A Community Participation Initiative During COVID-19 Pandemic:A Case Study From India

Background: A community participation initiative of stitching personal protective equipment (PPE), masks, and face shields for healthcare professionals working in the hospital during the COVID-19 pandemic was conducted using a case study design. Methods: The hospital tailoring unit was used to cater to the in-house demand for stitching safety gear kits for healthcare professionals. A transect walk was conducted to survey hospitals for selecting material for stitching the safety gears and to draw up a plan to meet future demand. The psychiatric social worker induced a community participatory initiative using the method of social work of community organization. A flyer was prepared to invite participants with prior experience in tailoring for this initiative. All participants were trained by the master trainers of the tailoring unit. The participants were also interviewed about their views on this initiative in an informal interview. Results: A total of 83 participants, including 26 individuals (8 volunteers and 18 who received an honorarium), 2 boutiques ( n = 12), and 1 government organization, participated in the activity ( n = 45). A total of 1700 complete PPE kits and 13,000 masks were stitched during this period. The participants reported that the benefit of being a part of this initiative was reduced boredom, sense of purpose and satisfaction, and improved mental health due to structured activity. Conclusions: A community participation initiative using the principles of community organization, a method of social work, can help produce desired outputs and improve the well-being of the participants

Schedule of Factors Influencing Adherence (SOFIA) to Psychiatric Treatment in Persons with Schizophrenia: Validity and Pilot Testing

Qualitative research has highlighted the complex interplay of multiple factors that preclude persons with schizophrenia in rural Indian settings for discontinued psychiatric treatment. In this context, this paper aims to establish the face and content validities of an interview schedule titled „Schedule of Factors Influencing Adherence (SOFIA) to Psychiatric Treatment in Persons with Schizophrenia‟ which comprehensively assesses factors for discontinued psychiatric treatment and the feasibility of its administration of the schedule. SOFIA contains 16 factors. This schedule involves three phases of interviewing patients and family members. This was given to twelve experts who used likert scales to rate each items wells as the dimensions of the schedule. Later on, fifteen persons with schizophrenia were interviewed with SOFIA to test the feasibility of administration. The results showed that Fourteen items were rated as either satisfactory (score=4) or very much satisfactory (score=5) by all twelve experts; remaining two were rated as 4 or 5 by 11 experts. Regarding comprehensiveness of the factors, scoring methods and general instructions given to the interviewers, all provided scores > 4; regarding method of interviewing, 11 provided score of > 4; with regard to overall interview schedule, all experts provided scores > 4. Pilot testing revealed that it took 60 minutes to administer SOFIA

Schedule of Factors Influencing Adherence (SOFIA) to Psychiatric Treatment in Persons with Schizophrenia: Validity and Pilot Testing

Qualitative research has highlighted the complexinterplay of multiple factors that preclude persons withschizophrenia in rural Indian settings for discontinuedpsychiatric treatment. In this context, this paper aims toestablish the face and content validities of an interviewschedule titled „Schedule of Factors InfluencingAdherence (SOFIA) to Psychiatric Treatment in Personswith Schizophrenia‟ which comprehensively assessesfactors for discontinued  psychiatric treatment and   thefeasibility of its administration of the schedule. SOFIAcontains 16 factors. This schedule involves three phases of interviewing patients and family members.  This wasgiven to twelve experts who used likert scales to rate eachitems wells as the dimensions of the schedule. Later on,fifteen persons with schizophrenia were interviewed withSOFIA to test the feasibility of administration. The resultsshowed that Fourteen items were rated as eithersatisfactory (score=4) or very much satisfactory (score=5)by all twelve experts; remaining two were rated as 4 or 5by 11 experts. Regarding comprehensiveness of thefactors, scoring methods and general instructions given tothe interviewers, all provided scores > 4; regardingmethod of interviewing, 11 provided score of > 4; withregard to overall interview schedule, all experts providedscores > 4. Pilot testing revealed that it took 60 minutes to administer SOFIA

Stakeholders’ perspectives on adverse effects of ECT: A qualitative thematic analysis

