School of Public Health and Preventive Medicine Improving

School of Public Health and Preventive Medicine Improving health literacy of people with severe mental illness: An informal community-based mental health care model in Vietnam Trang Nguyen*, Tuan Tran, Jane Fisher Jean Hailes Research Unit, Monash University, Australia Research and Training Center for Community Development (RCCD) Prof. Davey Jones Caulfield Campus 28 th February 2011

WHO Pyramid for an Optimal Mix of Services for MH Low F R E Q U E N C Y High C O S T S O F N E E D Low High Source: WHO, 2008 2

WHO Pyramid for an Optimal Mix of Services for MH Formal services Informal services 3

Kulhara, et al, 2009 Cohen, et al, 2014 Chatterjee, et al, 2009 Task-shifting Specialised Health workers Non-specialist Abbo, 2014 health or other workers A process whereby specific tasks are moved, where appropriate, to health workers with shorter training and fewer qualification Source: WHO, 2008 4

Mental health system in Vietnam INFORMAL CARE Provided by non-professional health workers FORMAL CARE Provided by professional health workers Non-government organizations Community care Family care Self-care © RTCCD, 2012 5

Project question and theory § Can quality of informal care for metally ill patients be improved sustainably by mobilisation of community resource and experience exchange? § Project theory

Objectives § Develop intervention materials to improve informal care in the community § Assess its effectiveness, acceptability, feasibility

Project intervention

Pilot intervention: Mental health support group Fortnight meetings Intervention Talent show Outcome Loudspeaker communication Mental health support group 01 commune 2013 -2014 Baseline survey Consultation &referral Before & after design (n=68) People with severe mental illness 12 months Participants Quality of life Endline survey 9

Intervention materials Presentation title 28 th February 2011 10

Wall painting with 8 topics 28 th February 2011 11

Wall painting with 8 topics Presentation title 28 th February 2011 12

Wall painting with 8 topics Presentation title 28 th February 2011 13

Background characteristics § Age: 40 (5 – 75) § Gender: Men (n=40, 58. 8%) § Marital status: Married (n=27, 49. 7%) § Education: Not completed primary school (n = 35, 51. 5%) 14

Presentation title 28 th February 2011 15

Effectiveness on health outcomes Components Baseline (N=68) Endline (N=68) P-value Social functioning Interpersonal 9. 34 (7. 32 -11. 36) relationship Social acceptability 20. 11 (19. 02 -21. 21) 11. 13 (9. 37 -12. 89) 0. 18 21. 28 (20. 19 -22. 36) 0. 13 Community living skills Activities 11. 65 (8. 52 -14. 79) Work skills 5. 67 (3. 89 – 7. 46) 14. 66 (11. 29 -18. 03) 0. 19 6. 39 (4. 81 -7. 97) 0. 55 Specific Levels of Functioning Scale – 30 items 16

Acceptability, feasibility § Positive deviance approach by sharing positive examples in the community can be applied in rural areas in Vietnam § Women’s Union staff can facilitate the mental health support groups with trainings. § The model and information were well accepted by caregivers due to its practical information § The project also contributed to reduce stigma against people with severe mental illness “Since the mental health support groups were established, I knew how to help my son to prevent crisis. Now he can work to earn money for his family”. A mother of a schizophrenia patient, Thuong village, Tien Ngoai commune, Hanam Province. 17

Conclusion § The intervention was promised to be effective to improve health literacy of people with severe mental illness in resourceconstrained settings § The project did not show a significant results There is a need of scaling up for a proper scientific evidence § Minor modification will be applied for culture adaptation to implement in other settings 18

Acknowledgement § Supervisors: Professor Jane Fisher, Doctor Arthur Hsueh § Research and Training Community Development (RTCCD) § Jean Hailes Research Unit staff and students § Monash University for scholarships (MIPRS & MGS & Travel Grant) § Grand Challenges Canada 19 19

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