Improving adherence in mental health service users with severe mental illness in South Africa: a pilot randomized controlled trial of a treatment partner and text message intervention vs. treatment as usual

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Abstract

Objectives

Medication non-adherence is a significant problem in treatment of severe mental disorders and is associated with poor clinical outcomes and increased demand on services. Task-shifting interventions incorporating mobile health may improve adherence in mental health service users in low- and middle-income countries. Seventy-seven participants were recruited from a psychiatric hospital in Cape Town, with 42 randomized to receive the intervention and 35 to treatment as usual. Intervention pairs underwent treatment-partner contracting and psychoeducation, and received monthly text message reminders of clinic appointments. Primary outcomes were intervention acceptability and feasibility. Secondary outcome for efficacy were adherence to clinic visit; relapse; quality of life; symptomatic relief and medication adherence.

Results

Treatment partner and psychoeducation components were acceptable and feasible. The text message component was acceptable but not feasible in its current form. Efficacy outcomes favoured the intervention but did not reach statistical significance. A treatment-partner intervention is acceptable and feasible in a low- and middle-income setting. Work is needed to ensure that additional components of such interventions are tailored to the local context. Appropriately powered efficacy studies are needed.

Trial Registration PACTR PACTR201610001830190, Registered 21 October 2016 (Retrospectively registered)

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The online version of this article (10.1186/s13104-017-2915-z) contains supplementary material, which is available to authorized users.

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Most cited references 26

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The future of psychiatry in low- and middle-income countries.

Kushang V. Patel (2009)

The great shortage, and inequitable distribution, of psychiatrists in low- and middle-income countries is one of the key reasons for the large treatment gap for people with mental disorders. Psychiatrists need to play a public mental health leadership role in increasing the coverage of mental health care through task shifting of effective interventions to non-specialist health workers. Psychiatrists' new roles should include designing and managing such programmes, building clinical capacity, supervision and quality assurance, providing referral pathways and research.

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Psychoeducation for schizophrenia.

Madhvi Belgamwar, L Merinder, Jun-Jie Xia (2010)

Schizophrenia can be a severe and chronic illness characterised by lack of insight and poor compliance with treatment. Psychoeducational approaches have been developed to increase patients' knowledge of, and insight into, their illness and its treatment. It is supposed that this increased knowledge and insight will enable people with schizophrenia to cope in a more effective way with their illness, thereby improving prognosis. To assess the effects of psychoeducational interventions compared with standard levels of knowledge provision. We searched the Cochrane Schizophrenia Group Trials Register (February 2010). All relevant randomised controlled trials focusing on psychoeducation for schizophrenia and/or related serious mental illnesses involving individuals or groups. We excluded quasi-randomised trials. At least two review authors extracted data independently from included papers. We contacted authors of trials for additional and missing data. We calculated risk ratios (RR) and 95% confidence intervals (CI) of homogeneous dichotomous data. We used a fixed-effects model for heterogeneous dichotomous data. Where possible we also calculated the numbers needed to treat (NNT), as well as weighted means for continuous data. This review includes a total of 5142 participants (mostly inpatients) from 44 trials conducted between 1988 and 2009 (median study duration ˜ 12 weeks, risk of bias - moderate). We found that incidences of non-compliance were lower in the psychoeducation group in the short term (n = 1400, RR 0.52 CI 0.40 to 0.67, NNT 11 CI 9 to 16). This finding holds for the medium and long term. Relapse appeared to be lower in psychoeducation group (n = 1214, RR 0.70 CI 0.61 to 0.81, NNT 9 CI 7 to 14) and this also applied to readmission (n = 206, RR 0.71 CI 0.56 to 0.89, NNT 5 CI 4 to 13). Scale-derived data also suggested that psychoeducation promotes better social and global functioning. In the medium term, treating four people with schizophrenia with psychoeducation instead of standard care resulted in one additional person showing a clinical improvement. Evidence suggests that participants receiving psychoeducation are more likely to be satisfied with mental health services (n = 236, RR 0.24 CI 0.12 to 0.50, NNT 5 CI 5 to 8) and have improved quality of life. Psychoeducation does seem to reduce relapse, readmission and encourage medication compliance, as well as reduce the length of hospital stay in these hospital-based studies of limited quality. The true size of effect is likely to be less than demonstrated in this review - but, nevertheless, some sort of psychoeducation could be clinically effective and potentially cost beneficial. It is not difficult to justify better, more applicable, research in this area aimed at fully investigating the effects of this promising approach.

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Is Open Access

Point of care in your pocket: a research agenda for the field of m-health

Alastair van Heerden, Mark Tomlinson, Leslie Swartz (2012)

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Author and article information

Contributors

Goodman Sibeko:

ORCID: http://orcid.org/0000-0002-7242-0878

goodmansibeko@gmail.com

Henk Temmingh: henk.temmingh@uct.ac.za

Sumaya Mall: sumaya.mall@gmail.com

Peter Williams-Ashman: peterwilliamsashman@gmail.com

Graham Thornicroft: graham.thornicroft@kcl.ac.uk

Ezra S. Susser: ess8@cumc.columbia.edu

Crick Lund: crick.lund@uct.ac.za

Dan J. Stein: dan.stein@uct.ac.za

Peter D. Milligan: Peter.Milligan@westerncape.gov.za

Journal

Journal ID (nlm-ta): BMC Res Notes

Journal ID (iso-abbrev): BMC Res Notes

Title: BMC Research Notes

Publisher: BioMed Central (London )

ISSN (Electronic): 1756-0500

Publication date (Electronic): 9 November 2017

Publication date PMC-release: 9 November 2017

Publication date Collection: 2017

Volume: 10

Electronic Location Identifier: 584

Affiliations

[1 ]ISNI 0000 0004 1937 1151, GRID grid.7836.a, Department of Psychiatry and Mental Health, , University of Cape Town, ; Cape Town, South Africa

[2 ]ISNI 0000 0001 2322 6764, GRID grid.13097.3c, Institute of Psychiatry Psychology and Neuroscience, King’s College London, ; London, UK

[3 ]Columbia University Mailman School of Public Health, New York State Psychiatric Institute, New York, USA

Author information

Goodman Sibeko http://orcid.org/0000-0002-7242-0878

Article

Publisher ID: 2915

DOI: 10.1186/s13104-017-2915-z

PMC ID: 5679373

PubMed ID: 29121999

SO-VID: 2029b89b-2b88-41fe-80ac-d4c3478ec78f

License:

Open AccessThis 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 : 11 August 2017

Date accepted : 3 November 2017

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ScienceOpen disciplines: Medicine

Keywords: mental health,task-shifting,treatment partner,adherence,text message,mobile health

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ScienceOpen disciplines: Medicine

Keywords: mental health, task-shifting, treatment partner, adherence, text message, mobile health

Improving adherence in mental health service users with severe mental illness in South Africa: a pilot randomized controlled trial of a treatment partner and text message intervention vs. treatment as usual

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Abstract

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Special series on COVID-19 and Mental Health

Most cited references 26

The future of psychiatry in low- and middle-income countries.

Psychoeducation for schizophrenia.

Point of care in your pocket: a research agenda for the field of m-health

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