ArticleLiterature Review

Traditional healers’ and biomedical practitioners’ perceptions of collaborative mental healthcare in low- and middle-income countries: A systematic review

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Abstract

Access to mental healthcare in low- and middle-income countries (LMICs) is one of the greatest challenges in public health today. One suggestion for improving accessibility is through collaboration between biomedical practitioners and traditional healers. This paper reviews studies of traditional healers’ and biomedical practitioners’ perceptions of collaboration. We conducted a systematic review of online databases, selected journals, and reference lists for relevant studies. Eligible papers were assessed using a tool designed for this review for quality and study characteristics, and qualitative data demonstrating participants’ views were extracted. A total of 14 papers from seven countries were included. The published literature on this topic is relatively homogenous and studies are of variable quality. The findings suggest that, despite differing conceptualisations of mental illness causation, both traditional healers and biomedical practitioners recognise that patients can benefit from a combination of both practices and demonstrate a clear willingness to work together. There are concerns about patients’ safety and human rights regarding traditional methods and some healers are sceptical about the effectiveness of Western psychiatric medication. Despite keeping the inclusion criteria open to all LMICs, all 13 studies were conducted in Africa, seven of which were in South Africa. This limits the applicability of the findings of this review to the wider LMIC context. The paper concludes with recommendations for research and practice.

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... However, there were concerns about patient safety and human rights regarding traditional methods. 19 A different systematic review of literature from Africa was less positive about the potential collaboration between traditional healing and biomedicine, stating that the relationship between traditional and biomedical health practitioners was influenced by power struggles, lack of mutual understanding, competition, distrust and disrespect. 20 Before we can argue for the need for a collaborative model, we first need to examine the effectiveness of traditional healing on mental health in particular settings and cultures, which, if effective, could be used as evidence to design a collaborative model between traditional and biomedical services. ...
... Three were across more than one country (one in Nigeria and Ghana, one in Ghana, Kenya and Nigeria). The studies were published between 1982 and 2022, and majority (19) of them were qualitatively followed by 18 cross-sectional studies and 6 mixed methods. There were two experimental studies, one each cluster RCT and RCT. ...
... [83][84][85] Despite the reported difference in the concept of mental health problems, including the illness cause and treatments between the practitioners, other previous review studies recommend building agreement and interest between two practitioners is possible to work together aiming at improving the lives of the patients in LMICs. 19 94 Such understanding can be introduced by recognising the benefit of collaborative service for the patients and by arranging training and discussion on fundamental mental health problems, 19 and innovative approaches are needed to enhance the collaborative service to provide community-based mental healthcare. 93 Complementary nature of traditional healing effect on mental health outcomes Evidence in this review 72 83 84 and from previous review 35 show that people with mental health problems improved after receiving a combination of traditional healing and biomedical treatments. ...
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Objectives In areas with limited and unaffordable biomedical mental health services, such as sub-Saharan Africa (SSA), traditional healers are an incredibly well-used source of mental healthcare. This systematic review synthesises the available evidence on traditional healing practices, factors to access it and its effectiveness in improving people’s mental health in SSA. Design Systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses approach. Data sources PubMed, MEDLINE, CINAHL and Scopus studies published before 1 December 2022. Eligibility criteria Qualitative and quantitative studies reported traditional healing practices to treat mental health problems in SSA countries published in English before 1 December 2022. Data extraction and synthesis Data were extracted using Covidence software, thematically analysed and reported using tables and narrative reports. The methodological quality of the included papers was evaluated using Joanna Briggs Institute quality appraisal tools. Results In total, 51 studies were included for analysis. Traditional healing practices included faith-based (spiritual or religious) healing, diviner healing practices and herbal therapies as complementary to other traditional healing types. Objectively measured studies stated that people’s mental health improved through collaborative care of traditional healing and biomedical care services. In addition, other subjectively measured studies revealed the effect of traditional healing in improving the mental health status of people. Human rights abuses occur as a result of some traditional practices, including physical abuse, chaining of the patient and restriction of food or fasting or starving patients. Individual, social, traditional healers, biomedical healthcare providers and health system-related factors were identified to accessing traditional healing services. Conclusion Although there is no conclusive, high-level evidence to support the effectiveness of traditional healing alone in improving mental health status. Moreover, the included studies in this review indicated that traditional healing and biomedical services collaborative care improve people’s mental health. PROSPERO registration number CRD42023392905.
... Given this reality, there have been some efforts to understand the perspectives of both traditional healers and healthcare professionals regarding potential collaboration. A qualitative review including data from seven (mostly African) countries suggests that, despite differences in their approaches to addressing mental illnesses, both traditional healers and healthcare professionals express a willingness to cooperate (Green & Colucci, 2020). However, healthcare professionals have consistently expressed concerns about the safety and autonomy of individuals who seek traditional healing, while traditional healers often maintain scepticism about the benefits of formal healthcare practices. ...
... Traditional healers' practices, however, were also considered ineffective in rare cases where 'a curse was too strong' compared to the power of the healing method (Van der Watt et al., 2018). There was limited information on barriers and facilitators people may face in accessing and engaging in interventions by traditional healers (Green & Colucci, 2020;Van der Watt et al., 2018). A recent scoping review including studies based in Nepal reported that religious-magical explanations and practices, informal cognitive restructuring methods, and catharsis were common interventions used by traditional healers, but this review did not address effectiveness (Pham et al., 2021). ...
... Barriers to accessing and engaging with interventions provided by traditional healers are critical to understand, yet have received limited attention. A review examining the perceptions of traditional healers and healthcare professionals regarding their collaboration provided some insights into barriers to collaboration (Green & Colucci, 2020). However, this review did not encompass the perspectives of individuals seeking traditional healing (Green & Colucci, 2020). ...
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We investigated the effectiveness of interventions provided by traditional healers for common mental disorders (CMDs) together with associated barriers and facilitators. Electronic databases including MEDLINE, APA Psych Info, Allied and Complementary Medicine, Embase, CINAHL, Social Science Citation Index, and Scopus were searched from inception until October 2021. Randomised controlled trials (RCTs) assessing interventions by traditional healers for CMDs and qualitative and mixed-methods studies examining traditional healers and their attendees' views about the treatment of CMDs by traditional healers were included. Cochrane Risk of Bias Assessment tool (RoB-1) and Critical Appraisal Skills Programme (CASP) were used for the quality assessment of studies. A meta-analysis and thematic synthesis were conducted. Sixteen RCTs (1,132 participants) and 17 qualitative or mixed-methods studies (380 participants) were included. Improvement in symptoms was greater for interventions by traditional healers compared to control groups for both depression and anxiety. Subgroup analyses indicated that only "spiritual passe" interventions showed improvement in depression and anxiety, and participants with co-morbid anxiety and physical conditions showed improvement in anxiety. Facilitators to engaging with interventions by traditional healers were shared faith-based world-view exhibited by traditional healers and their attendees and perceived effectiveness of traditional healing. Stigma and concealing mental illness were found to be barriers not only to formal healthcare but also to traditional healers' services. Interventions by traditional healers such as "spiritual passe" are effective in improving CMDs. However, evidence is still limited due to the low quality of studies and lack of long-term evidence.
... It has often been suggested that in such contexts, particularly in Africa, a major reason for the popularity of non-biomedical interventions is related to health beliefs that lean more toward supernatural explanations for mental illness (Gureje et al., 2015;Musyimi et al., 2016;Opare-Henaku & Utsey, 2017;Read, 2012). Although beliefs in spiritual and animist factors related to ill-health are common in Africa, as in many other countries (Green & Colucci, 2020), several studies have identified that additional context-related factors such as limited availability of biomedical facilities and health professionals, as well as systemic issues such as cost and accessibility, also play an important role in determining the under-utilisation of biomedical mental health services (Ae-Ngibise et al., 2010;Badu et al., 2018;Esan et al., 2019). There is, in fact, evidence to suggest that spiritual beliefs do not prevent help-seekers from making use of several healthcare streams, operating within a pluralistic approach in which the perceived benefits of different approaches to care are considered to be mutually enhancing (Badu et al., 2019;de-Graft Aikins, 2005;van der Watt et al., 2017;Read, 2012). ...
... However, these have not always been successful. In a review of mental health practitioners' perceptions about collaboration in LMICs, Green and Colucci (2020) identified that traditional healers and biomedical professionals were both cognisant of the benefits of collaborating; however, there was mutual distrust of each other's motives and practices. This notwithstanding, in recent years a few projects have explored ways in which collaborations between biomedicine and traditional or faithbased healing systems can be strengthened (Baheretibeb et al., 2021;Gureje et al. 2020;Ofori-Atta et al., 2018). ...
... As others have identified, collaborations have not been sustainable because of deep distrust and suspicion between practitioners of different healing paradigms (Abdullahi, 2011;Green & Colucci, 2020;Krah et al., 2018). The mental health workers in this study recognised this problem. ...
... It has often been suggested that in such contexts, particularly in Africa, a major reason for the popularity of non-biomedical interventions is related to health beliefs that lean more toward supernatural explanations for mental illness (Gureje et al., 2015;Musyimi et al., 2016;Opare-Henaku & Utsey, 2017;Read, 2012). Although beliefs in spiritual and animist factors related to ill-health are common in Africa, as in many other countries (Green & Colucci, 2020), several studies have identified that additional context-related factors such as limited availability of biomedical facilities and health professionals, as well as systemic issues such as cost and accessibility, also play an important role in determining the under-utilisation of biomedical mental health services (Ae-Ngibise et al., 2010;Badu et al., 2018;Esan et al., 2019). There is, in fact, evidence to suggest that spiritual beliefs do not prevent help-seekers from making use of several healthcare streams, operating within a pluralistic approach in which the perceived benefits of different approaches to care are considered to be mutually enhancing (Badu et al., 2019;de-Graft Aikins, 2005;van der Watt et al., 2017;Read, 2012). ...
... However, these have not always been successful. In a review of mental health practitioners' perceptions about collaboration in LMICs, Green and Colucci (2020) identified that traditional healers and biomedical professionals were both cognisant of the benefits of collaborating; however, there was mutual distrust of each other's motives and practices. This notwithstanding, in recent years a few projects have explored ways in which collaborations between biomedicine and traditional or faithbased healing systems can be strengthened (Baheretibeb et al., 2021;Gureje et al. 2020;Ofori-Atta et al., 2018). ...
... As others have identified, collaborations have not been sustainable because of deep distrust and suspicion between practitioners of different healing paradigms (Abdullahi, 2011;Green & Colucci, 2020;Krah et al., 2018). The mental health workers in this study recognised this problem. ...
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The practices of traditional and faith-based healers in low- and middle-income countries in Africa and elsewhere have come under intense scrutiny in recent years owing to allegations of human rights abuses. To mitigate these, there have been calls to develop collaborations between healers and formal health services to optimise available mental health interventions in poorly resourced contexts. For various reasons, attempts to establish such partnerships in a sustainable manner in different countries have not always been successful. In this article, we present findings from the Together for Mental Health visual research project to showcase examples of healer–health worker collaborations in Ghana that have been largely successful and discuss the barriers and facilitators to establishing these partnerships. Data reported in this article were collected using visual ethnography and filmed individual interviews with eight community mental health workers, six traditional and faith-based healers and two local philanthropists in the Bono East Region. The findings suggest that successful collaborations were built through mutually respectful interpersonal relationships, support from the health system and access to community resources. Although these facilitated collaboration, resource constraints, distrust and ethical dilemmas had to be overcome to build stronger partnerships. These findings highlight the importance of dedicated institutional and logistic support for ensuring the successful integration of the different health systems in pluralistic settings.
... Such a profound establishment of mystical belief and superstition has been a consequence of illiteracy, limited healthcare standards, and a high poverty rate [5] . In MLICs, the chain of healthcare and infrastructure are weak, medical assistance is expensive, and the threshold of inflation is far beyond reach [6] . ...
... Here the role of traditional healers comes into play [6] . These traditional local healers make use of the fear and financial limitations of these populations to make them believe that a mystical or supernatural force is causing these 'unexplained symptoms' in them [5] . ...
... These traditional local healers make use of the fear and financial limitations of these populations to make them believe that a mystical or supernatural force is causing these 'unexplained symptoms' in them [5] . They also integrate elements of cultural and religious ideologies to support their superstition, promising to get rid of their pain and illness [6] . ...
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Conversion disorder is a somatoform condition in which patients present with a range of neurologic deficits and sensorimotor loss with no obvious pathology. There has been a rising trend in the incidence of conversion disease in countries with low socioeconomic backgrounds, accounting to be one-third of ambulatory visits in middle and low-income countries (MLIC). However, even with such a high prevalence health-seeking practice for conversion disorder is low in MLIC. One possible reason for such behavior could be the high prevalence of mystical beliefs and traditional healing in MLIC. Existing economic distress with limited healthcare resources convinces people to opt for traditional and local healers who make use of mystical and superstition beliefs prevalent in those regions to offer prospering and cheaper methods of treatment. In this scenario, addressing and counseling mythological fallacies and the use of an economically friendly 'holistic model' of treatment should be adopted in these countries.