Background: In the Indian context, published systematic research on the opinions of mental health professionals and other stakeholders (patients and caregivers) regarding the different adverse effects of electroconvulsive therapy (ECT) is not available. This type of study allows for an in-depth exploration of complex phenomena, such as the perspectives of mental health professionals, which can provide a rich understanding of their experiences regarding ECT and also helps to understand the views of mental health professionals regarding the adverse effects of ECT during the post-ECT recovery period and its management. Conversely, the perception of patients and caregivers regarding the adverse effects of ECT can provide a more comprehensive understanding of the treatment and its impact on the patients who receive it. Purpose: To explore the understanding of participants about the various adverse effects following ECT and their perception of managing different adverse effects of ECT during the post-ECT recovery period. Methods: A qualitative approach using focus group discussion (FGD) was used. A convenience sampling technique was followed for selecting the participants. FGDs were conducted with stakeholders including mental health professionals, patients, and caregivers. Five FGDs were conducted with psychiatry residents, nursing officers from the ECT suite, and different psychiatry wards at NIMHANS. Four FGDs were held separately for patients receiving ECT and their caregivers, admitted to various psychiatry wards at NIMHANS. A total of 28 mental health professionals, 20 patients, and 20 caregivers participated. The number of participants for FGDs was decided based on data saturation. The FGDs, lasting 30–40 minutes each, occurred between October 2022 and December 2022. The FGDs were audio-recorded with prior permission from the participants. All the participants were informed about the study. Written informed consent was obtained. All FGDs were transcribed. Thematic analysis was done using Atlas. ti software. Results: The broad categories identified were adverse events associated with ECT during the ECT procedure, adverse events associated with ECT after the ECT procedure, prevalence of different adverse effects according to mental health professionals, effects of adverse effects on the continuity of ECT, and difficulties encountered by mental health professionals throughout the management. Other broad categories were found after conducting FGDs with caregivers and patients, which were patients’ experience as per the caregivers over the course of ECT, caregivers’ and patients’ willingness to continue ECT, unfavorable impacts of ECT experienced by the patients immediately after ECT sessions, and, later till the end of that day, suggestions of the caregivers and patients to improvise the management of ECT-related adverse effects and management of adverse effects by the treating team. Conclusion: The findings will develop a standard operating procedure that may help nursing officers monitor and identify the adverse effects immediately after ECT and minimize the complications during the post-ECT recovery period

Effectiveness of Bifrontal ECT in Practice: A Comparison with Bitemporal ECT

Background: Bifrontal (BF) placement of electrodes in electroconvulsive therapy (ECT) has emerged as an alternative option to the conventional bitemporal (BT) and right unilateral electrode placement in view of fewer cognitive adverse effects. However, the results have been contradictory in terms of clinical efficacy. Materials and Methods: We studied the records of all patients referred for ECT between the months of August 2008 and July 2010 (n=1575). One hundred and five of these patients had received BF-ECT. These records were compared with the records of 105 patients who received BT-ECT. For each patient who received BF-ECT, the very next person posted for BT-ECT was taken as the control. All patients received bilateral ECTs at 1.5-times the threshold stimulus dose. The number of ECTs administered, duration of hospital stay after ECT initiation, seizure threshold and failure to achieve adequate seizures were compared. Two raters who achieved good inter-rater reliability assessed the initial severity using the clinical global impression scale and clinical improvement using a Likert scale. Results: The speed of response, as assessed by the number of ECTs received and the duration of hospital stay after ECT initiation was similar in the two groups. In addition, both groups were comparable in terms of clinical improvement scores on the Likert scale. BF-ECT patients also had a significantly higher seizure threshold, which remained significant in spite of controlling for age. This study is chart based, with its inherent limitations. Standard outcome measures were not used. Cognitive adverse effects were not studied. Conclusions: BF-ECT performed similar to BT-ECT with regard to therapeutic efficacy. Given the consistent results of the former, with fewer cognitive side-effects, the findings of the present study support BF-ECT as the first line for electrode application