S Chidarikire

Treatments for people living with schizophrenia in Sub-Saharan Africa: an adapted realist review

AIM To identify the treatments and interventions available and their impact on people living with schizophrenia in Sub-Saharan Africa. BACKGROUND Help-seeking behaviour and the choice of treatment are largely influenced by socio-cultural factors and beliefs about the causes of mental illness. This review addresses the gap in knowledge regarding the treatment options available to people living with schizophrenia in Sub-Saharan Africa. DESIGN Adapted realist literature review. DATA SOURCES Electronic databases searched in June 2016 included PubMed, EMBASE, PsycINFO, ProQuest and CINAHL. REVIEW METHODS The adapted realist review approach used to synthesize the published research involved identifying the review aim, searching and selecting relevant studies, extracting, iteratively analysing and synthesizing relevant data and reporting results. RESULTS Forty studies from eight countries were reviewed. Most people were treated by both faith/traditional healers and modern psychiatry. Common treatments included antipsychotics, electroconvulsive therapy and psychosocial interventions. Few treatment options were available outside major centres, there was poor adherence to medication and families reported a high level of burden associated with caring for a relative. LIMITATIONS Major limitations of this review were the lack of studies, variable quality and low level of evidence available from most countries from Sub-Saharan Africa and lack of generalizability. CONCLUSION People living with schizophrenia in Sub-Saharan Africa were treated by faith, traditional healers and modern psychiatry, if at all. Further research is needed to better understand the local situation and the implications for caring for people from this region. IMPLICATIONS FOR NURSING AND HEALTH POLICY Mental health services in Sub-Saharan Africa are limited by fiscal shortages, lack of mental health services and qualified mental health professionals. This review provides evidence to inform nursing and healthcare policy, including recruiting and training mental health professionals and ensuring access to evidence-based, person-centred and culturally relevant mental health services within the primary care context.

Navigating Nuances of Language and Meaning: Challenges of Cross-Language Ethnography Involving Shona Speakers Living With Schizophrenia:

For people living with schizophrenia, their experience is personal and culturally bound. Focused ethnography enables researchers to understand people’s experiences in-context, a prerequisite to providing person-centered care. Data are gathered through observational fieldwork and in-depth interviews with cultural informants. Regardless of the culture, ethnographic research involves resolving issues of language, communication, and meaning. This article discusses the challenges faced by a bilingual, primary mental health nurse researcher when investigating the experiences of people living with schizophrenia in Zimbabwe. Bilingual understanding influenced the research questions, translation of a validated survey instrument and interview transcripts, analysis of the nuances of dialect and local idioms, and confirmation of cultural understanding. When the researcher is a bilingual cultural insider, the insights gained can be more nuanced and culturally enriched. In cross-language research, translation issues are especially challenging when it involves people with a mental illness and requires researcher experience, ethical sensitivity, and cultural awareness.

A phenomenological study into the role of spirituality and religiousness in the mental health of people with cancer in Zimbabwe

ABSTRACT This study examines the role of spirituality in illness management and mental health of selected people with cancer in Harare, Zimbabwe. The study inspects religiosity and spiritual elements among people with cancer. Narratives of women and men with cancer situated on different body sites was gathered using qualitative methodology. Data is analyzed using interpretive phenomenological analysis. Results indicate the central role of spiritual well-being and spirituality among people with cancer. Crucially, owing to scarcity and low uptake of institutionalized services, churches become essential conduits to cater for the spiritual well-being of people with cancer in resource constrained settings like Zimbabwe.

An ethnographic study of schizophrenia in Zimbabwe: The role of culture, faith, and religion

ABSTRACT This ethnographic study explored the experiences of eighteen Shona speakers living with schizophrenia in Zimbabwe. Data were collected using semistructured interviews, observations and field notes. Almost three in four participants reported having a strong religious affiliation and believed mental illnesses are caused by spirits (zvirwere zvemweya) or witchcraft (zvirwere zvevaroyi). Cultural and religious beliefs influenced the perceived causes of schizophrenia, symptom explanations, and help-seeking behavior. Schizophrenia compounded social disadvantage, often leading to family disruption, isolation, homelessness, and wandering. Faith and religious belonging provided participants access to support and fostered hope, resilience, a sense of self-worth and greater quality of life.