... The diagnosis and treatment of an illness using traditional medicine is mostly culture-specific and based on beliefs in the community (Mbwayo et al., 2013). The popularity of traditional healers is due to a number of reasons: confidence in the explanations offered for the cause of illness (which can be more acceptable than conventional medicine) and in the traditional healers' ability to understand patients' illness experience within their cultural framework; affordability; and accessibility of traditional healers especially in remote areas where hospital facilities are lacking (Green & Colucci, 2020;WHO, 2002). ...
... conventional medical care), but more recently it has been demonstrated that THs are resorted to even when conventional medical facilities are available. This is particularly true of mental illnesses, where social and cultural determinants play a heightened role (Green & Colucci, 2020). ...
... There may be advantages in closer collaboration between mainstream psychiatric care and THs, especially as regards the role that THs may play in the early identification of mental illnesses that may help reduce delays in patients reaching appropriate care. Despite different conceptualizations of mental illness, evidence suggests that both THs and medical practitioners recognize that patients can benefit from a combination of both practices and have demonstrated a willingness to work together (Green & Colucci, 2020). However, any such collaboration should proceed cautiously, given that there may be negative consequences from closer integration, given that many THs have no formal training to identify and treat mental illnesses. ...
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Background Despite the availability of mental health services in the United Arab Emirates (UAE), reluctance in seeking a mental health professional is widely prevalent. In many countries, psychiatric patients consult Traditional Healers (THs) prior to seeing mental health professionals. Data from the UAE on the pattern of consulting THs is limited. Aims To investigate patterns and factors for visiting THs in psychiatric patients in Abu Dhabi, the capital of UAE. Method We conducted a cross-sectional study of patients attending the adult psychiatry clinic, Maudsley Health, Abu Dhabi. We assessed 214 patients for the pattern and possible factors for contact with THs on their pathway to psychiatric care. Results There were 58 males and 156 females. Most (43.5%) had a depressive disorder. Prior to consulting a mental health professional, 28% had seen a TH, of whom 36.7% had only one visit and 60% had seen only one TH. Advice from a friend or family member was the commonest reason for consulting THs (81.7%). Envy was the commonest explanation given by THs for symptoms (26.7%). Female gender and having a high school education or less significantly predicted contact with THs. Conclusions Almost a third of our sample consulted THs prior to seeking psychiatric care. Closer collaboration with THs could help bridge the gap with psychiatrists to avoid delays in patients accessing psychiatric care, however caution is needed to mitigate the possible negative effects of such a collaboration.
... Traditional healthcare practitioners in this study indicated that they supported the integration of the two systems and that it would benefit patients if it was done correctly. This finding was in line with Green and Colucci (2020), which suggested that traditional health practitioners and allopathic healthcare practitioners recognised that integration between the two would benefit patients. Children's caregivers were also mainly supporting the integration; however, some were sceptical about the risks that may be involved with integrating the two. ...
... This lack of testing may make some patients to be sceptic about using traditional healthcare practitioners citing safety reasons, whereas allopathic healthcare practitioners may as well exhibit the same attitude of questioning patients' safety associated with the use of traditional healthcare practices. This finding is supported by a review study conducted by Green and Colucci (2020), which presented multiple authors' findings that biomedical practitioners' concerns were primarily rooted in patient safety and human rights. These worries might be well founded because, in certain cases, traditional healthcare practitioners act unethically, endangering patient safety in the absence of regulation. ...
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Background Numerous forums both domestically and internationally have discussed integration of allopathic and traditional healthcare. In South Africa, using traditional child healthcare is popular practice. If properly controlled, integrating this aspect of traditional child-health with allopathic healthcare may be advantageous to communities that use both healthcare systems. Allopathic and traditional healthcare remain separate organisations in South Africa despite efforts and discussions to integrate them. Aim The study sought to explore the integration of traditional and allopathic child healthcare from the perspectives of children’s caregivers and traditional healthcare practitioners. Setting The study was conducted in a semi-urban area in the city of Tshwane. Methods An exploratory qualitative research study was conducted using semi-structured interviews to collect data from 11 traditional healthcare practitioners and 15 children’s caregivers who were sampled using snowball and convenient sampling respectively. Results The participants expressed their understanding of the usage of traditional healthcare practitioners in the care of children as well as their support for integration, and further indicated its necessity. Religion and its effects in health-seeking behaviour were cited as a factor in why there has not been greater integration between the two healthcare systems. Conclusion The undocumented and undisclosed use of traditional healthcare potentially hinders the delivery of therapeutic healthcare. As such, integrating the two systems is essential to ensure patients’ safety. Contribution This article highlights understanding of culture congruence and safe child healthcare that may be brought forward by the integration of the two healthcare systems.
... The tranquility experienced by individuals with mental disorders brings relief to their families, who no longer feel disadvantaged in terms of fulfilling the requirements. 36 Research conducted on faith-based healing at a prayer camp in Ghana for individuals with mental or mood disorders demonstrated a positive effect in reducing symptoms, although the benefits were not long-lasting. 37 The report suggests that a collaborative approach involving doctors, therapists, and spiritual teachers can yield a comprehensive understanding of the situation and holds the potential for successful treatment outcomes. ...
... Additionally, offering spiritually-based traditional medical services rooted in a shared cultural understanding with the family can provide valuable psychosocial support for individuals with less severe mental disorders and prove to be an effective means of assistance. 36 Furthermore, it was reported that families expressed satisfaction with traditional spiritual treatment due to the presence of valuable coping resources. These resources include spiritual support and social assistance from other family members and relatives, contributing to their contentment. ...
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The practice of confinement of people with mental disorders not only infringes upon individuals' fundamental rights but also contravenes established health legislation, including in Indonesia, the setting for this study. In this country, confinement may be practiced by isolation or seclusion in a room or a small hut built in the family's garden or rice field, some ten-minute walk from the house to the hut. Leg restraints or shackles may also be used. This study delved into the significance of confining individuals with mental disorders by analyzing the linguistic expressions of spiritual leaders from the Banggai culture in Central Sulawesi, Indonesia. Engaging with cultural and spiritual leaders within a community is imperative to gain insights into the underlying perspectives that influence family decision-making processes. This exploration involved a detailed examination of the linguistic expressions these leaders conducted within the cultural context of the Banggai community from March to June 2023. This study employed an ethnosemantic approach and in-depth interviews according to the framework outlined in Spradley's Developmental Research Sequence model. The participants were 13 cultural and spiritual leaders in the Banggai region, commonly referred to as Talapu. They were chosen using snowball sampling techniques. The data-gathering process was facilitated through in-depth interviews structured to incorporate descriptive queries, structured inquiries, and contrasting questions. The data processing involved the analysis of interview transcripts utilizing domain analysis, taxonomic analysis, and component analysis techniques. This analytical approach yielded 11 domains, six taxonomies, and six paradigms, contributing to identifying three distinct cultural themes. These themes were utilizing spiritual rituals as an intervention for the treatment of individuals with mental disorders, the multifaceted roles played by Talapu in managing individuals with mental disorders, and the association between Talapu and the practice of confining individuals with mental disorders. The use of physical restraint and confinement by the Talapu in treating individuals with mental disorders raises ethical concerns, particularly regarding autonomy, non-maleficence, and adherence to international human rights standards in contemporary nursing practice. Nurses in Indonesia should engage in collaborative education with the Talapu, emphasizing the careful and strategic implementation of Indonesia's health legislation to prohibit human rights infringements, ensuring effective treatment and psychosocial support for individuals with mental disorders, and promoting their seamless integration into family and society.
... A recent study from Sudan [48] reported that most of the 108 interviewed psychiatrists and psychiatry trainees see no role for traditional healing methods in the treatment of psychosis. A systematic review by Green et al. [32] ]. As opposed to reports on general mental health [32], a study at a holy water site in Ethiopia, where mostly psychotic patients were treated, reported that incompatibility of beliefs was an important reason for resistance among some of ]. ...
... A systematic review by Green et al. [32] ]. As opposed to reports on general mental health [32], a study at a holy water site in Ethiopia, where mostly psychotic patients were treated, reported that incompatibility of beliefs was an important reason for resistance among some of ]. Furthermore, a promising, multicentre international research project called TRANSFORM [51] is currently running in Nigeria and Bangladesh, which attempts to build an innovative and durable referral system together with TFH for individuals with psychotic disorders and severe mood disorders. ...
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Purpose of review: This review summarizes the current literature on the role of traditional and faith-based healthcare in the management of psychotic disorders in Africa. Recent findings: In contemporary Africa, individuals with psychosis and traditional and faith healers (TFH) are pluralistic towards their understanding of psychosis and their help-seeking behaviour. Traditional healing is perceived to be helpful to patients with psychotic disorders and their family members and may have a positive influence on the course of psychosis in some selected individuals. Studies show that potentially harmful practices are commonly used by African TFH, but that these are associated with a lack of resources and are susceptible to training. Although various TFH and biomedical practitioners are open to collaboration, the many identified obstacles hinder actual partnerships. However, the few studies that have been conducted on collaborative care for patients with psychotic disorders on the continent, show positive outcomes. Summary: Rather than harmonizing the two healing paradigms, synergistic collaboration between traditional/faith-based and biomedical mental healthcare in the management of individuals with psychosis seems to be possible within certain limits. Synergistic collaboration is more culturally syntonic and may actually contribute to bridging the treatment gap for mental disorders in present-day Africa.
... Similarly, joint care has also been demonstrated to effectively reduce symptoms of both common and severe mental illnesses such as depression and psychosis 16 . Several studies have also shown a desire for increased collaboration in the management of mental illnesses among both traditional and western healthcare workers 17,18,19 . This indicates that attempts are warranted to establish a collaboration model between the two groups to improve the care for people with mental illness. ...
... Several factors influencing this distrust and suspicion were identified in this study: these included concerns about the safety and efficiency of traditional treatments, human rights abuses, lack of regulation of traditional medicine, beliefs in supernatural forces and the secrecy of traditional medicine. These reasons have also dominated many studies done in LMIC 27,19,20 . The distrust might also emanate from the poor relationship that has existed between traditional and western medicine practitioners in Malawi and the lack of dialogue. ...
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IntroductionCollaboration between traditional and biomedical medicine can lead to holistic care and improved health outcomes for people withmental illnesses. The current study aimed to explore the views and experiences of traditional and western medicine practitioners onpotential collaboration in the care of people living with mental illness in Blantyre, Malawi.MethodA phenomenological qualitative research design was used. Data were collected using both one-on-one in-depth interviews (IDIs)and focus group discussions (FGDs). Participants were traditional healers and western medicine practitioners in Blantyre, Malawi.We conducted 10 in-depth interviews with traditional healers, 4 focus group discussions (2 for traditional healers and 2 for westernmedicine practitioners) and 6 key informant interviews with leaders of the two groups. The sample was determined based on datasaturation. Thematic analysis was used to analyse the data. We used a combination of deductive and inductive coding.ResultsFive broad themes were identified from the data: experiences with collaboration, views on collaboration, models of collaboration,barriers to collaboration, and factors that can facilitate collaboration. participants had no experience of formal collaboration betweentraditional healers and western healthcare workers in the management of mental illness. However, some reported experience ofsuccessful collaborations in other health areas such as safe motherhood, tuberculosis and HIV/AIDS. Many participants showed apositive attitude toward collaboration and were in support of it. Barriers to collaboration included negative attitudes and a lack ofresources. Factors that can facilitate collaboration were dialogue, training and respect. Referral and training were the preferred formsof collaboration.Conclusion With proper structures and respectful dialogue, a collaboration between traditional and western medicine practitioners is possible inBlantyre, Malawi.
... Individuals in both the intervention and control group experienced a significant decrease in harmful practices such as chaining (Gureje et al., 2020). Overall, collaboration between traditional healers and healthcare providers is likely beneficial for patients, despite perceived incompatibilities and mutual apprehensions regarding care strategies (Green & Colucci, 2020;van der Zeijst et al., 2023). ...
