Implementing integrated services for people with epilepsy in primary care in Ethiopia: a qualitative study
Abstract Background In order to tackle the considerable treatment gap for epilepsy in many low- and middle-income countries (LMICs), a task sharing model is recommended whereby care is integrated into primary health services. However, there are limited data on implementation and impact of such servi...
Main Authors: | , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
BMC
2018-05-01
|
Series: | BMC Health Services Research |
Subjects: | |
Online Access: | http://link.springer.com/article/10.1186/s12913-018-3190-y |
id |
doaj-98df9d7eb2c54b988b968c3f47bc2b92 |
---|---|
record_format |
Article |
spelling |
doaj-98df9d7eb2c54b988b968c3f47bc2b922020-11-24T21:15:54ZengBMCBMC Health Services Research1472-69632018-05-0118111310.1186/s12913-018-3190-yImplementing integrated services for people with epilepsy in primary care in Ethiopia: a qualitative studyRaquel Catalao0Tigist Eshetu1Ruth Tsigebrhan2Girmay Medhin3Abebaw Fekadu4Charlotte Hanlon5Camden and Islington NHS Foundation TrustAddis Ababa University, College of Health Sciences, School of Medicine, Department of PsychiatryAddis Ababa University, College of Health Sciences, School of Medicine, Department of PsychiatryAddis Ababa University, Aklilu-Lemma Institute of PathobiologyKing’s College London, Institute of Psychiatry, Psychology and Neuroscience, Health Service and Population Research Department, Centre for Global Mental HealthKing’s College London, Institute of Psychiatry, Psychology and Neuroscience, Health Service and Population Research Department, Centre for Global Mental HealthAbstract Background In order to tackle the considerable treatment gap for epilepsy in many low- and middle-income countries (LMICs), a task sharing model is recommended whereby care is integrated into primary health services. However, there are limited data on implementation and impact of such services in LMICs. Our study aimed to explore the perspectives of service users and caregivers on the accessibility, experience and perceived impact of epilepsy treatment received in a task-shared model in a rural district of Ethiopia. Methods A qualitative study was carried out using interviews with purposively sampled service users (n = 13) and caregivers (n = 3) from a community-ascertained cohort of people with epilepsy receiving integrated services in primary care in rural Ethiopia. Interviews followed a topic guide with questions regarding acceptability, satisfaction, barriers to access care, pathways through care and impact of services. Framework analysis was employed to analyse the data. Results Proximity of the new service in local primary health centers decreased the cost of transportation for the majority of service users thus improving access to services. First-hand experience of services was in some cases associated with a willingness to promote the services and inform others of the existence of effective biomedical treatment for epilepsy. However, most service users and their caregivers continued to seek help from traditional healers alongside biomedical care. Most of the care received was focused on medication provision with limited information provided on how to manage their illness and its effects. Caregivers and service users spoke about the high emotional and financial burden of the disease and lack of ongoing practical and emotional support. The majority of participants reported clinical improvement on medication, which in over half of the participants was associated with ability to return to money generating activities. Conclusions Task-sharing improved the accessibility of epilepsy care for services users and caregivers and was perceived as having a positive impact on symptoms and productivity. Nonetheless, promotion of self-management, holistic care and family engagement were highlighted as areas requiring further improvement. Future work on implementing chronic care models in LMIC contexts is warranted.http://link.springer.com/article/10.1186/s12913-018-3190-yEpilepsyImplementationTask-sharingPrimary health servicesCommunity health caremhGAP |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Raquel Catalao Tigist Eshetu Ruth Tsigebrhan Girmay Medhin Abebaw Fekadu Charlotte Hanlon |
spellingShingle |
Raquel Catalao Tigist Eshetu Ruth Tsigebrhan Girmay Medhin Abebaw Fekadu Charlotte Hanlon Implementing integrated services for people with epilepsy in primary care in Ethiopia: a qualitative study BMC Health Services Research Epilepsy Implementation Task-sharing Primary health services Community health care mhGAP |
author_facet |
Raquel Catalao Tigist Eshetu Ruth Tsigebrhan Girmay Medhin Abebaw Fekadu Charlotte Hanlon |
author_sort |
Raquel Catalao |
title |
Implementing integrated services for people with epilepsy in primary care in Ethiopia: a qualitative study |
title_short |
Implementing integrated services for people with epilepsy in primary care in Ethiopia: a qualitative study |
title_full |
Implementing integrated services for people with epilepsy in primary care in Ethiopia: a qualitative study |
title_fullStr |
Implementing integrated services for people with epilepsy in primary care in Ethiopia: a qualitative study |
title_full_unstemmed |
Implementing integrated services for people with epilepsy in primary care in Ethiopia: a qualitative study |
title_sort |
implementing integrated services for people with epilepsy in primary care in ethiopia: a qualitative study |
publisher |
BMC |
series |
BMC Health Services Research |
issn |
1472-6963 |
publishDate |
2018-05-01 |
description |
Abstract Background In order to tackle the considerable treatment gap for epilepsy in many low- and middle-income countries (LMICs), a task sharing model is recommended whereby care is integrated into primary health services. However, there are limited data on implementation and impact of such services in LMICs. Our study aimed to explore the perspectives of service users and caregivers on the accessibility, experience and perceived impact of epilepsy treatment received in a task-shared model in a rural district of Ethiopia. Methods A qualitative study was carried out using interviews with purposively sampled service users (n = 13) and caregivers (n = 3) from a community-ascertained cohort of people with epilepsy receiving integrated services in primary care in rural Ethiopia. Interviews followed a topic guide with questions regarding acceptability, satisfaction, barriers to access care, pathways through care and impact of services. Framework analysis was employed to analyse the data. Results Proximity of the new service in local primary health centers decreased the cost of transportation for the majority of service users thus improving access to services. First-hand experience of services was in some cases associated with a willingness to promote the services and inform others of the existence of effective biomedical treatment for epilepsy. However, most service users and their caregivers continued to seek help from traditional healers alongside biomedical care. Most of the care received was focused on medication provision with limited information provided on how to manage their illness and its effects. Caregivers and service users spoke about the high emotional and financial burden of the disease and lack of ongoing practical and emotional support. The majority of participants reported clinical improvement on medication, which in over half of the participants was associated with ability to return to money generating activities. Conclusions Task-sharing improved the accessibility of epilepsy care for services users and caregivers and was perceived as having a positive impact on symptoms and productivity. Nonetheless, promotion of self-management, holistic care and family engagement were highlighted as areas requiring further improvement. Future work on implementing chronic care models in LMIC contexts is warranted. |
topic |
Epilepsy Implementation Task-sharing Primary health services Community health care mhGAP |
url |
http://link.springer.com/article/10.1186/s12913-018-3190-y |
work_keys_str_mv |
AT raquelcatalao implementingintegratedservicesforpeoplewithepilepsyinprimarycareinethiopiaaqualitativestudy AT tigisteshetu implementingintegratedservicesforpeoplewithepilepsyinprimarycareinethiopiaaqualitativestudy AT ruthtsigebrhan implementingintegratedservicesforpeoplewithepilepsyinprimarycareinethiopiaaqualitativestudy AT girmaymedhin implementingintegratedservicesforpeoplewithepilepsyinprimarycareinethiopiaaqualitativestudy AT abebawfekadu implementingintegratedservicesforpeoplewithepilepsyinprimarycareinethiopiaaqualitativestudy AT charlottehanlon implementingintegratedservicesforpeoplewithepilepsyinprimarycareinethiopiaaqualitativestudy |
_version_ |
1716744188407578624 |