Innovation summary

Psychosis is a growing concern in Tanzania, an estimated 3.9% of urban Tanzanians are affected by this condition1. Due to cultural beliefs and lack of rural medical services, over 60% of Tanzanians seek mental health care from traditional healers, who place an emphasis on spiritual and intuitive causes2. Conversely, less than one quarter of the population uses biomedical services to address their mental health needs3. The biomedical model of care focuses on biological, psychological and social causes of mental illness. Without an integrated model of care, biological symptoms of psychosis may go untreated and reach chronic stages, which may lead to long-term disability. Each model offers different benefits, however when used separately the individual does not receive the holistic care that they need.

The main goal is to test the feasibility and acceptability of a mobile app for facilitating collaboration between traditional healers and biomedical professionals in order to provide holistic, comprehensive, and accessible treatment for psychosis.

This innovation involves 4 phases:

  1. Building Partnerships
  2. Mobile Application Development
  3. Training of Traditional Healers and Biomedical Professionals  
  4. Implementation: Screening, Referral and Treatment of patients

 

Impact summary

  • An anticipated 500 patients will be seen and/or referred between traditional healers and biomedical professionals for psychosis.
  • Traditional healers see approximately 20 patients per week
  • 27 patients were screened for psychosis using the app and 24 screened positive for psychosis and were referred for biomedical treatment 

 

“The project is good, the patient will benefit from it because the patient will be diagnosed and if it is the illness [psychosis], the patient will be referred to the hospital for further treatment.” 
 
   - [Translated from Kiswahili]  Mohamedi Hatibu, Traditional Healing Coordinator and representative from CHAWATIATA, Traditional Healer Organization 
 
 
“When traditional healers are working with the professional staff, they get knowledge, experience, to learn about different [biomedical] treatment modalities, [and] to give up the stigma of mental illness in society."
 
  - George A. Semsela, Mental Health Nurse at Pangani District Hospital 
 
This innovation is funded by Grand Challenges Canada. 

 

Innovation details

The innovation connects two models of care for treating psychosis through a specialized mobile application (app). This innovation aims to:  

  1. Improve diagnosis and management of psychosis
  2. Increase referrals and facilitate early diagnosis
  3. Develop shared treatment plans
  4. Reduce stigma

Phase 1: Building Partnerships

The project team recruited professionals from Pangani District hospital as the biomedical participants in the study. This includes one medical doctor and three psychiatric nurses who work as a team to treat mental illness on a daily basis. This is the only primary health care facility with outpatient mental health services in the Tanga region. A traditional healer from CHAWATIATA traditional healer organization, acted as the liaison in recruiting other traditional healers. 

Phase 2: Mobile Application Development

Noxyt Software Solution Company, a Tanzanian programming group, was hired to develop the mobile screening and consultation app. A Kiswahili version of The Psychosis Screening Questionnaire (PSQ) was adapted and included in the app to screen patients with psychosis. The app enables PSQ scores to be shared between traditional healers and biomedical professionals in order to facilitate cross referrals and to prioritize next steps. Both practitioners were consulted in PSQ adaptation and the app development process to ensure it is culturally relevant and user friendly.

Phase 3: Training of Traditional Healers and Biomedical Professionals 

Traditional healers and biomedical professionals participated in a week long training course that covered the following:

  • an overview of the study
  • an overview of clinical, biomedical and spiritual and intuitive aspects of psychosis
  • group work on techniques for treating mental illness
  • case studies on depressive psychosis, bipolar and schizophrenia
  • training on how to use the app to screen for psychosis and refer patients between the two systems of care 

Phase 4: Implementation: Screening, Referral and Treatment of patients

Individuals seeking care from participating traditional healers will undergo a preliminary assessment, this involves a prescreening checklist to identify symptoms of mental illness. If the checklist criteria is met, the healer will administer the first portion of the mobile-adapted Psychosis Screening Questionnaire (PSQ). The first portion of the PSQ assessment involves a series of questions that the traditional healer is trained to answer. Based on this score, the traditional healer may refer the patient for further screening and possible biomedical treatment at Pangani District Hospital. Biomedical professionals will be able to access the patient’s file and administer the second portion of the PSQ assessment via the app. A diagnosis is made by the biomedical professional and the treatment plan is determined. Once the biomedical treatment is administered, the patient is re-referred to the traditional healer for complementary treatment. Biomedical professionals and the traditional healers have the option of discussing their treatment plans via chat or text. 

 

Key drivers

Involvement of the Local Community and Partners

  • Partners include: Ministry of Health & Social Welfare, biomedical professionals from Pangani District Hospital, and CHAWATIATA Traditional Healer Organization
  • These stakeholders have been consulted and actively involved in the app development process and training phases. This was essential in developing a sense of ownership among key stakeholders and ensuring greater acceptability of the innovation. 

 

Challenges

  • Finding interested mobile telecom companies to provide subsidized phones and plans - the project team decided to purchase these items privately
  • The availability of high potency anti-psychotic medication is very limited at publicly funded institutions such as Pangani District hospital. This is an ongoing problem that the country is faced with in treating mental illness. As a result, lower potency medications are being substituted which may not be as effective. This makes it difficult to adequately treat patients who are referred from traditional healers to biomedical professionals
  • There is stigma associated with both models of care from both perspectives
  • Technical issues, such as poor internet connection in some rural areas 

 

Continuation

The innovation is currently being tested. The innovation can be scaled up to other rural districts in Tanzania and regions where traditional medicine plays a major role in treating psychosis. 

 

Evaluation methods

The future plan for evaluation includes collecting quantitative and qualitative data in phases 3 and 4:

Phase 3: Training of Traditional Healers and Biomedical Professionals 

  • A pre and post survey was administered to both traditional healers and biomedical professionals at the training. The survey measured the knowledge regarding psychosis from both perspectives, psychosis assessment skills and stigma related to mental illness. Findings show that levels of stigma and knowledge about psychosis from both perspectives has increased as a result of the training.

Phase 4: Implementation: Screening, Referral and Treatment of patients

The app will collect the following information:

  • The number of patients screened for psychosis
  • The social and demographic factors of patients
  • The number of patients referred for biomedical treatment
  • The number of patients that seek biomedical treatment after referral
  • The number of patients that are officially diagnosed with psychosis
  • The number of times traditional healers and biomedical professionals communicate

Qualitative data will be collected through in-depth exit interviews to assess the acceptability of the mobile app. A minimum of 10 traditional healers, two biomedical professionals, and 25 patients will be randomly selected and interviewed. 

 

Cost of implementation

Cost analysis has yet to be conducted.

 

Impact details

It is anticipated the following outcomes will occur as a result of this project:

  • 500 patients will benefit from collaborative services for psychosis provided by traditional healers and biomedical professionals
  • A 50% increase in knowledge regarding psychosis among traditional healers and biomedical professionals is expected as a result of collaboration between the two models of care
  • An increase in knowledge, attitudes and health seeking behavior of patients - this data will be collected from the app.
  • Policy change regarding national/local management and referrals of patients with psychosis

 

References

  1. Jenkins R et al. (2010) Prevalence of psychotic symptoms and their risk factors in urban Tanzania. International journal of environmental research and public health, 7(6): 2514-2525.
  2. Kayombo EJ et al. (2012) Experience on healthcare utilization in seven administrative regions of Tanzania. J Ethnobiol Ethnomed, 8(5).
  3. Schulsinger FE & Jablensky AE (1991) The national mental health programme in the United Republic of Tanzania: A report from WHO and DANIDA. Acta Psychiatrica Scandinavica.

 

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