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Background: While early intervention in psychosis (EIP) programs have been increasingly implemented across the globe, many initiatives from Africa, Asia and Latin America are not widely known. The aims of the current review are (a) to describe population-based and small-scale, single-site EIP programs in Africa, Asia and Latin America, (b) to examine the variability between programs located in low-and-middle income (LMIC) and high-income countries in similar regions and (c) to outline some of the challenges and provide recommendations to overcome existing obstacles. Methods: EIP programs in Africa, Asia and Latin America were identified through experts from the different target regions. We performed a systematic search in Medline, Embase, APA PsycInfo, Web of Science and Scopus up to February 6, 2024. Results: Most EIP programs in these continents are small-scale, single-site programs that serve a limited section of the population. Population-based programs with widespread coverage and programs integrated into primary health care are rare. In Africa, EIP programs are virtually absent. Mainland China is one of the only LMICs that has begun to take steps toward developing a population-based EIP program. High-income Asian countries (e.g. Hong Kong and Singapore) have well-developed, comprehensive programs for individuals with early psychosis, while others with similar economies (e.g. South Korea and Japan) do not. In Latin America, Chile is the only country in the process of providing population-based EIP care. Conclusions: Financial resources and integration in mental health care, as well as the availability of epidemiological data on psychosis, impact the implementation of EIP programs. Given the major treatment gap of early psychosis in Africa, Latin America and large parts of Asia, publicly funded, locally-led and accessible community-based EIP care provision is urgently needed. Impact statement Early intervention in psychosis (EIP) programs aim to offer evidence-based case management, psychopharmacology and psychosocial support in the early stages that individuals seek help for psychosis. While the number of such programs in high-income countries is steadily growing, much less is known about their existence in low-and middle-income settings, specifically in large parts of Asia, Africa and Latin America. We also have much to learn about the characteristics of regions in terms of economy and healthcare system and the association with the successful implementation of these care models. Overall, few EIP programs are population-based and cover a large proportion of the population presenting with a first psychotic episode. Most programs are single-site programs that have incorporated the philosophy of EIP care but are not scalable and able to reach a high proportion of people with early psychosis at the country level. This review provides an overview of EIP programs in Africa, Asia and Latin America and focuses primarily
... Individuals in both the intervention and control group experienced a significant decrease in harmful practices such as chaining (Gureje et al., 2020). Overall, collaboration between traditional healers and healthcare providers is likely beneficial for patients, despite perceived incompatibilities and mutual apprehensions regarding care strategies (Green & Colucci, 2020;van der Zeijst et al., 2023). ...
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Background While early intervention in psychosis (EIP) programs have been increasingly implemented across the globe, many initiatives from Africa, Asia and Latin America are not widely known. The aims of the current review are (a) to describe population-based and small-scale, single-site EIP programs in Africa, Asia and Latin America, (b) to examine the variability between programs located in low-and-middle income (LMIC) and high-income countries in similar regions and (c) to outline some of the challenges and provide recommendations to overcome existing obstacles. Methods EIP programs in Africa, Asia and Latin America were identified through experts from the different target regions. We performed a systematic search in Medline, Embase, APA PsycInfo, Web of Science and Scopus up to February 6, 2024. Results Most EIP programs in these continents are small-scale, single-site programs that serve a limited section of the population. Population-based programs with widespread coverage and programs integrated into primary health care are rare. In Africa, EIP programs are virtually absent. Mainland China is one of the only LMICs that has begun to take steps toward developing a population-based EIP program. High-income Asian countries (e.g. Hong Kong and Singapore) have well-developed, comprehensive programs for individuals with early psychosis, while others with similar economies (e.g. South Korea and Japan) do not. In Latin America, Chile is the only country in the process of providing population-based EIP care. Conclusions Financial resources and integration in mental health care, as well as the availability of epidemiological data on psychosis, impact the implementation of EIP programs. Given the major treatment gap of early psychosis in Africa, Latin America and large parts of Asia, publicly funded, locally-led and accessible community-based EIP care provision is urgently needed.
... Women in this study generally did not view clinical mental healthcare as an appropriate treatment for their distress. Many already had effective strategies for managing their distress PLOS Introduction Treatment uptake and adherence are persistent challenges for mental healthcare around the world [1]. Some of the best-supported, evidence-based randomized controlled trial studies for community-based depression and other common mental disorder treatment report that only 10% of eligible participants accept an offer of treatment [2]. ...
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Objectives Lack of engagement with mental health services is a challenge for Global Mental Health research and intervention in lower- and middle-income settings. In India particularly, there is a significant treatment gap for people experiencing common mental disorders. This exploratory mixed-method study investigated women’s attitudes toward mental healthcare in Mysuru, India, and investigated what distress copings strategies they used in their everyday lives. Methods We conducted qualitative interviews and administered a depression symptom screener with a community-based sample of 54 adult women. Interviews asked women to comment on their own distress experiences and stress management techniques, as well as their dispositions toward seeking mental healthcare for themselves or others. Results Nearly 65 percent of the study sample screened for any level of depression risk, but only 5 had ever received mental healthcare. Around 20 percent of women stated that they would hypothetically be open to receiving such care. Yet, there was strong agreement across the study sample that mental healthcare was not an appropriate resource for addressing their own distress. Most women who rejected mental healthcare mentioned concerns about stigma and lack of perceived need or treatment inadequacy as their main reasons. Women described a broad range of coping strategies they used for dealing with distress, and which they reported as being effective. Many of these approaches resemble behavioral and talk therapies used in psychology and psychiatry. Conclusions Women in this study generally did not view clinical mental healthcare as an appropriate treatment for their distress. Many already had effective strategies for managing their distress and analogous to existing psychological behavioral and talk therapies. A better understanding of why people reject mental healthcare is necessary for increasing the success of mental health interventions, and for developing new intervention approaches that support coping outside of clinical encounters.
... Studies show that up to 60% of Ugandans seek support from traditional healers, as well as spiritual and religious leaders, to cope with personal health and relationship issues [22,24]. Despite popularity, traditional, spiritual, and religious leaders often have limited training in evidence-based mental healthcare [25,26]. Investment in training mental health professionals; integrating traditional, spiritual, and religious leaders; expanding mental healthcare to marginalized areas; and funding mental health research are all necessary for building capacity [27]. ...
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Mental health capacity building is a growing priority in Ugandan healthcare systems. Despite increased governmental attention to community mental health and mental healthcare needs, no empirical assessments document qualitative perspectives from stakeholders in the Ugandan mental health system. The goal of the current needs assessment study was to systematically explore stakeholders’ perceptions of strengths, challenges, and recommendations for enhancing capacity in the national mental health system in Uganda. Using ethnographic research methods, data were collected from 15 key informant interviews and four community focus groups with a total of 44 stakeholders involved in mental healthcare in Uganda. Thematic analyses of data yielded several themes in each domain, including 1) system strengths reflected in the existing policy and action plan, free medications, growing private sector, and partnerships and collaborations; 2) system challenges including socioeconomic constraints, stigma, and limited family engagement; and 3) recommendations surrounding enhanced education and training, integrating systemic approaches, and policy advocacy. We describe clinical, research, and policy implications that can inform systemic mental health efforts in Uganda and comparable global settings.
... Indigenous communities have long utilized these circles to foster unity, share stories, build a sense of community, establish deep spiritual connections, and cultivate confidence within a safe space. The literature in theology and mental health further demonstrates that faith leaders from various religions have provided mental health services and mediated such circles, utilizing religious sentiments, scriptural vocabulary, and their professional experiences to create profound and meaningful connections [40,70,135]. Sociotechnical systems can introduce similar features, allowing victims of online hate within religious minority communities to engage in meaningful conversations moderated by a community leader who already has social acceptance and trust among the community members. ...
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Despite significant research on online harm, polarization, public deliberation, and justice, CSCW still lacks a comprehensive understanding of the experiences of religious minorities, particularly in relation to fear, as prominently evident in our study. Gaining faith-sensitive insights into the expression, participation, and inter-religious interactions on social media can contribute to CSCW's literature on online safety and interfaith communication. In pursuit of this goal, we conducted a six-month-long, interview-based study with the Hindu, Buddhist, and Indigenous communities in Bangladesh. Our study draws on an extensive body of research encompassing the spiral of silence, the cultural politics of fear, and communication accommodation to examine how social media use by religious minorities is influenced by fear, which is associated with social conformity, misinformation, stigma, stereotypes, and South Asian postcolonial memory. Moreover, we engage with scholarly perspectives from religious studies, justice, and South Asian violence and offer important critical insights and design lessons for the CSCW literature on public deliberation, justice, and interfaith communication.
... Indigenous communities have long utilized these circles to foster unity, share stories, build a sense of community, establish deep spiritual connections, and cultivate confidence within a safe space. The literature in theology and mental health further demonstrates that faith leaders from various religions have provided mental health services and mediated such circles, utilizing religious sentiments, scriptural vocabulary, and their professional experiences to create profound and meaningful connections [40,70,135]. Socio-technical systems can introduce similar features, allowing victims of online hate within religious minority communities to engage in meaningful conversations moderated by a community leader who already has social acceptance and trust among the community members. ...
Article
Full-text available
Despite significant research on online harm, polarization, public deliberation, and justice, CSCW still lacks a comprehensive understanding of the experiences of religious minorities, particularly in relation to fear, as prominently evident in our study. Gaining faith-sensitive insights into the expression, participation, and inter-religious interactions on social media can contribute to CSCW's literature on online safety and interfaith communication. In pursuit of this goal, we conducted a six-month-long, interview-based study with the Hindu, Buddhist, and Indigenous communities in Bangladesh. Our study draws on an extensive body of research encompassing the spiral of silence, the cultural politics of fear, and communication accommodation to examine how social media use by religious minorities is influenced by fear, which is associated with social conformity, misinformation, stigma, stereotypes, and South Asian postcolonial memory. Moreover, we engage with scholarly perspectives from religious studies, justice, and South Asian violence and offer important critical insights and design lessons for the CSCW literature on public deliberation, justice, and interfaith communication.
... The integration of traditional and modern healthcare practices has the potential to increase community acceptance of HIV/AIDS interventions. However, challenges include differing belief systems, potential conflicts between traditional and modern practices, and the need for regulatory frameworks to ensure the safe and effective use of traditional remedies [35,36]. ...
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Community-based programs had become a pivotal element in the management of HIV/AIDS in Uganda, addressing the unique needs of diverse communities and bridging gaps left by conventional healthcare systems. These programs, were driven by local organizations, volunteers, and grassroots initiatives, had significantly contributed to prevention, treatment, and support for people living with HIV/AIDS (PLWHA). This review examined the role of these programs, highlighting their impact on community mobilization, access to testing and counseling services, support systems, and the integration of traditional and modern healthcare practices. The review also explored youth-focused HIV prevention efforts and the challenges faced by community-based programs, such as limited resources, persistent stigma, and the need for better integration with national health systems. A comprehensive analysis of relevant literature and case studies was conducted to provide a detailed understanding of these initiatives. The findings emphasized the importance of sustained support, innovative strategies, and collaborative efforts to enhance the effectiveness of community-based programs in Uganda's fight against HIV/AIDS. Addressing these challenges and leveraging the strengths of community-based initiatives will be crucial for achieving long-term success in managing the epidemic.
... Traditional healers are known to consult with modern health professionals when faced with problems beyond their ability to treat, but it is not common for biomedical professionals to refer back to healers [27]. This is often due to their negative attitudes toward traditional healing practices, including the belief that traditional healers do not incorporate a human right approach and/or compassionate care when dealing with people with mental health problems [35,36]. Their negative attitudes have a detrimental effect on the WHO's recommended collaboration of biomedical treatment and traditional healing to close the treatment gap in low and middle-income countries because cooperation between the two needs mutual respect and recognition. ...
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Background Mental illness is a global problem that receives less attention, particularly in developing countries. Integrating modern treatment with traditional healing approaches has been proposed as one way to address mental health problems, especially in developing countries. Despite health professionals’ participation in traditional healing being crucial to integrative approaches, their participation is limited to date. This review protocol is designed to explore the attitudes of health professionals towards traditional healing practices in mental health services. Methods The review will follow the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Searching databases, including PubMed/Medline, PsychINFO, EMBASE, Scopus, and the Web of sciences will be conducted. Additionally, Google and Google Scholar will be searched for other information, including grey literature. Moreover, a manual search of identified articles’ reference lists will also be conducted to help ensure all potential papers are included in the review. Qualitative, quantitative, and mixed study methods published in English between January 2014 and April 2024 will be included. The qualities of the included studies will be assessed using the Mixed Methods Appraisal Tool (MMAT) Version 2018. A mixed-method synthesis will be used to synthesis the results. Discussion It is crucial for healthcare professionals to provide culturally sensitive care to empower people to manage their health. This systematic review will summarize the attitudes of health professionals towards the adoption and delivery of traditional healing approaches to people experiencing mental illness. Therefore, the findings of this review will support integration between traditional healers and modern mental health practitioners for the treatment of mental illness. Trial registration Protocol registration number: CRD42024535136.
... The pros and cons of initiatives such as GMH and ENIGMA continue to be contested, particularly within the realms of cross-cultural or transcultural psychiatry and medical anthropology. Debates persist, for instance, about the validity of mental disorders, the potential for medical imperialism, initiatives dominated by biomedical systems of knowledge and practice, implementation issues, and lesser attention paid to both social determinants of mental health and local understandings and practices (Green and Colucci 2020;Hampshire et al. 2022;Patel et al. 2011;Sood 2016). While it is not possible to state with any precision the impact such initiatives are having on ADHD specifically, it is clear that they are contributing to new mental health research and policy initiatives to address the core aims of these movements. ...
