SD 2.4) prompts, and used the app for 5.3 (SD 2.7) days weekly. Pre-post analyses revealed a significant and clinically meaningful reduction in psychiatric symptom severity (Brief Psychiatric Rating Scale score range 52.3 to 30.9; Brief Symptom Inventory score range 76.4 to 27.9), psychological distress (Talbieh Brief Distress Inventory score range 37.7 to 16.9), shame (Other as Shamer Scale score range 41.9 to 28.5), and stigma (Brief Internalized Stigma of Mental Illness Scale score range 11.8 to 10.3). We recorded a significant reduction in days chained (1.6 to 0.5) and a promising trend for reduction in the days of forced fasting (2.6 to 0.0, P=.06). We did not identify significant pre-post changes in patient-reported working alliance with healers (Working Alliance Inventory), depressive symptom severity (Patient Health Questionnaire-9), quality of life (Lehman Quality of Life Interview for the Mentally Ill), beliefs about medication (Beliefs about Medications Questionnaire-General Harm subscale), or other human rights abuses. No major side effects, health and safety violations, or serious adverse events occurred over the course of the trial.
UNASSIGNED: The M&M intervention proved to be feasible, acceptable, safe, and clinically promising. Preliminary findings suggest that the M-Healer toolkit may have shifted healers\' behaviors at the prayer camp so that they commit fewer human rights abuses.