Abstracts Category : Other

The development and evaluation of a community-basedrehabilitation intervention for people withschizophrenia in Ethiopia.

by L Asher

Background:Community-based rehabilitation (CBR) is a promising intervention to address thecomplex needs of people with schizophrenia in low-income countries, in particularthe high levels of disability, problems accessing treatment and stigma experiencedby this group. There have been few randomised controlled trials of communitybasedpsychosocial interventions for schizophrenia using non-specialist workers,and none which have utilised a community mobilisation approach or that are set inlow-income countries. This thesis presents the intervention development, pilotingand evaluation plans of a CBR intervention for people with schizophrenia inEthiopia.Methods:A theory of change approach was used. Intervention development work, includinga situational analysis, qualitative interviews and participatory workshops, wasconducted to design the CBR intervention. The intervention was manualised andten non-specialists were trained to deliver CBR. Ten people with schizophreniaand their caregivers received CBR in a 12 month pilot study. Qualitative, processand quantitative data were collected. The protocol for a cluster randomised trial toevaluate CBR, refined on the basis of the pilot findings, was produced.Results:CBR delivered by non-specialists is an acceptable approach for people withschizophrenia in rural Ethiopia. This CBR intervention is likely to be feasible butthis requires evaluation on a larger scale. CBR may improve functioning in peoplewith schizophrenia through maximising family and community support,supporting income-generating activities, facilitating access to medication, andincreasing hope. However, contextual factors, including poverty and inaccessibleanti-psychotic medication, may be beyond the capacity of CBR to overcome.Conclusion:A community-based intervention such as CBR should be provided for people withschizophrenia in low-income countries, alongside accessible anti-psychoticmedication. There are indications that CBR can impact on functioning but arandomised controlled trial remains essential. The trial analysis will help todetermine the active ingredients of CBR that should be prioritised in scaling up.