BJPsych Open (Sep 2022)

Perceived sustainability of psychosocial treatment in low- and middle-income countries in South-Eastern Europe

  • Emina Ribic,
  • Hana Sikira,
  • Alma Dzubur Kulenovic,
  • Tamara Pemovska,
  • Manuela Russo,
  • Nikolina Jovanovic,
  • Tamara Radojicic,
  • Selman Repisti,
  • Miloš Milutinović,
  • Biljana Blazevska,
  • Jon Konjufca,
  • Fjolla Ramadani,
  • Stefan Jerotic,
  • Bojana Savic

DOI
https://doi.org/10.1192/bjo.2022.539
Journal volume & issue
Vol. 8

Abstract

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Background DIALOG+ is an evidence-based, generic, cost-saving and easily deliverable psychosocial intervention, adaptable to clinicians’ personal manner of interaction with patients. It was implemented in mental health services in five low- and middle-income countries in South-Eastern Europe during a 12-month randomised-controlled trial (IMPULSE) to improve the effectiveness of out-patient treatment for people with psychotic disorders. Aims To investigate barriers and facilitators to the perceived sustainability of DIALOG+ that has been successfully implemented as a part of the IMPULSE project. Method Three months after the IMPULSE trial's end, perceived sustainability of the DIALOG+ intervention was assessed via a short survey of clinicians and patients who took part in the trial. Quantitative data collected from the survey were analysed using descriptive statistics; content analysis assessed qualitative survey data. The views and experiences of key informants (patients, clinicians and healthcare policy influencers) regarding the sustainability and scale-up of DIALOG+ were further explored through semi-structured interviews. These data were explored using framework analysis. Results Clinicians mostly appreciated the comprehensiveness of DIALOG+, and patients described DIALOG+ meetings as empowering and motivating. The barrier most commonly identified by key informants was availability of financial resources; the most important facilitators were the clinically relevant structure and comprehensiveness of the DIALOG+ intervention. Conclusions Participants showed a willingness to sustain the implementation of DIALOG+. It is important to maintain collaboration with healthcare policy influencers to improve implementation of DIALOG+ across different levels of healthcare systems and ensure availability of resources for implementing psychosocial interventions such as DIALOG+.

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