Changes in mental health stigma among healthcare professionals and community representatives in Northern Sri Lanka during an mhGAP intervention study

Purpose: Research indicates that exposure to conflict, natural disasters, and internal displacement can increase mental health conditions. Since the end of the civil conflict within Sri Lanka, the country has worked to increase access to mental health services to meet the needs of conflict-affected populations, however, gaps remain. To address this, integration of mental health services into primary care can reduce the strain on growing specialized care. As part of a larger study primary care practitioners (doctors), public health professionals (nurses, midwives), and community representatives (teachers, social workers) were trained to deliver mental health services in primary care across the heavily impacted Northern Province. The aim was to reduce mental health stigma among enrolled healthcare workers and community representatives by 50%. Methods: Stigma was measured across all participant groups at six time points: pre- and post- initial training at baseline, pre- and post- refresher training 3-months after initial training, and pre- and post- refresher training 6-months after initial training. Results Results indicate a small improvement in average stigma scores at the 6-month refresher point for primary care practitioners, and no meaningful difference in average scores across time points for public health professionals or community representatives. Conclusion: World Health Organization mhGAP training appears to reduce stigma among primary care practitioners and could be an effective strategy to counteract mental health stigma in low resource settings. Future research should investigate underlying mechanisms of stigma reduction to improve delivery of mental health services in primary care and community settings..</p

Research and Health Care provision with trafficked populations: understanding ethical complexities and mitigation strategies

Dangerous migration pathways, such as human trafficking, increase as legal options for migration become scarce. Human trafficking carries high risk of negative health outcomes for those exploited and research is vital to understand risks and outcomes to inform public health responses. Currently, there is no ethics guidance for health research/provision with trafficked populations. The aim of this thesis was to understand ethical complexities and mitigation strategies involved in research and health care provision with trafficked populations. The objectives of this thesis were 1) conduct a systematic review of associated health consequences of human trafficking, 2) conduct a qualitative review of ethical complexities inherent in human trafficking research, 3) utilize data collected from fifteen in-depth interviews with researchers (9) and health care providers (6) to investigate identification and interpretation of ethical challenges, and 4) make recommendations regarding application of findings to future research. Constructivism was used to reconstruct identification and interpretation of ethical challenges from the viewpoint of researchers and health care providers. Qualitative Content Analysis was used for analysis. Six main categories of themes emerged from conducted interviews: evidence generation, equality and fairness, research procedures, autonomy, harmful practice, and environment. Emergent themes were temporally bound to stages of research and health care provision. An architectural blueprint of a house was used to visualize the research process and health care interactions. Health research with trafficked populations carries multiple ethical challenges at all stages of research and health care provision. Human trafficking is a complex phenomenon influenced by multiple external factors that complicate ethical challenges. Understanding how researchers and health care providers identify and interpret ethical challenges, along with examples of mitigation strategies will allow health research to be conducted to a high ethical standard, and enable development of a valid and reliable evidence base that can inform needed public health responses

Integrated care systems in England: the significance of collaborative community assets in promoting and sustaining health and wellbeing

Until recently the healthcare system in England was based on a commissioning/provider model. However, this has been replaced with an Integrated Care Systems (ICSs) approach, aimed at improving health and wellbeing and reducing inequalities through local collaborative partnerships with public sector organizations, community groups, social enterprise organizations and other local agencies. Part of this new approach is an emphasis on the role of community assets (i.e., local resources), that are considered integral to promoting positive health and wellbeing outcomes. This paper presents research from a series of three research studies on “community assets” conducted in the East of England within a newly established ICS. Based on analysis of qualitative data highlighting the lived experience of community asset members, this paper shows the positive wellbeing impact on vulnerable community members that assets provide. Further insight on the local impact and the collaborative nature of the research is provided suggesting that new asset-based approaches recognize the social determinants of health. This presents a shift away from positivistic linear approaches to population health and wellbeing to a new non-linear collaborative approach to addressing health inequalities and promoting wellbeing. The authors suggest that exploring this through a complexity theory lens could illuminate this further. Finally, the authors warn that while community assets have an important role to play in empowering citizens and providing much needed support to vulnerable and disadvantaged communities, they are not a substitute for functioning funded public sector services that are currently being undermined by ongoing local governments funding cuts. As such, while community assets can help ameliorate some of the negative effects people experience due to economic, structural and health disadvantages, only a more fair and more equal distribution of resources can address growing health inequalities</p

The impact of engaging with community groups: asset-based approaches and the lived experience of socially vulnerable populations in the UK

IntroductionAsset-based approaches to improve citizen wellbeing and address inequalities are now being adopted by public health practitioners. There is some evidence that participatory approaches and the promotion of community assets have the capacity to mitigate against the social determinants that generate health disparities. However, questions remain about how they work in practice. This paper reports on research carried out to provide insight into how a diverse range of community assets support (or not) the wellbeing of vulnerable citizens and to provide an improved understanding of people's lived experiences including the challenges of citizens who belong to community assets face. Two subsequent studies were undertaken in a region of England comprising of two neighboring municipalities where health inequalities are stark. Both municipalities contain within them areas of social deprivation. The initial study was completed in March 2020, 1 week before England's first COVID-19 lockdown restrictions were introduced and the subsequent study was conducted to explore the impact of social restrictions on the community assets forum members.MethodsA combined phenomenological and ethnographic methodological approach was adopted for both studies. For the initial study ethnographic methods were used including 42 qualitative face-to-face interviews focusing on the lived experience of participants. Observations, informal conversations, photographs, and field notes were also carried out to allow researchers to become familiar with the setting, to build rapport and trust provide a contextual understanding of the relationship between the activity or place and participants' experiences of wellbeing. For the subsequent study thirty-six interviews (including interviews with community assets leaders) were conducted online or by phone due to COVID-19 social restrictions.Results and discussionThe studies' findings support the supposition that these groups are community assets which help ameliorate against the social detriments of health and wellbeing that have led to widening health inequalities in the region. The findings from both studies clearly illustrate the importance of sociality for wellbeing, and that participation in these groups are an important determinant of wellbeing. The data demonstrates how social capital is generated within a range of community groups and spaces. It also conveys the needs and deficits existing within groups highlighting the need to provide more assistance to vulnerable citizens. While most themes were common to all community forums, there were some noticeable place-based differences.</p