WHO Collaborating Centre for Mental Health Research and Capacity Building, Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Ethiopia; and School of Nursing and Midwifery, College of Health Sciences and Medicine, Haramaya University, Ethiopia
WHO Collaborating Centre for Mental Health Research and Capacity Building, Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Ethiopia; Centre for Innovative Drug Development and Therapeutic Studies for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Ethiopia; and Centre for Global Mental Health, Department of Health Services and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
Lauren Ng
Department of Psychology, University of California, Los Angeles, USA
King's Global Health Institute, Department of Global Health and Social Medicine, King's College London, UK
Sisay Abayneh
WHO Collaborating Centre for Mental Health Research and Capacity Building, Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Ethiopia
Abebaw Fekadu
WHO Collaborating Centre for Mental Health Research and Capacity Building, Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Ethiopia; Centre for Innovative Drug Development and Therapeutic Studies for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Ethiopia; Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, UK; and Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
Background Evidence from high- and middle-income countries indicates that psychological interventions (PSIs) can improve the well-being of people with bipolar disorder. However, there is no evidence from low-income countries. Cultural and contextual adaptation is recommended to ensure that PSIs are feasible and acceptable when transferred to new settings, and to maximise effectiveness. Aims To develop a manualised PSI for people with bipolar disorder in rural Ethiopia. Method We used the Medical Research Council framework for the development and evaluation of complex interventions and integrated a participatory theory-of-change (ToC) approach. We conducted a mental health expert workshop (n = 12), four independent ToC workshops and a final workshop with all participants. The four independent ToC workshops comprised people with bipolar disorder and caregivers (n = 19), male community leaders (n = 8), female community leaders (n = 11) and primary care workers (n = 21). Results During the workshops, participants collaborated on the development of a ToC roadmap to achieve the shared goal of improved quality of life and reduced family burden for people with bipolar disorder. The developed PSI had five sessions: needs assessment and goal-setting; psychoeducation about bipolar disorder and its causes; treatment; promotion of well-being, including sleep hygiene and problem-solving techniques; and behavioural techniques to reduce anxiety and prevent relapse. Participants suggested that the intervention sessions be linked with patients’ monthly scheduled healthcare follow-ups, to reduce economic barriers to access. Conclusions We developed a contextually appropriate PSI for people with bipolar disorder in rural Ethiopia. This intervention will now be piloted for feasibility and acceptability before its wider implementation.