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Recent decades have witnessed the increased emergence and global application of medicalized meanings and practices related to mental health, with cases of contestation, adoption, as well as resistance observed. Such globalization raises a number of important sociological questions about the nature and consequences of such practices, as well as what they might mean for the changing nature of medicalization. Focusing on a classic case within medicalization studies, Attention Deficit Hyperactivity Disorder, this paper reviews existing insights on medicalization and mental health diagnosis and treatment in global context, future lines of inquiry, and related challenges.
... to traditional methods before seeking medical help, further delaying effective treatment (Green & Colucci, 2020;van der Zeijst et al., 2023). ...
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Over 970 million people globally and over 50 million in Nigeria are estimated to be affected by mental illness. The condition is associated with several psycho-cultural and social problems including stigma which poses a major challenge for people with mental illness experience. The paper examines the understanding of mental illness narrative and treatment experiences and employs a combination of Social Construction Theory and Total Institution Theory to enhance understanding of the phenomenon. The illness narrative highlights the role of social construction in shaping mental health perceptions, particularly in Africa fraught with mental health misconceptions and stigmatization. The understanding and perception of mental illness in African societies are deeply embedded in cultural and social contexts. This includes the attribution of mental illness to spiritual causes and the reliance on traditional healing methods. The lived experience of mental illness is characterized by prejudice, negative labels, devaluation of their capabilities, and discrimination. Obstacles in treating mental illness in Africa include cultural misconceptions, inadequate healthcare infrastructure, limited financial resources, a scarcity of trained professionals, and political commitment from African governments and policymakers. The paper strongly advocates for utilizing traditional and religious leaders to campaign against discrimination towards individuals with mental health issues.
... Dalam penelitian tersebut dilaporkan bahwa penyembuh tradisional terlibat dalam program pelatihan perawatan paliatif karena mereka dapat menawarkan perawatan psikologis, budaya, dan spiritual kepada para pasien (Campbel & Amin, 2014). Kolaborasi antara praktisi penyembuhan tradisional dan dan pengobatan modern sangat penting untuk meningkatkan layanan kesehatan mental, karena hal ini dapat meningkatkan aksesibilitas, mengurangi penundaan dalam mengakses intervensi akut, dan meringankan beban keuangan pada layanan kesehatan (Green & Colucci, 2020). ...
Article
Penyembuhan tradisional tetap menjadi salah satu alternatif pengobatan yang banyak dipilih oleh masyarakat. Berbeda dengan pengobatan medis modern yang berorientasi pada rasio, metodologi dan bukti ilmiah, penyembuhan tradisional memiliki epistemologinya tersendiri. Penelitian ini mencoba mengelaborasi epistemologi dari penyembuhan tradisional serta potensi dan tantangan dari kolaborasi penyembuhan tradisional dan pengobatan modern. Metode yang digunakan adalah tradisional literature review. Tahapan yang dilakukan dalam literatur review ini, yaitu dengan memilih topik ulasan, mencari literatur terkait di database Google Scholar, mengumpulkan dan menganalisis literatur yang relevan, menulis ulasan, dan membuat daftar pustaka. Hasil tinjauan pustaka ini menjelaskan tentang sumber pengetahuan penyembuhan tradisional, bagaimana pengetahuan penyembuhan tradisional didapatkan, dan apa saja potensi serta tantangan dalam kolaborasi penyembuhan tradisional dengan pengobatan medis modern. Oleh sebab itu, penelitian ini dapat menjadi masukan untuk penelitian selanjutnya dalam menjawab tantangan dan potensi kolaborasi penyembuhan tradisional dan penyembuhan medis modern, khususnya di Indonesia.
... Given that we know that individuals with psychotic disorders in countries in the Global Majority have better clinical courses than those in Western countries (Brekke & Barrio, 1997;Iyer et al., 2010;Kulhara et al., 2009;Leff et al., 1992;Sartorius et al., 1978), it may make more sense to center the treatment of psychotic disorders around existing local cultural treatment strategies rather than trying to heavily integrate a Western treatment into standard protocol. Indeed, given the reliance that some cultures have on traditional healers for consultation on mental health care, it has been suggested that a collaborative, integrative model of care combining health care providers with traditional healers may be more palatable for individuals from these cultures (Green & Colucci, 2020;Shields et al., 2016). Furthermore, given the existing emphasis of collectivistic cultures on upholding family values, it may be for this reason that family interventions, relying on core collectivistic principles, are the most popular culturally adapted treatment for psychosis (Degnan et al., 2018). ...
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Cognitive behavioral therapy for psychosis is an effective treatment for psychosis. However, psychosis presents differentially according to an individual’s cultural context, and it is currently unclear which methods have been used to formulate culturally adapted cognitive behavioral therapy for psychosis (CaCBTp). The current systematic review examines the approaches to CaCBTp that have been evaluated to date and comments on preliminary evidence for the efficacy of CaCBTp. Key features of CaCBTp interventions are discussed in reference to broader cultural adaptations of psychosocial interventions for psychosis and culturally adapted cognitive behavioral therapy for other disorders. Overall, our results identified 12 studies and highlighted five overarching themes of cultural adaptation that clinicians should integrate into the design of future CaCBTp interventions, including family members in treatment, targeting stigma, relying on spiritual leaders, using multifaceted models of mental health, and ensuring adequate language match. The results of this review also highlight the paucity of literature in global CaCBTp interventions, as only 10 studies examining CaCBTp interventions were found.
... Other studies found practices in referral indicating that traditional healthcare practitioners usually delayed patient referral until it is too late 11 . However, in this study, the traditional health practitioners cited an almost immediate referral depending on the patient's condition. ...
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Introduction: It may be necessary for healthcare professionals to refer patients to other professionals and institutions that areable to provide the care needed by patients, depending on the severity each case presents, healthcare requirements, and resourcesavailable to offer care. In healthcare generally, patient referral is standard procedure; however, in South Africa, referral patternsbetween allopathic and traditional healthcare practitioners are unknown, and this is a problem yet to be addressed. Objectives: The study objective was to explore patient referral practices from the perspectives of traditional healthcare practitionersof South Africa. Methods: A qualitative, exploratory and descriptive design was employed to collect data from 11 traditional healthcare practitionerswho were sampled using snowball sampling. An individual semi structured interview schedule was used to collect data.Content analysis was used to analyze the data. Results: Patient referral was common practice in traditional health practices, however not reciprocal between the traditionaland allopathic healthcare. Several indications for patient referral to allopathic healthcare practitioners included management ofchronic conditions amongst others. Discussion: Patient referral being an important part of healthcare practices should be promoted and regulation and traditionalhealth practices improved to promote safe referral practices and curb unsafe self-referrals by patients. Keywords: Referral system; patient referral; traditional healthcare; allopathic healthcare.
... Effective regulation of herbal medicine requires collaboration and dialogue between traditional healers and modern healthcare practitioners (Green and Colucci, 2020). By fostering mutual respect, understanding, and partnership, regulatory agencies can harness the expertise of traditional healers while integrating evidence-based practices into the formal healthcare system. ...
Article
The regulation of herbal medicine in Nigeria stands at the intersection of tradition and modernity, presenting a complex landscape shaped by historical practices, cultural beliefs, and contemporary healthcare standards. This paper delves into the intricate dynamics surrounding the regulation of herbal medicine in Nigeria, aiming to elucidate the challenges and opportunities inherent in balancing traditional practices with modern regulatory standards. Drawing from a multidisciplinary approach encompassing medical anthropology, public health, and legal studies, this research explores the historical roots of herbal medicine in Nigeria, tracing its evolution from indigenous healing practices to its current status within the broader healthcare system. It examines the cultural significance of traditional medicine, considering its role in local communities and its enduring relevance in addressing healthcare needs, particularly in underserved rural areas. However, alongside the rich tapestry of traditional healing, concerns regarding safety, efficacy, and standardization have prompted calls for regulatory reforms to align herbal medicine practices with modern healthcare standards. This paper scrutinizes the existing regulatory frameworks governing herbal medicine in Nigeria, analyzing the strengths, weaknesses, and gaps therein. It explores the tension between preserving traditional knowledge and ensuring consumer protection, highlighting the need for a nuanced approach that respects cultural heritage while safeguarding public health. Furthermore, this research assesses the implications of regulatory interventions on various stakeholders, including herbal practitioners, consumers, and policymakers. It considers strategies for enhancing collaboration between traditional healers and the formal healthcare sector, fostering mutual respect, and promoting evidence-based practices. Ultimately, this study underscores the imperative of striking a delicate balance between tradition and modernity in regulating herbal medicine in Nigeria, advocating for a harmonized approach that upholds both cultural integrity and healthcare quality.
... Many Ugandans also seek spiritual assistance from religious leaders to cope with personal health and relationship issues [28]. Despite their popularity, traditional healers and religious leaders have limited training in evidence-based mental healthcare [29,30]. Increased investment in training mental health professionals, expanding mental healthcare to marginalized areas, acknowledging religious and traditional healers, and funding mental health research are all necessary [31] for building capacity. ...
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Background Mental health capacity building is a critical need and a growing priority in Ugandan health and education systems. Despite increased governmental attention to community mental health and mental healthcare needs, no published assessments garner qualitative perspectives directly from stakeholders in the Ugandan mental health system. Addressing this gap, the goal of the current needs assessment study was to systematically explore stakeholders’ perceptions of strengths, challenges, and recommendations for enhancing capacity in the national mental health system in Uganda. Methods Using qualitative ethnographic methods, data was collected from key informants through interviews and focus groups. A total of 44 stakeholders, who were engaged in the mental health system, were included in our final sample. Results Thematic analyses of data yielded several themes in each category, including system strengths related to existing policy and action plan, free medications, private sector, partnerships and collaborations; system challenges including socioeconomic constraints, stigma, and limited family engagement; and recommendations for improvement including enhanced education and training, integrating systemic approaches, and policy advocacy. Conclusion The results of this study have clinical, research, and policy implications that may inform mental health capacity, not only in Uganda, but in other global settings, advancing capacity to respond to pressing community mental health needs.
... Provision of family support could therefore prevent delayed identification and perceived obligation to seek help from spiritual and faith healers [44,45]. As previously reported, In LMICs such as Pakistan, India, Bangladesh, and Ethiopia; faith and religious healers are primary consultation resources for mental illness, especially among Muslims [46][47][48][49][50]. ...
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Introduction Adolescents’ Mental Healthcare (MHC) is influenced by numerous factors, and adolescents occasionally seek professional help for mental health (MH) issues. These factors become more complex within low-middle-income countries (LMICs); therefore, this study aims to understand barriers and facilitators to access mental health services among adolescents aged 10 to 19 years old from the perspective of users (parents) and providers (Mental Healthcare Providers - MHPs). Method Using a qualitative exploratory design, a semi-structured interview guide was developed using Andersen’s health service utilization model. In-depth interviews were conducted with MHPs (n = 21) and parents of adolescents (n = 19) in the psychiatry department of public and private hospitals in Karachi, from October—December 2021. Data was thematically analyzed using an inductive approach. Result The findings revealed a consensus of users and providers in all three categories of the Andersen model and referred the compulsion as the major driving force to MHC access and utilization rather than personal choices. Within pre-disposing, need, and enabling factors; the participants highlighted a unique perspective; users regarded frequent migration, daily wage loss, and women’s societal status as barriers while the need for marriage and patient willingness were stated as facilitators. Whereas, MHPs indicated societal tolerance, the burden on the health system, and the absence of Child and Adolescent Mental Health (CAMH) services as major gaps in service delivery. Conclusion Service utilization is mainly facilitated by the severity of illness rather than healthy choices and beliefs, and accessibility and affordability. It is therefore imperative to prioritize adolescent MH through promotion and prevention approaches and address service delivery gaps to prevent treatment delays via task-shifting and capacity building of the health workforce.
... While collaboration between both sectors is limited, there is evidence that some programs and countries have attempted to improve collaboration between biomedical and traditional medicine practitioners. Recent reviews have examined opportunities for integration of traditional healers in the provision of mental health 10,11 , HIV/STDs 12,13 and primary care 14 . However, reviews tend to be focused on specific conditions and we believe there is the need for a comprehensive review on collaboration between traditional healers and biomedical professionals. ...
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Introduction: Traditional healers play a crucial role in healthcare provision, particularly in low- and middle-income countries. Thus, there is a global interest in understanding the possibilities for collaboration between traditional healers and biomedical professionals. We believe there is the need for a comprehensive review on collaboration between traditional healers and biomedical professionals. Therefore, the aim of this review is to synthesise the literature on collaboration between traditional healers and biomedical professional including relevant interventions. Methods: A systematic review was conducted, utilizing a search strategy in PubMed, Web of Science, SCOPUS, and Google Scholar. Articles addressing collaboration between traditional healers and biomedical professionals were included, with a focus on attitudes, perceptions, interventions, and collaborative models. Data extraction followed a predefined template and the D'Amour et al. framework was employed for analysis. Results: The review identified 29 relevant articles, predominantly conducted in Africa. The majority of studies (n=22) explored attitudes and perceptions, revealing a willingness among traditional healers to collaborate, while biomedical professionals exhibited mixed feelings. Seven studies focused on interventions aimed at fostering collaboration primarily focused on improving referral systems and educational initiatives. These studies found positive outcomes. Examining collaboration through the lens of D'Amour et al.'s framework revealed that trust was a significant barrier to collaboration. Conclusion: This review highlights a willingness to collaborate amongst of traditional healers and biomedical professionals and provides some successful examples of working across systems. It also reveals areas for attention in developing collaborative models of working.
