Exploring mental health practice among Traditional health practitioners: a qualitative study in rural Kenya

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Abstract

Background

Involvement of traditional health practitioners (THPs) in the form of collaboration with the formal health care system is suggested to improve the pathways to mental health care in Kenya, yet understanding of the current traditional practice and THPs’ perspectives is lacking. The aim of this study was to explore the views of THPs with respect to their mental health practice.

Methods

This study qualitatively explored the views of THPs, using four focus group discussions (FDGs) each consisting of 8–10 traditional and faith healers, resulting in a total of 36 participants. Thematic content analysis using a grounded theory approach was performed using QSR NVivo 10. Emerging topics were identified and examined by re-reading the transcripts several times and constantly re-sorting the material.

Results

Four themes that reflect THPs’ mental health practice perspectives emerged as follows: 1) Categorization of mental illness; 2) Diagnostics in traditional mental health practice; 3) Treatments and challenges in current traditional mental health practice; and 4) Solutions to improve traditional mental health practice.

Conclusions

These themes provide insight into the perspectives of Kenyan traditional and faith healers on their mental health practice, in an attempt to offer a meaningful contribution to the debate on collaboration between informal and formal health care providers in improving mental health services in Kenya. Furthermore, the presented challenges and solutions can inform policy makers in their task to improve and scale up mental health services in resource-poor areas in Kenya. Addressing these issues would be a first step towards understanding the solid foundation of traditional medicine that is necessary before collaboration can be successfully attempted. Further research is also recommended to assess patients’ needs and explore potential forms of collaboration, in order to achieve sustainable improvement in the mental health care pathways for patients.

Electronic supplementary material

The online version of this article (10.1186/s12906-018-2393-4) contains supplementary material, which is available to authorized users.

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Most cited references 33

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Culture, illness, and care: clinical lessons from anthropologic and cross-cultural research.

A. Kleinman, L. Eisenberg, B. Good (1978)

Major health care problems such as patient dissatisfaction, inequity of access to care, and spiraling costs no longer seem amenable to traditional biomedical solutions. Concepts derived from anthropologic and cross-cultural research may provide an alternative framework for identifying issues that require resolution. A limited set of such concepts is described as illustrated, including a fundamental distinction between disease and illness, and the notion of the cultural construction of clinical reality. These social science concepts can be developed into clinical strategies with direct application in practice and teaching. One such strategy is outlined as an example of a clinical social science capable of translating concepts from cultural anthropology into clinical language for practical application. The implementation of this approach in medical teaching and practice requires more support, both curricular and financial.

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The role of global traditional and complementary systems of medicine in the treatment of mental health disorders

Oye Gureje, Gareth Nortje, Victor Makanjuola … (2015)

Traditional and complementary systems of medicine include a broad range of practices, which are commonly embedded in cultural milieus and reflect community beliefs, experiences, religion, and spirituality. Two major components of this system are discernible: complementary alternative medicine and traditional medicine, with different clientele and correlates of patronage. Evidence from around the world suggests that a traditional or complementary system of medicine is commonly used by a large number of people with mental illness. Practitioners of traditional medicine in low-income and middle-income countries fill a major gap in mental health service delivery. Although some overlap exists in the diagnostic approaches of traditional and complementary systems of medicine and conventional biomedicine, some major differences exist, largely in the understanding of the nature and cause of mental disorders. Treatments used by providers of traditional and complementary systems of medicine, especially traditional and faith healers in low-income and middle-income countries, might sometimes fail to meet widespread understandings of human rights and humane care. Nevertheless, collaborative engagement between traditional and complementary systems of medicine and conventional biomedicine might be possible in the care of people with mental illness. The best model to bring about that collaboration will need to be established by the needs of the extant mental health system in a country. Research is needed to provide an empirical basis for the feasibility of such collaboration, to clearly delineate its boundaries, and to test its effectiveness in bringing about improved patient outcomes.

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'Whether you like it or not people with mental problems are going to go to them': a qualitative exploration into the widespread use of traditional and faith healers in the provision of mental health care in Ghana.

Kenneth Ae-Ngibise, Sara Cooper, Edward Adiibokah … (2010)

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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Author and article information

Contributors

Christine W. Musyimi: christine.musyimi@amhf.or.ke

Victoria N. Mutiso: vmutiso@amhf.or.ke

Lianne Loeffen: lianneloeffen@hotmail.com

Anja Krumeich: a.krumeich@maastrichtuniversity.nl

David M. Ndetei: +254-020-2716315 , +254-020-2651360 , dmndetei@amhf.or.ke

Journal

Journal ID (nlm-ta): BMC Complement Altern Med

Journal ID (iso-abbrev): BMC Complement Altern Med

Title: BMC Complementary and Alternative Medicine

Publisher: BioMed Central (London )

ISSN (Electronic): 1472-6882

Publication date (Electronic): 14 December 2018

Publication date PMC-release: 14 December 2018

Publication date Collection: 2018

Volume: 18

Electronic Location Identifier: 334

Affiliations

[1 ]ISNI 0000 0001 2019 0495, GRID grid.10604.33, Africa Mental Health Foundation and Department of Psychiatry, , University of Nairobi, ; Mawensi Road, Off Elgon road, Mawensi Garden, P.O. BOX 48423-00100, Nairobi, Kenya

[2 ]ISNI 0000 0004 1754 9227, GRID grid.12380.38, Vrije Universiteit, ; 1081 HV Amsterdam, Netherlands

[3 ]ISNI 0000 0001 0481 6099, GRID grid.5012.6, Maastricht University, ; P.O. Box 616, 6200 MD Maastricht, Netherlands

[4 ]ISNI 0000 0001 2019 0495, GRID grid.10604.33, University of Nairobi, ; P. O. Box 30197 00100, Nairobi, Kenya

Article

Publisher ID: 2393

DOI: 10.1186/s12906-018-2393-4

PMC ID: 6295025

PubMed ID: 30547778

SO-VID: 0200a96a-145d-4015-aaf9-036c60611cbf

License:

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 6 June 2017

Date accepted : 28 November 2018

Funding

Funded by: Grand Challenges Canada (GCC)

Award ID: (grant number S5_0415-01)

Award Recipient : Christine W. Musyimi

Custom metadata

ScienceOpen disciplines: Complementary & Alternative medicine

Keywords: traditional health practitioners,traditional medicine,mental health,rural,kenya

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ScienceOpen disciplines: Complementary & Alternative medicine

Keywords: traditional health practitioners, traditional medicine, mental health, rural, kenya

Exploring mental health practice among Traditional health practitioners: a qualitative study in rural Kenya

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The International Journal of Person Centered Medicine

Most cited references 33

Culture, illness, and care: clinical lessons from anthropologic and cross-cultural research.

The role of global traditional and complementary systems of medicine in the treatment of mental health disorders

'Whether you like it or not people with mental problems are going to go to them': a qualitative exploration into the widespread use of traditional and faith healers in the provision of mental health care in Ghana.

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