The Care of Older People With Depression in Nigeria: Qualitative Exploration of the Experience of Lay Providers in Primary Care Settings

IF 3.6 3区 医学 Q2 GERIATRICS & GERONTOLOGY
Akin Ojagbemi, Stephanie Daley, Yvonne Feeney, Oye Gureje
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Abstract

Objectives

There is a large treatment gap for mental health conditions in sub-Saharan Africa where most patients who receive any care do so from lay primary health care workers (PHCW). We sought to examine the experiences of PHCW who provide care for older people with depression in Nigerian primary health care (PHC) settings.

Methods

Qualitative study design. A total of 24 PHCW participated. Using in-depth key informant interviews (KIIs), we explored the views of 15 PHCW selected from 10 rural and urban PHCs in South-Western Nigeria. An additional focus group discussion comprising nine participants was also conducted to discuss emerging themes from KIIs. Data were analysed using thematic analysis.

Results

Three overall themes were identified: views about depression, treatment options, and community outreach implications. Participants perceived depression in older people as being characterised by a range of mood, behavioural, and cognitive symptoms which made clinical assessments particularly challenging. Common treatment options used by PHCW included general advice and counselling, as well as frequent need to prescribe mild analgesics, vitamins and occasional sedatives in line with patients' expectations. Antidepressants were rarely used even though PHCW are authorised. While home visits are part of their expected work schedule, PHCW rarely implemented these due to non-availability of transport facilities. Mobile technology was identified as a possible way of overcoming this constraint to providing community based mental healthcare for older people.

Conclusion

PHCWs perceived that patients' poor cognitive performance, expectations to prescribe sedatives, analgesics and vitamins, as well as non-existence of community-based services were existing barriers to providing evidenced based continued care for older people with depression in the study settings.

尼日利亚抑郁症老年人的护理:对基层医疗机构非专业医疗人员经验的定性探索。
目标:在撒哈拉以南非洲地区,精神疾病的治疗缺口很大,那里的大多数患者都是由非专业的初级卫生保健工作者(PHCW)提供治疗。我们试图研究尼日利亚初级卫生保健(PHC)机构中为老年抑郁症患者提供护理的初级卫生保健工作者的经验:定性研究设计。共有 24 名初级保健工作者参与。通过深入的关键信息提供者访谈(KII),我们探讨了从尼日利亚西南部 10 个农村和城市初级保健中心选出的 15 名初级保健工作者的观点。此外,我们还进行了一次由九名参与者组成的焦点小组讨论,以讨论关键信息访谈中出现的主题。采用主题分析法对数据进行了分析:结果:确定了三个总体主题:对抑郁症的看法、治疗方案和社区外联影响。参与者认为,老年人抑郁症的特征是一系列情绪、行为和认知症状,这使得临床评估特别具有挑战性。初级保健工作者常用的治疗方案包括一般建议和咨询,以及经常需要根据病人的期望开具温和的镇痛剂、维生素和偶尔的镇静剂。尽管初级保健社工获得了授权,但他们很少使用抗抑郁药物。虽然家访是他们预期工作日程的一部分,但由于没有交通设施,初级保健工作者很少进行家访。移动技术被认为是克服这一限制,为老年人提供社区精神医疗服务的可行方法:结论:初级保健社工认为,患者认知能力差,期望开具镇静剂、止痛药和维生素,以及不存在以社区为基础的服务,是在研究环境中为患有抑郁症的老年人提供以证据为基础的持续护理的现有障碍。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
6.10
自引率
2.50%
发文量
168
审稿时长
4-8 weeks
期刊介绍: The rapidly increasing world population of aged people has led to a growing need to focus attention on the problems of mental disorder in late life. The aim of the Journal is to communicate the results of original research in the causes, treatment and care of all forms of mental disorder which affect the elderly. The Journal is of interest to psychiatrists, psychologists, social scientists, nurses and others engaged in therapeutic professions, together with general neurobiological researchers. The Journal provides an international perspective on the important issue of geriatric psychiatry, and contributions are published from countries throughout the world. Topics covered include epidemiology of mental disorders in old age, clinical aetiological research, post-mortem pathological and neurochemical studies, treatment trials and evaluation of geriatric psychiatry services.
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