... This resulted in changes in health behaviours for patients after THPs provided services and further resulted in improvements in health conditions. 44,45 Because of improved knowledge, community health practices improved in all sites. This demonstrates the opportunities that lie in capacitating THPs as the first point of contact with many African patients. ...
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Background Traditional health practitioners (THPs) play an important role in communities by providing necessary health services for a variety of health problems. Possessing complementary biomedical knowledge and skills is vital in saving lives of patients. However, less is known about biomedical knowledge and skills among THPs. Aim This study aimed to explore and describe the training needs of THPs on biomedical knowledge and skills in urban townships in South Africa. Setting The study was conducted in a township in the City of Tshwane Metropolitan Municipality of Gauteng province, South Africa. Methods A qualitative, explorative, descriptive design with 18 THPs was employed through snowballing sampling. Data were collected through a lekgotla group discussion and thematic content analysis undertaken. Results Themes that emanated include knowledge of the basic physiological functioning of the human body; biomedical knowledge and skills required for the assessment of patients; managing emergency health conditions and understanding diagnostic concepts used in traditional health practice versus biomedical systems. Conclusion Traditional health practitioners have demonstrated interest in being trained on certain skills used within the biomedical system to care for patients. Performing the necessary first-aid skills by THPs will assist patients in the communities while waiting for emergency services or referrals. Provision of training programmes for THPs on first aid interventions during emergencies is therefore recommended. Contribution The study revealed that capacitating THPs with biomedical knowledge and skills can improve their ability to promote healthy living and prevent health problems in communities where access to resources is limited.
... Predominant among these is a lack of trust between biomedical practitioners and TFH. [15] In many contexts, this distrust has roots in colonial histories where traditional practitioners were dismissed as "witch doctors" and their expertise devalued and, in some cases, criminalized. [16] Health workers often have limited first-hand knowledge of healers' practices and may view them as "backward" and superstitious, particularly healers whose practices do not align with religious orthodoxy. ...
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There is an increasing interest in collaboration between biomedical services and traditional and faith healers for mental health care. In this article, we briefly outline recent research in this area and discuss some of the challenges to collaboration, particularly in relation to the care of people living with serious mental illness (SMI). Several approaches to collaborative mental health care have been attempted primarily in Africa, but also in Asia. Challenges to these collaborations include mutual distrust, power differentials, conceptual and methodological problems, and a lack of organizational support and resources. Importantly, the perspectives of people with lived experiences of mental illness are seldom considered. Research suggests that “bottom-up” approaches using community engagement, dialogue, and mutual learning may enable more effective and sustainable collaboration. We identify a need for greater involvement of people with lived experience of mental illness and their families and consider the potential of a public mental health approach in which collaborations are embedded within communities and existing support structures and accompanied by policies and interventions to address social as well as spiritual and medical needs.
... THs in Neno strongly recommend a collaborative approach with HCWs to ensure that they are educated about danger signs that guarantee a straight referral of snakebite victims to the hospital. There is extensive literature on the integration of THs and modern medicine for various diseases and conditions, snakebites could equally benefit [61,62]. ...
Article
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Snakebite envenoming remains a public health threat in many tropical countries including Malawi. Traditional healers (THs) have been consulted by victims of snakebites as primary caregivers for millennia. There are no studies in Malawi to understand this phenomenon, therefore, our study aimed to explore the experiences and practices of THs regarding snakebite treatment and prevention in rural Malawi. Between August and September 2022, we conducted semi-structured interviews with 16 THs who were purposefully selected from various locations across Neno District, Malawi. We analysed the interview data using Dedoose software, where we generated codes and grouped them into themes. Out of the 16 THs interviewed, 68.8% (n = 11) were male, and 43.8% were aged between 40 and 60 years. Our study identified five themes: THs’ knowledge of snakes and treatment, the continuum of care they provide, payment procedures, snakebite prevention, and their relationship with health facilities. They claimed a good understanding of the snakes in their area, including the seasons with more snakebites, and were confident in their ability to provide treatment, however, this was not scientifically proven. They offered a comprehensive care package, including diagnosis, first aid, main treatment, and follow-up care to monitor the victim’s condition and adjust treatment as needed. THs provide free treatment for snakebites or use a “pay later” model of service delivery. All THs claimed a “vaccine” for snakebites that could prevent bites or neutralize the venom. However, no formal relationship existed between THs and Health Care Workers (HCWs). We recommend collaboration between HCWs and THs, establishing clear referral pathways for snakebite victims and educating THs on identifying danger signs requiring prompt referral to healthcare facilities.
... traditional and faith-based healers; Ahmedani, 2011;Green and Colucci, 2020). However, stigma has been indicated as one of the most significant factors responsible for the perpetuation of avoiding mental health care across the world (Sayers, 2001;Ciftci, 2012;Sickel et al., 2014). ...
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Background Mental illness stigma is universally prevalent and a significant barrier to achieving global mental health goals. Mental illness stigma in Bangladesh has gained little attention despite its widespread impact on seeking mental health care in rural and urban areas. This study aimed to investigate mental illness stigma and the associated factors in rural and urban areas of Bangladesh. Methods The study areas were divided into several clusters from which 325 participants (≥18 years) were recruited with systematic random sampling. The Bangla version of the Days’ Mental Illness Stigma Scale was used to collect data. Independent-samples t -test, ANOVA, and multiple regression were performed. Results Results suggest that gender, age, geographical location, socioeconomic status, and occupation significantly differed across subscales of stigma. Age, gender, seeking treatment of mental illness, having knowledge on mental health, and socioeconomic status were predictive factors of mental illness stigma. The results also showed a high treatment gap in both rural and urban areas. Conclusion This study supports that mental illness stigma is prevalent in Bangladesh, requiring coordinated efforts. Results can inform the development of contextually tailored mental health strategies to reduce stigma and contribute to the promotion of mental health of individuals and communities across Bangladesh.
... However, despite all its pitfalls, alternative medicine remains a popular choice for those who might not have access to clinical healthcare and has been an integral part of healthcare in non-Western societies. (Green & Colucci, 2020). ...
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As the world experiences rapid industrialization and we stray away from deeper aspects of being, there is an alarming increase in problems related to mental health. A paucity of mental health professionals burdens health‐care systems worldwide, and this problem has become more evident postpandemic. Such a situation indicates a gap that indigenous healing systems can bridge. This article aims to recognize the role of indigenous healing systems in mental health promotion. We also focus on how alternative medicine addresses cultural differences in mental health. After a brief comparison between conventional and alternative medicine, we explore possibilities for collaboration between the two. Findings suggest that individuals in emerging and low‐income countries widely resorted to alternative medicine. It has a comprehensive set of benefits but also has its limitations as it is a loosely regulated field. Alternative practices remain a popular healthcare choice in emerging countries, and combining them with conventional medicine opens up new possibilities for holistic healing and decolonizing narratives in mental health.
... The person who is expressing hopelessness may be convinced that they are deserving of respect as people and that life is worthwhile if they are given a compassionate approach, good rapport, and attentive listening. 32 Most patients are relieved when their loved ones learn of their suicidal thoughts. Approximately 90% of people who take their own life have a co-morbid mental illness. ...
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Suicide is defined as a death caused by willful acts of taking one’s own life. It might be a way for people to get away from suffering or anguish. Globally, an estimated a million people individuals lose their life due to suicide annually. Before the age of 50 years old more than half (58%) of all suicide deaths occur. This commentary aims to highlight the Ethiopian context, feasible preventive measures, and the way forward in tackling suicidal behavior. Worldwide in adolescent age groups between the ages of 15 and 29, suicide is the fourth leading cause of death. Even though suicide occurs everywhere in the world, according to data in 2019, 77% of all suicides that occurred in the world reside in developing countries. Due to the numerous psychosocial pressures present in Ethiopia, one in four citizens suffers from a mental disorder. According to Ethiopian national data figures, suicide ideation affects 9%, 5–16% of people, whereas suicidal attempt affects 4%, 1–8%. Even though, there is a variation of prevalence over the years based on the variation in design, settings, and sample size. There is an increment in the prevalence’s suicidal ideation and attempts in the past 10 years. The country’s Ministry of Health needs to act to address and prevent this urgent public health situation. The prevention of suicide should be a top concern, and working with numerous stakeholders is an efficient and practical approach.
... Because there is significant regional variation in the strength of relationships with traditional healers, this strategy might have to vary by region. In addition numerous studies have shown that the integration of traditional healers into biomedical practice and health promotion is challenging and complex due to substantial training needs of healers, the lack of systems for referral between traditional and biomedical services, and the discrimination and hostility of biomedical staff towards traditional healers [41]. In the Bolivian context, our findings also suggest that a lack of consistent outreach and interaction with the health system is at the root of distrust. ...
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Background Despite efforts to increase cervical cancer screening access in rural Bolivia, uptake remains low. Bolivia has one of the highest cervical cancer mortality rates in the Americas. As it redoubles efforts to deliver Universal Health Care, the Bolivian government needs information on the factors constraining cervical cancer screening access and utilization, especially in rural areas. Methods Our qualitative study explored cervical cancer screening barriers and described community and provider perceptions and experiences of care. Bolivian and US researchers analyzed data collected from eight focus groups with male and female community members (n = 80) and interviews with healthcare providers (n = 6) in four purposively selected rural communities in Hernando Siles, Bolivia. Deductive and inductive codes were used to thematically analyze data using MaxQDA software. Results Four themes emerged from the data: lack of knowledge/misconceptions, health system inadequacy, lack of confidence in providers, and opportunities for improvement. Both men and women displayed misconceptions about the causes of cervical cancer, its consequences, the recommended screening frequency, and the means of accessing care. Providers noted community members’ lack of knowledge and low risk-perception as utilization barriers but also highlighted poor health service quality and inconsistent health education as factors. Poor healthcare quality was a significant barrier; this included poor patient-provider communication, lack of transportation to screening facilities, and severe delays in receiving test results. Providers also noted problems with provider training and physical space for screening. Community members reported low confidence in nurses to perform screening, preferring doctors and specialists. They also expressed discomfort in having male healthcare providers conduct screening. Suggestions for improvements included more intensive cervical cancer outreach to rural areas and having specialists train lower-level providers to perform screening. Conclusions Our findings suggest that poor healthcare quality has affected screening uptake in addition to physical barriers to care. They indicate a need for initiatives to reduce reporting time for Pap test results, the incorporation of community-based HPV self-sampling into screening protocols, and the implementation of programs to improve community confidence in providers’ ability to perform screening.
... An interrelated issue also arises from the perspective of systemic capacity building (Brooks & Muyia Nafukho, 2006;Fricchione et al., 2012;Green & Colucci, 2020). The mindfulness field has built an important track record regarding the scaling up (dissemination) of interventions, while attending to standards of intervention fidelity (Crane & Hecht, 2018). ...
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Objective The modern mindfulness movement and the public health field are aligned in many approaches, including recognizing psychosocial stress impacts and physical-mental health linkages, valuing “upstream” preventive approaches, and seeking to integrate health promotion activities across multiple social sectors. Yet mindfulness is conspicuously absent from most global and public health literature and practice, suggesting unfulfilled potential. This paper analyzes the mindfulness field from a public health perspective, with the aim of identifying evidential and conceptual bases, methods, potential consequences, and initial research and action agendas for greater integration of mindfulness approaches into global, national, and local public health efforts. Methods This paper reviews scientific and scholarly literature on the currently existing and potential relationships between mindfulness and public health, with special attention to 14 dimensions of potential tension or alignment. Results Several alignments were noted above. However, the mindfulness field is substantially lagging on multi-level interventions (e.g., both individual and collective levels), cultural and religious adaptations, and epidemiologic underpinnings. Both mindfulness and public health initiatives are in need of efforts to promote intercultural, interreligious, and intercontemplative competencies, in developing interventions to address pathogenic factors in the collective attentional environments in society, and in attending to religious and spiritual factors. Conclusions Full public health uptake will benefit from several additional lines of research and innovation, especially greater attention to cultural and religious adaptation, with attention also much needed to multi-level interventions and epidemiologic foundations.
... Meanwhile, individuals living with a mental illness rely heavily on traditional sources of care [6,7,10]. Notably, despite the widespread use of traditional medicine by individuals living with a mental illness, there is still very little formal interaction between the biomedical and traditional sectors in mental health care in Tanzania [11,12]. However, to meet patients' needs and to create more inclusive and culturally sensitive mental health care, it is necessary to pay attention to the role of the traditional sector in mental health care. ...
