Browsing by Author "Brayne, Carol"

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    Perceived causes of mental illness and views on appropriate care pathways among Indonesians
    (BioMed Central, 2021-09-23) Anjara, Sabrina Gabrielle; Brayne, Carol; Van Bortel, Tine
    Background The mental health system in Indonesia comprises attempts to modernise a colonial relic. There is still a disconnect between available services and help-seeking behaviours at the grassroots level. This study aims to explore the perceptions of Javanese people on the aetiology of mental illness and their ideas on how to deal with individuals who may have mental illness. Methods This qualitative study involves semi-structured interviews, embedded in a cluster randomised trial examining the clinical and cost-effectiveness of primary mental health services. Interviews were conducted with Indonesian and Javanese. The recruitment procedure was aligned to the trial. Participants were primary care patients recruited from 21 sites across Yogyakarta province. Interviews were recorded, transcribed, and translated into English. Thematic analysis was used to analyse the interview transcripts. Results 75 participants took part in the study: 51 women (68%) and 24 men (32%). Key themes emerged around perceived causes of mental health problems (including ‘extrinsic factors’; ‘intrinsic factors’; and ‘spiritual factors’), and perceived appropriate pathways of care (‘modern medical science’; ‘social support and activities’; and ‘religious or spiritual interventions’). Gender potentially influenced some of the responses. Conclusions Themes indicate the variety of preconceptions towards mental health problems and assumptions regarding the best management pathways. Some of these preconceptions and assumptions support the utility of modern medical care, while the rest promote spiritual or religious healers. Participants’ ideas of the appropriate care pathways largely correspond to their perception of what the symptoms are caused by. Despite hints to some understanding of the bio-psycho-social model of mental illness, most participants did not capture the complexity of mental health and illness, indicating the importance of contextual (especially culturally and religiously-aligned) public education around mental health, illness and care.
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    “Sickness has no time”: Awareness and perceptions of health care workers on universal health coverage in Uganda
    (PLOS, 2024-07-18) Ifeagwu, Susan C.; Nakaboga Kikonyogo, Ruth; Nakkazi, Suzan; Beinomugisha, Joshua; Ojiambo Wandera, Stephen; Kiwanuka, Suzanne N.; King, Rachel; Bortel, Tine Van; Brayne, Carol; Parkes-Ratanshi, Rosalind; Patrick Christian Ilboudo
    Introduction Each person having access to needed health services, of sufficient quality, and without suffering financial hardship, defined as universal health coverage (UHC) by the World Health Organization, is critical to improve population health, particularly for vulnerable populations. UHC requires multisectoral collaboration and good governance, and this will require buy-in of key stakeholders; but their views are under-documented. The aim of this stakeholder analysis was to explore the awareness and perceptions of UHC by health care workers (HCWs) in Uganda. Methods A mixed-methods study was conducted based on primary data from HCWs including an online QualtricsXM survey of 274 HCWs (from a database of persons who had received training at an academic institution), 23 key informant semi-structured interviews, and one eight-person focus group discussion. Data was collected from February to April 2022. Microsoft Excel and R Programme were used for quantitative analyses and NVivo version 12 for qualitative analyses. Results HCWs attributed a high level of importance to UHC in Uganda. Participants discussed national communication and management practices, organisational roles, health financing and power dynamics, health care demand and the impact of and learnings from COVID-19. Four main themes–each with related sub-themes–emerged from the interview data providing insights into: (1) communication, (2) organisation, (3) power, and (4) trust. Conclusion There is a critical need for better communication of UHC targets by policymakers to improve understanding at a grassroots level. Results indicated that ensuring trust among the population through transparency in metrics and budgets, strong accountability measures, awareness of local cultural sensitivities, sensitisation of the UHC concept and community inclusion will be essential for a multisectoral roll out of UHC. Further provision of quality health services, a harmonisation of efforts, increased domestic health financing and investment of HCWs through fair remuneration will need to underpin the delivery of UHC.