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Abstract Introduction Access to mental health care in low- and middle-income countries (LMICs) is low. In Tanzania specifically, there is an urgent need to scale up mental health care, decrease the mental health treatment gap, and make mental health care more acceptable and accessible within the community. Since traditional medicine plays a prominent role in the mental health care system in Tanzania, improving access through collaboration between biomedical practitioners and traditional healers could be a possible way forward. Methods The aim of the current study is to explore views among biomedical practitioners and traditional healers on collaboration between both groups in mental health care in the Dodoma region, Tanzania. We will conduct qualitative interviews using key informant interviews (KII) and in-depth-interviews (IDI) with mental health care providers, traditional healers, and coordinators from the Dodoma region till saturation is achieved. Interviews will be transcribed verbatim and coded, followed by a thematic analysis. Conclusion This qualitative study is the first to explore opportunities for strengthening the mental health care system by establishing views on collaboration among biomedical practitioners and traditional healers in Tanzania mainland.
... Finally, our results reinforce findings of previous studies on the complex relationships between vaccine hesitancy and CAM and highlight how sociocultural contexts and discourses shape vaccine hesitancy and CAM (Bryden et al., 2018;Dub e et al., 2021). Furthermore, as CAM evolve in different regulatory settings and different power relationships with the state or biomedicine, it is necessary to take into account these political, economic and legal contexts when making statements about CAM and vaccination (Almeida & Gabe, 2016;Green & Colucci, 2020;Jansen, 2016;Simchai & Keshet, 2016;Uibu, 2021). Such perspective gives insights into the underpinning logics of vaccine hesitancy among CAM practitioners and users and avoid abusive generalizations. ...
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Canadians and Quebecers increasingly consult complementary and alternative medicine (CAM) practitioners in parallel with biomedical providers. The close relationship between vaccine hesitancy and CAM use remains under explored in Western countries. We present the results of a qualitative study conducted among one of Quebec's most used CAM approaches: naturopathy. Using Boholm and Corvellec's relational theory of risk to illustrate naturopaths' construction of vaccination as an “object of risk”, we describe how the health representations of 30 Quebec naturopath interviewees are associated with the ways they perceived the risks of infectious diseases and vaccination. Our findings illustrate how Quebec naturopaths' view the body as “at risk” from the possible harmful effects of vaccines. For these naturopaths, the body is a site, a “terrain”, where homeostasis must continually be preserved, and needs to be protected from risks such as vaccines—which were seen as far riskier than infectious diseases—through natural means. Such views are often perceived as unscientific or even irrational by public health researchers. Our study highlights that naturopaths' attitudes towards vaccination are perfectly aligned with the epistemological tenets of their risk representations and conceptions of health.
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Traditional medicine is widely used in sub-Saharan Africa, particularly in Ghana, where it is commonly integrated with modern orthodox medicine. This study examines the barriers that delay the pursuit of orthodox medical care for prostate cancer (PCa) in Ghana’s Central region, where a blend of traditional and modern orthodox medicine exists. The preference for indigenous traditional medicine often results in late-stage presentations of PCa, adversely affecting patient outcomes. This prospective cross-sectional study was conducted from July to December 2022 at the Cape Coast Teaching Hospital (CCTH) and in four local communities. We investigated why men prefer traditional over orthodox medicine and identified cultural beliefs, attitudes, and gaps in health awareness that contribute to delays in diagnosing and treating PCa. The study involved administering questionnaires, providing education on PCa, and conducting free prostate-specific antigen (PSA) screening. Ethical approval was obtained from the Ethics Research Committee of the Ghana Health Service. A total of 282 patients participated, including 268 men from the communities and 14 diagnosed with PCa at CCTH after initially consulting traditional healers. Of the community-recruited patients who underwent PSA testing, 26% had elevated PSA levels and underwent further diagnostic procedures. Ultimately, nine of 268 community patients were confirmed to have PCa. Most patients (57.4%) had limited education, which correlated with late presentations and various misconceptions about PCa. The study highlights significant cultural and economic barriers that lead to the late-stage presentation of PCa among men in Ghana’s Central region. There is a critical need for a culturally sensitive, multi-pronged strategy that enhances public education about the benefits of early diagnosis and fosters collaboration between traditional healers and orthodox healthcare providers to improve prostate cancer outcomes in Ghana.
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Rationale of Study – This study explores issues that should be considered in implementing IMK in providing quality healthcare by county governments in Kenya. The study’s specific objectives were to determine different categories of IMK systems, to analyse categories of IMK practitioners and to propose issues that need to be considered in the application of IMK in the provision of quality health care by county governments in Kenya.Methodology – The study used a qualitative research approach. Data was collected from literature sources identified purposively through different search engines based on their relevance to the research topic.Findings – The study found that there are different systems of IMK, including pharmacology, physiotherapy, spiritual therapy and surgical therapy. In terms of practitioners, the study found that IMK practitioners can be categorised as herbalists, generalists, bone setters, dentists, traditional birth attendants and spiritual healers. Further, the issues that the county government should consider the application of IMK in the provision of health care include governance issues, intellectual property rights, application of IMK to health care provision, and proper management of IMK covering creation, codification, transfer, utilisation, validation and preservation.Implications – The study recommended that county governments in Kenya should: involve IMK practitioners in their healthcare delivery, address IMK management issues, and put in place appropriate legal and policy instruments to guide their efforts in integrating IMK systems in healthcare delivery. Implementing these recommendations will ensure that county governments can pull back their healthcare challenges by appropriately investing in their IMK resources.Originality – The study was original and explores a unique issue within the context of traditional knowledge in Kenya.
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Background Indigenous knowledge healers (IKHs) provide alternative healthcare to formal health services in rural South Africa, but there is a gap in knowledge regarding their treatment of surgical conditions. This study evaluated IKH surgical care and described their perspective of the dual health system. Methods A cross sectional survey of IKHs in the Madwaleni Hospital catchment of the Eastern Cape, South Africa was conducted. Topics included the training and experience of IKHs, treatment of nine common surgical conditions, referral patterns, disease origin beliefs, benefits and limitations of care, and collaborative opportunities between the two health systems. Results Thirty‐five IKHs completed the survey. IKHs were consulted by persons with all nine surgical conditions. The most common forms of treatment were application of an ointment on the affected site (88%) and oral medication (82%). Operative treatment was only done for abscess. Referrals to the formal healthcare sector were made for all surgical conditions. IKHs reported that they were limited by their lack of training and resources to perform operations. On the other hand, they perceived the treatment of the spiritual aspect of surgical disease as a benefit of their care. Thirty‐five (100%) IKHs were interested in closer collaboration with the formal health sector. Conclusion IKHs treat surgical conditions but refer to the formal health sector when diagnostic and operative services are needed. More research is needed to determine the potential advantages and disadvantages between the formal health sector and IKH collaboration.
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Background Timely diagnosis of childhood cancer, early hospital presentation and completion of treatment significantly improve outcomes. Unfortunately, in Tanzania, thousands of children die of cancer each year without ever being diagnosed or treated. To reduce childhood death from cancer, it is important to understand the social‐cultural context, values and beliefs that influence healthcare‐seeking behaviours among the Tanzanian community. Methods This was a cross‐sectional qualitative study conducted in Mwanza, Kilimanjaro and Dar‐es‐Salaam regions between March and June 2021. We purposively selected community members aged ≥18 years from three rural and three urban settings to participate in seven focus group discussions (each with eight to 12 respondents). The participants were from communities without any affiliation to the treatment of children with cancer or treatment facilities. We transcribed, coded and analyzed data using a thematic‐content approach with the support of NVIVO 12 software. Results Many had heard of breast or cervical cancer; however, most were unaware of childhood cancer. Adults believe that cancer in children is caused by witchcraft and cannot be cured by modern medicines available at hospitals. These beliefs lead parents to first seek care from traditional healers, which hence delay presentation to the hospital. Other community concerns included the cost of transportation, investigation‐related costs, and the long duration of treatment. These have an influence on treatment adherence leading to seeking alternative treatment, such as spiritual or traditional treatment. Conclusion Low community awareness, late hospital presentation, and treatment abandonment remain a challenge in childhood cancer in most parts of Tanzania. Belief about childhood cancer being a result of witchcraft and superstition contributes to limited health‐seeking behaviours. Cultural and contextually relevant awareness campaign interventions are needed to increase cancer knowledge in Tanzanian communities.
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Tato publikace představuje komplexní úvod do problematiky a dosud první souhrnný přehled situace v oblasti fenoménu užívání psychedelik v České republice, shrnující výsledky výzkumného projektu Aplikace výzkumných metod při tvorbě návrhu systému služeb pro uživatele psychedelických látek realizovaného v letech 2019–2021 v Národním ústavu duševního zdraví a spolufinancovaného se státní podporou Technologické agentury České republiky. This publication is a comprehensive introduction to the phenomenon and so far the first complex overview of the situation in the field of psychedelics use in the Czech Republic, summarizing the results of the research project Application of Research Methods in Creating a Design of a System of Services for Users of Psychedelics (hereinafter referred to as National Psychedelic Research) implemented in 2019–2021 at the National Institute of Mental Health.
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The present technical report introduces the Global Healthcare Systems (G2HS), a novel dataset containing information on the historical evolution of healthcare systems in 167 countries worldwide. Existing datasets typically focus on specific healthcare schemes or programmes, leaving a gap in comprehensive data that encompasses healthcare systems in their entirety, as well as the timing and mode of a state's commitment to healthcare. The G2HS dataset fills this void by providing insights into the inception of healthcare systems in a global perspective, including their timing of introduction and their characteristics at inception, specifically financing, service provision, and regulatory aspects. This document presents the primary definitions used to develop the dataset and details the data collection process, which encompasses the scope and coverage, the sources, and the practical procedure. Importantly, the indicators and variables represented in the dataset are also explored. Developed at the University of Bremen and funded by the Deutsche Forschungsgemeinschaft (German Research Foundation), the G2HS dataset is stored in the Welfare State Information System (WeSIS).
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Programa da 19.ª edição da Formação de Psicoterapeutas Clássicos de Xamanismo Transcultural (Estudos Antropológicos Teórico-Práticos) que se realizará através de teleaulas e de telepráticas (por videoconferência, portanto, ao vivo, mas online) entre os dias 14 de junho e 16 de novembro de 2025. Neste curso os formandos colaboram (facultativamente) num estudo científico (quase-experimental) sobre a efetividade psicoterapêutica de um compósito de práticas xamânicas transculturais, praticando-as (entre os formandos e com voluntários) com supervisão. Trata-se de um curso pioneiro, onde, pela primeira vez se aplicam métodos mistos de investigação científica, no sentido de aferir: as práticas xamânicas funcionam mesmo? O nosso estudo preliminar deu uma resposta afirmativa. Mas, será que com a ampliação da amostra (de formandos e de voluntários), se mantêm os resultados sobre a efetividade do xamanismo? Conforme Krippner (2002) os investigadores têm dissertado (em estudos sobre o xamanismo) com um teor predominantemente pejorativo (talvez até projetivo). Com o nosso estudo, sugerimos um novo olhar sobre o xamanismo: uma psicoterapia clássica, que pode ser estruturada e testada cientificamente conforme ocorre com outras psicoterapias. Assim, mais do que teórico, este é um curso prático onde se aprende, fazendo. Mas, fazendo de uma forma cientificamente estruturada, ajustando as práticas xamânicas milenares às demandas e às realidades contemporâneas das sociedades ditas «modernas». Este é um curso para pessoas com uma mentalidade integrativa, não-sectária e com interesse ontológico. Porque o «ser humano» é mais que apenas o «humano». O «ser» faz parte do «ser humano». E é no estudo do «ser» que (da nossa perspetiva) se encontra o «ouro» que complementa e torna inteiro o estudo sobre o Ser Humano.
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Although global rates of suicide have dropped in the last 30 years, youth in low- and middle-income countries (LMICs) continue to be highly represented in suicide statistics yet underrepresented in research. In this review we present the epidemiology of suicide, suicidal ideation, and suicide attempts among youth in LMICs. We also describe population-level (attitudes toward suicide, socioeconomic, and societal factors) and individual-level clinical and psychosocial risk factors, highlighting specific considerations pertaining to youth in LMICs. These specific considerations in risk factors within this population can inform how multi-level prevention strategies may be targeted to meet their specific needs. Prevention and intervention strategies relying on the stepped-care framework focusing on population-, community-, and individual level targets while considering locally- and culturally relevant practices are key in LMICs. In addition, systemic approaches favoring school-based and family-based interventions are important among youth. Cross-culturally adapted multimodal prevention strategies targeting the heterogeneity that exists in healthcare systems, suicide rates, and risk factors in these countries should be accorded a high priority to reduce the burden of suicide among youth in LMICs.
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The revised edition of the Handbook offers the only guide on how to conduct, report and maintain a Cochrane Review. The second edition of The Cochrane Handbook for Systematic Reviews of Interventions contains essential guidance for preparing and maintaining Cochrane Reviews of the effects of health interventions. Designed to be an accessible resource, the Handbook will also be of interest to anyone undertaking systematic reviews of interventions outside Cochrane, and many of the principles and methods presented are appropriate for systematic reviews addressing research questions other than effects of interventions. This fully updated edition contains extensive new material on systematic review methods addressing a wide-range of topics including network meta-analysis, equity, complex interventions, narrative synthesis, and automation. Also new to this edition, integrated throughout the Handbook, is the set of standards Cochrane expects its reviews to meet. Written for review authors, editors, trainers and others with an interest in Cochrane Reviews, the second edition of The Cochrane Handbook for Systematic Reviews of Interventions continues to offer an invaluable resource for understanding the role of systematic reviews, critically appraising health research studies and conducting reviews.
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Background: Many current debates about global mental health have increasingly called for collaboration between biomedical and traditional medical health systems. Despite these calls, not much has been written about the variables that would influence such collaboration. To a large extent, collaboration dialogues have considered biomedicine on the one hand, and a wide range of traditional and faith-based treatments on the other hand. However, this dualistic bifurcation does not reflect the plurality of healing systems in operation in many contexts, and the diverse investments that different non-biomedical healing approaches may have in their own power to heal. Objective: We set out to explore the diversity of different healers’ perceptions of power, and the relationship between that power and the perceived power of biomedical approaches. Methods: Through a qualitative design, and using the case of medical pluralism in urban Ghana as an example, we conducted interviews among different categories of traditional and alternative medicine (TAM) practitioners living and/or working in the Greater Accra Region of Ghana. Results: Through thematic analyses, differences in the notions about collaboration between the different categories of healers were identified. Their perceptions of whether collaboration would be beneficial seemed, from this study, to co-occur with their perceptions of their own power. Conclusions: We suggest that an important way to move debates forward about collaboration amongst different sectors is to examine the notions of power and positioning of different categories of TAM healers in relation to biomedicine, and the attendant implications of those notions for integrative mental healthcare.
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Practitioners of traditional African medicine (traditional healers) are an important part of the health care system in South Africa, yet their voices are often absent from discussions about public health. In this context, we set out to investigate how a group of traditional healers in South Africa understand suicide and suicide prevention. In-depth, semistructured interviews were conducted with 6 traditional healers and analysed using thematic content analysis. The traditional healers report they are frequently consulted by suicidal individuals and they are confident about their ability to help people in a suicidal crisis. Findings suggest that traditional healers understand suicidal behaviour as a symptom of social disconnection and cultural discontinuity. Traditional healers report that suicidal individuals can be helped by reestablishing interpersonal connections, reconnecting to family and ancestors, and renewing their cultural identities through rituals. These findings suggest that there is some congruence between the way traditional healers understand suicide and the Western scientific and biomedical literature. Our findings raise important questions about cultural approaches to suicide research which are commonly premised on dualistic thinking that constructs culture as something distinct from Western biomedicine.
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p> Background. Referral between psychiatrists and spiritual workers (e.g. Christian pastoral care workers, traditional healers, imams, rabbis and others) in the heterogeneous South African (SA) society is complicated and requires investigation to establish appropriate norms. Objective. To capture the views of some local psychiatrists on referral and collaboration between SA psychiatrists and religious or spiritual advisers. Methods. This explorative qualitative study involved indepth, semistructured interviews with 13 local academic psychiatrists selected through purposive sampling. Each participant had a single interview with the aim of exploring themes related to the referral and collabora­tion process between psychiatrists and spiritual advisers. Theme content analysis of interview transcripts was done. Results for one of the six identified themes are reported; other results are reported elsewhere. Results. Within the theme ‘referral and collaboration between psychiatrists and spiritual professionals’, three subthemes were identified: facilitating appropriate referral and intervention for individual users; information sharing and mutual awareness between disciplines; and addressing stigmatisation of users with psychiatric conditions. Conclusion. Dialogue between psychiatrists and religious or spiritual advisers should be developed on an individual practitioner and facility basis, as well as on an organised basis between representative societies. The process of formalising a relationship between local psychiatrists and different spiritual workers may, however, still have some way to go.</p
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div class="column"> Background . Western definitions of, and approaches to, mental illness have been critiqued for their lack of incorporation of cultural and spiritual elements. Objective. To explore perceptions of mental illness, particularly in terms of the role of Islam in the understanding of mental illness among South African Muslim psychiatrists practising in Johannesburg. Methods . Using a qualitative design, semi-structured interviews were conducted with a convenience sample of 7 Muslim psychiatrists in the Johannesburg area. Thematic content analysis was used to analyse the transcribed data. Results. Psychiatrists subscribe to a more biomedical model of illness. The findings of this study also suggest that psychiatrists attempt to remain objective and to refrain from imposing their religious and cultural beliefs on their patients. However, their conceptualisation of mental illness is influenced by their religion and culture. Furthermore, all participating psychiatrists indicated that they always draw on Islamic values when treating their patients. Issues of cultural competence were also highlighted. Psychiatrists indicated that they were open to collaboration with traditional healers and psychologists but that this was quite challenging. Conclusion . The necessity for formal bodies to develop routes for collaboration between healthcare professionals and traditional healers was brought to the fore. So, too, was the need to incorporate indigenous theory and knowledge into mainstream definitions and approaches to mental illness. </div
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The treatment gap for mental illness is wide between low- and middle-income countries. The World Health Organization and other relevant bodies are seeking to reduce this gap through culturally innovative and sensitive programming. In Ghana, for example, only 2 % of the mentally ill access treatment, which means that 98 % do not receive care. Various discourses are ongoing to scale up mental health services in Ghana. One of these is the fostering of a collaborative framework between lay mental health workers (such as religious leaders or faith healers) and professional mental health workers. This article seeks to provide a framework within which collaborative linkages between religious leaders (e.g., the clergy, traditional healers) and professional mental health workers can be established. The article begins with a brief overview of Ghana’s mental health landscape, followed by a description of the challenges that make collaboration a difficult task. Next, the need for a holistic view of health in Ghana is addressed by examining Engel’s biopsychosocial model and Twumasi’s work on the complementary role of traditional systems. The essay ends by providing a three-step approach—understanding, task shifting, and broadened curricula—as a model to guide any collaboration between religious leaders and health practitioners in Ghana.
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Background Qualitative evidence on dialogue formation and collaboration is very scanty in Kenya. This study thus aimed at the formation of dialogue and establishment of collaboration among the informal (faith and traditional healers) and formal health workers (clinicians) in enhancing community–based mental health in rural Kenya. Methods Qualitative approach was used to identify barriers and solutions for dialogue formation by conducting nine Focus Group Discussions each consisting of 8–10 participants. Information on age, gender and role in health care setting as well as practitioners’ (henceforth used to mean informal (faith and traditional healers) and formal health workers) perceptions on dialogue was collected to evaluate dialogue formation. Qualitative and quantitative data analysis was performed using thematic content analysis and Statistical Package Social Sciences (SPSS) software respectively. Results We identified four dominant themes such as; (i) basic understanding about mental illnesses, (ii) interaction and treatment skills of the respondents to mentally ill persons, (iii) referral gaps and mistrust among the practitioners and (iv) dialogue formation among the practitioners. Although participants were conversant with the definition of mental illness and had interacted with a mentally ill person in their routine practice, they had basic information on the causes and types of mental illness. Traditional and faith healers felt demeaned by the clinicians who disregarded their mode of treatment stereotyping them as “dirty”. After various discussions, majority of practitioners showed interest in collaborating with each other and stated that they had joined the dialogue in order interact with people committed to improving the lives of patients. Conclusion Dialogue formation between the formal and the informal health workers is crucial in establishing trust and respect between both practitioners and in improving mental health care in Kenya. This approach could be scaled up among all the registered traditional and faith healers in Kenya.
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Background. Referral between psychiatrists and spiritual workers (e.g. Christian pastoral care workers, traditional healers, imams, rabbis and others) in the heterogeneous South African (SA) society is complicated and requires investigation to establish appropriate norms. Objective. To capture the views of some local psychiatrists on referral and collaboration between SA psychiatrists and religious or spiritual advisers. Methods. This explorative qualitative study involved in-depth, semistructured interviews with 13 local academic psychiatrists selected through purposive sampling. Each participant had a single interview with the aim of exploring themes related to the referral and collaboration process between psychiatrists and spiritual advisers. Theme content analysis of interview transcripts was done. Results for one of the six identified themes are reported; other results are reported elsewhere. Results. Within the theme 'referral and collaboration between psychiatrists and spiritual professionals', three subthemes were identified: facilitating appropriate referral and intervention for individual users; information sharing and mutual awareness between disciplines; and addressing stigmatisation of users with psychiatric conditions. Conclusion. Dialogue between psychiatrists and religious or spiritual advisers should be developed on an individual practitioner and facility basis, as well as on an organised basis between representative societies. The process of formalising a relationship between local psychiatrists and different spiritual workers may, however, still have some way to go.
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The experience of epilepsy is profoundly culturally mediated and the meanings attributed to the condition can have a great impact on its social course. This qualitative study used Kleinman’s Explanatory Model framework to explore traditional healers’ perspectives on epilepsy in an urban township in Cape Town, South Africa. The healers who participated in the study were Xhosa-speaking, had experience caring for patients with epilepsy, and had not received any training on epilepsy. Six individual in-depth interviews and one focus group with nine traditional healers were conducted using a semi-structured interview guide. Traditional healers identified several different names referring to epilepsy. They explained epilepsy as a thing inside the body which is recognized by the way it presents itself during an epileptic seizure. According to these healers, epilepsy is difficult to understand because it is not easily detectable. Their biomedical explanations of the cause of epilepsy included, among others, lack of immunizations, child asphyxia, heredity, traumatic birth injuries and dehydration. These healers believed that epilepsy could be caused by amafufunyana (evil spirits) and that biomedical doctors could not treat the supernatural causes of epilepsy. However, the healers believed that western medicines, as well as traditional medicines, could be effective in treating the epileptic seizures. Traditional healers were supportive of collaboration with western-trained practitioners and highlighted that the strategy must have formal agreements in view of protection of intellectual property, accountability and respect of their indigenous knowledge. The findings suggest a need for interventions that promote cultural literacy among mental health practitioners. Research is urgently needed to assess the impact of such collaborations between biomedical services and traditional healers on epilepsy treatment and care.
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In resource-limited contexts in low- and middle-income countries (LMICs), a considerable proportion of individuals seeking care for mental disorders consult traditional and religious healers in their pathway to mental health care. Reports from Africa suggest that early involvement of healers may result in delays in the care pathway; a potential barrier to early identification and intervention. A systematic review was conducted to evaluate the proportion of patients attending formal health services after making first contact for treatment of mental disorders with traditional or religious healers or other informal and formal care providers within published research in Africa. Electronic databases were searched for the period from January 1990 to February 2014. Quality assessment of included studies was conducted the SAQOR tool. Fourteen papers were identified with data on category of first care provider. Utilizing random effects modelling with inverse variance method, the pooled proportion of participants making first contact for treatment of mental disorders with two broadly categorised providers (informal and formal) was 48.1 % (95 % CI 36.4-60.0 %) and 49.2 % (95 % CI 38.0-60.4 %), respectively. The pooled proportion of participants making first contact with specific providers was: traditional healers (17.0 %, 95 % CI 10.9-24.1 %); religious healers (26.2 %, 95 % CI 18.1-35.1 %); general health services (24.3 %, 95 % CI 16.9-32.5 %); and mental health services (13.0 %, 95 % CI 5.1-23.5 %). Substantial regional variation in patterns of first provider choice was evident. Conclusions of this review must be qualified in the light of several limitations. Approximately half of individuals seeking formal health care for mental disorders in Africa, choose traditional and religious healers as their first care provider. Previous reports suggest that this choice is associated with delays in accessing formal mental health services. Strategies to improve pathways to mental health care in Africa must include innovative programmes aimed at fostering collaboration between biomedical mental health services and these key community-based providers.
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The views of a sample of Xhosa-speaking psychiatric nurses on traditional healing and its role in mental health care in South Africa are examined. We explore how the nurses manage apparent incompatibilities between their practice of Western psychiatry and the use of traditional healing services. Under normal circumstances this incongruity appears unproblematic for the respondents; these systems co-exist pluralistically in their experience. However, when questioned about the possible cooperation of these systems, respondents give views inconsistent with their pluralistic world-view and promote psychiatry’s hegemony. Implications for healthcare planning are discussed.
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Aims and method A cross-sectional, interview survey of the beliefs, knowledge, attitudes and practice towards mental illness of 29 traditional healers in the Pallisa district of Uganda was carried out. Results Many of the healers had experienced emotional problems that had been treated by other healers. Almost all had a family member who was also a traditional healer. They treated a wide range of conditions and all dealt with mental illness. Most believed that mental disorders were caused by supernatural processes. Many recognised the role of environmental agents. Their diagnosis and management of mental illness was eclectic. The healers were either traditional herbalists or spirit diviners or a mixture of both. Almost all referred patients to the district hospitals and were willing to work with government health services. Clinical implications The results of the survey suggest the presence of fertile ground on which to build cooperation between traditional healers and medical services. Such cooperation may harness primary care resources more effectively. Sequential or simultaneous models of collaboration (or combinations of both) may be considered. Further work on specific treatments, their outcomes and the evaluation of collaborative models is needed.
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In Nicaragua there are attempts, at various levels, to bridge the gap between Western and indigenous medicine and to create more equal forms of therapeutic cooperation. This article, based on anthropological fieldwork, focuses on this process in the North Atlantic Autonomous Region, a province dominated by the Miskitu people. It examines illness beliefs among the Miskitu, and how therapeutic cooperation is understood and acted upon by medical personnel, health authorities and Miskitu healers. The study focuses on ailments locally considered to be caused by spirits and sorcery and problems that fall outside the scope of biomedical knowledge. Of special interest is the mass-possession phenomena grisi siknis where Miskitu healing methods have been the preferred alternative, even from the perspective of the biomedical health authorities. The paper shows that Miskitu healing knowledge is only used to compensate for biomedicine's failure and not as a real alternative, despite the intentions in the new Nicaraguan National Health Plan. This article calls for more equal forms of therapeutic cooperation through ontological engagement by ongoing negotiation and mediation between local and biomedical ways of perceiving the world.
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This article charts the historical development of the discipline of global mental health, whose goal is to improve access to mental health care and reduce inequalities in mental health outcomes between and within nations. The article begins with an overview of the contribution of four scientific foundations toward the discipline's core agenda: to scale up services for people with mental disorders and to promote their human rights. Next, the article highlights four recent, key events that are indicative of the actions shaping the discipline: the Mental Health Gap Action Programme to synthesize evidence on what treatments are effective for a range of mental disorders; the evidence on task shifting to nonspecialist health workers to deliver these treatments; the Movement for Global Mental Health's efforts to build a common platform for professionals and civil society to advocate for their shared goal; and the Grand Challenges in Global Mental Health, which has identified the research priorities that, within the next decade, can lead to substantial improvements in the lives of people living with mental disorders. The article ends by examining the major challenges for the field, and the opportunities for addressing them in the future.
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Health care utilization in many developing countries, Tanzania included, is mainly through the use of traditional medicine (TRM) and its practitioners despite the presence of the conventional medicine. This article presents findings on the study that aimed to get an experience of health care utilization from both urban and rural areas of seven administrative regions in Tanzania. A total of 33 health facility managers were interviewed on health care provision and availability of supplies including drugs, in their respective areas. The findings revealed that the health facilities were overburden with higher population to serve than it was planned. Consequently essential drugs and other health supplies were available only in the first two weeks of the month. Conventional health practitioners considered traditional health practitioners to be more competent in mental health management, and overall, they were considered to handle more HIV/AIDS cases knowingly or unknowingly due to shear need of healthcare by this group. In general conventional health practitioners were positive towards traditional medicine utilization; and some of them admitted using traditional medicines. Traditional medicines like other medical health systems worldwide have side effects and some contentious ethical issues that need serious consideration and policy direction. Since many people will continue using traditional/alternative medicine, there is an urgent need to collaborate with traditional/alternative health practitioners through the institutionalization of basic training including hygiene in order to improved healthcare in the community and attain the Millennium Development Goals by 2015.
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The authors apply two contemporary notions of culture to advance the conceptual basis of cultural competence in psychotherapy: Kleinman's (1995) definition of culture as what is at stake in local, social worlds, and Mattingly and Lawlor's (2001) concept of shared narratives between practitioners and patients. The authors examine these cultural constructs within a clinical case of an immigrant family caring for a young boy with an autism-spectrum disorder. Their analysis suggests that the socially based model of culture and the concept of shared narratives have the potential to broaden and enrich the definition of cultural competence beyond its current emphasis on the presumed cultural differences of specific racial and ethnic minority groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved).
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The WHO estimates that more than 80% of African populations attend traditional healers for health reasons and that 40%-60% of these have some kind of mental illness. However, little is known about the profiles and outcome of this traditional approach to treatment. The purpose of this study was to describe the profiles and outcome of traditional healing practices for severe mental illnesses in Jinja and Iganga districts in the Busoga region of Eastern Uganda. Four studies were conducted. Study I used focus group discussions (FGDs) with case vignettes with local community members and traditional healers to explore the lay concepts of psychosis. Studies II and III concerned a cross-sectional survey of patients above 18 years at the traditional healer's shrines and study IV was made on a prospective cohort of patients diagnosed with psychosis in study III. Manual content analysis was used in study I; quantitative data in studies II, III, and IV were analyzed at univariate, bivariate, and multivariate levels to determine the association between psychological distress and socio-demographic factors; for study IV, factors associated with outcome were analyzed. One-way ANOVA for independent samples was the analysis used in Study IV. The community gave indigenous names to psychoses (mania, schizophrenia, and psychotic depression) and had multiple explanatory models for them. Thus multiple solutions for these problems were sought. Of the 387 respondents, the prevalence of psychological distress was 65.1%, where 60.2% had diagnosable current mental illness, and 16.3% had had one disorder in their lifetime. Over 80% of patients with psychosis used both biomedical and traditional healing systems. Those who combined these two systems seemed to have a better outcome. All the symptom scales showed a percentage reduction of more than 20% at the 3- and 6-month follow-ups. Traditional healers shoulder a large burden of care of patients with mental health problems. This calls for all those who share the goal of improving the mental health of individuals to engage with traditional healers.
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Limited research has been conducted to explore the factors that support or obstruct collaboration between traditional healers and public sector mental health services. The first aim of this study was to explore the reasons underpinning the widespread appeal of traditional/faith healers in Ghana. This formed a backdrop for the second objective, to identify what barriers or enabling factors may exist for forming bi-sectoral partnerships. Eighty-one semi-structured interviews and seven focus group discussions were conducted with 120 key stakeholders drawn from five of the ten regions in Ghana. The results were analysed through a framework approach. Respondents indicated many reasons for the appeal of traditional and faith healers, including cultural perceptions of mental disorders, the psychosocial support afforded by such healers, as well as their availability, accessibility and affordability. A number of barriers hindering collaboration, including human rights and safety concerns, scepticism around the effectiveness of 'conventional' treatments, and traditional healer solidarity were identified. Mutual respect and bi-directional conversations surfaced as the key ingredients for successful partnerships. Collaboration is not as easy as commonly assumed, given paradigmatic disjunctures and widespread scepticism between different treatment modalities. Promoting greater understanding, rather than maintaining indifferent distances may lead to more successful co-operation in future.
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The majority of the black African population in South Africa utilize both traditional and public sector Western systems of healing for mental health care. There is a need to develop models of collaboration that promote a workable relationship between the two healing systems. The aim of this study was to explore perceptions of service users and providers of current interactions between the two systems of care and ways in which collaboration could be improved in the provision of community mental health services. Qualitative individual and focus group interviews were conducted with key health care providers and service users in one typical rural South African health sub-district. The majority of service users held traditional explanatory models of illness and used dual systems of care, with shifting between treatment modalities reportedly causing problems with treatment adherence. Traditional healers expressed a lack of appreciation from Western health care practitioners but were open to training in Western biomedical approaches and establishing a collaborative relationship in the interests of improving patient care. Western biomedically trained practitioners were less interested in such an arrangement. Interventions to acquaint traditional practitioners with Western approaches to the treatment of mental illness, orientation of Western practitioners towards a culture-centred approach to mental health care, as well as the establishment of fora to facilitate the negotiation of respectful collaborative relationships between the two systems of healing are required at district level to promote an equitable collaboration in the interests of improved patient care.
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Drawing on data collected from 3 focus groups with 24 traditional healers, the aim of this qualitative study was to use the constructs of the Theory of Planned Behaviour (TPB) to gain an understanding of traditional healer referral practices of their patients with a mental illness. Results indicated that traditional healers possess a concept of mental illness, mainly referring to a patient behaving abnormally. They often report regularly treating patients with these behaviours. Traditional healer referral to Western care is considered a temporary measure or a last resort. A majority of healers feel that allopathic physicians do not treat them with the respect that they feel their contribution to the health of the community warrants. Recommendations include the need for traditional healers to be trained to identify potential cases of mental illness in their communities and for dialogue between traditional and allopathic physicians in regard to mental health care.
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The aim of this study was investigate the HIV/AIDS/STI and TB knowledge, beliefs and practices of traditional healers in South Africa. In a cross-sectional study 233 traditional healers were interviewed in three selected communities in KwaZulu-Natal. Results indicate that the most common conditions seen were STIs, a variety of chronic conditions, HIV/AIDS (20%) and tuberculosis (29%). Although most healers had a correct knowledge of the major HIV transmission routes, prevention methods and ARV treatment, their knowledge was poorer on other HIV transmission routes, and 21% believed that there is a cure for AIDS. A minority reported unsafe practices in terms of reuse of razor blades on more than one patients and the reuse of enema equipment without sterilization, and two-thirds used gloves when carrying out scarifications. Randomized control trials are called for to test the effectiveness of traditional healing for HIV/AIDS, STI and TB prevention and care.
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Collaboration between traditional healers and biomedical practitioners is now being accepted by many African countries south of the Sahara because of the increasing problem of HIV/AIDS. The key problem, however, is how to initiate collaboration between two health systems which differ in theory of disease causation and management. This paper presents findings on experience learned by initiation of collaboration between traditional healers and the Institute of Traditional Medicine in Arusha and Dar-es-Salaam Municipalities, Tanzania where 132 and 60 traditional healers respectively were interviewed. Of these 110 traditional healers claimed to be treating HIV/AIDS. The objective of the study was to initiate sustainable collaboration with traditional healers in managing HIV/AIDS. Consultative meetings with leaders of traditional healers' associations and government officials were held, followed by surveys at respective traditional healers' "vilinge" (traditional clinics). The findings were analysed using both qualitative and quantitative methods. The findings showed that influential people and leaders of traditional healers' association appeared to be gatekeepers to access potential good healers in the two study areas. After consultative meetings these leaders showed to be willing to collaborate; and opened doors to other traditional healers, who too were willing to collaborate with the Institute of Traditional Medicine in managing HIV/AIDS patients. Seventy five percent of traditional healers who claimed to be treating HIV/AIDS knew some HIV/AIDS symptoms; and some traditional healers attempted to manage these symptoms. Even though, they were willing to collaborate with the Institute of Traditional Medicine there were nevertheless some reservations based on questions surrounding sharing from collaboration. The reality of past experiences of mistreatment of traditional healers in the colonial period informed these reservations. General findings suggest that initiating collaboration is not as easy as it appears to be from the literature, if it is to be meaningful; and thus we are calling for appropriate strategies to access potential healers targeted for any study designed with sustainability in mind.
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There is a growing recognition of the value of synthesising qualitative research in the evidence base in order to facilitate effective and appropriate health care. In response to this, methods for undertaking these syntheses are currently being developed. Thematic analysis is a method that is often used to analyse data in primary qualitative research. This paper reports on the use of this type of analysis in systematic reviews to bring together and integrate the findings of multiple qualitative studies. We describe thematic synthesis, outline several steps for its conduct and illustrate the process and outcome of this approach using a completed review of health promotion research. Thematic synthesis has three stages: the coding of text 'line-by-line'; the development of 'descriptive themes'; and the generation of 'analytical themes'. While the development of descriptive themes remains 'close' to the primary studies, the analytical themes represent a stage of interpretation whereby the reviewers 'go beyond' the primary studies and generate new interpretive constructs, explanations or hypotheses. The use of computer software can facilitate this method of synthesis; detailed guidance is given on how this can be achieved. We used thematic synthesis to combine the studies of children's views and identified key themes to explore in the intervention studies. Most interventions were based in school and often combined learning about health benefits with 'hands-on' experience. The studies of children's views suggested that fruit and vegetables should be treated in different ways, and that messages should not focus on health warnings. Interventions that were in line with these suggestions tended to be more effective. Thematic synthesis enabled us to stay 'close' to the results of the primary studies, synthesising them in a transparent way, and facilitating the explicit production of new concepts and hypotheses. We compare thematic synthesis to other methods for the synthesis of qualitative research, discussing issues of context and rigour. Thematic synthesis is presented as a tried and tested method that preserves an explicit and transparent link between conclusions and the text of primary studies; as such it preserves principles that have traditionally been important to systematic reviewing.
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Drawing on two years of ethnographic field research among the Navajos, this book explores a controversial Native American ritual and healthcare practice: ceremonial consumption of the psychedelic Peyote cactus in the context of an indigenous postcolonial healing movement called the Native American Church (NAC), which arose in the 19th century in response to the creation of the reservations system and increasing societal ills, including alcoholism. The movement is the locus of cultural conflict with a long history in North America, and stirs very strong and often opposed emotions and moral interpretations. Joseph Calabrese describes the Peyote Ceremony as it is used in family contexts and federally funded clinical programs for Native American patients. He uses an interdisciplinary methodology that he calls clinical ethnography: an approach to research that involves clinically informed and self-reflective immersion in local worlds of suffe