Community-based Mental Health Promotion: Exploratory Study Using Theory of Planned Behavior in Primary Care of Dum Southwest Papua, Indonesia
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Abstract
Introduction: The treatment gap in mental health services in Indonesia is a critical issue driven by the shortage of professionals, challenging geography, limited medication availability, and stigma around mental health. Despite having limited access and facilities, Dum Primary Care in the District of Sorong Islands is the only primary care that provides mental health services to the community. This study aims to explore community-based mental health promotion using the theory of planned behavior. Methods: This study used qualitative research consist of three stages: developing interview guidelines, which were piloted with local health workers; semi-structured (SSIs) interviews; and focus group discussions (FGDs). A total of 11 participants were engaged in the study, including six professionals, two patients, and three caregivers. Results: Behavioral beliefs influence patients' intentions to recover and seek treatment independently. In subjective norms, patients with mental illness face contrasting family attitudes toward treatment, including support and rejection. Perceived control factors affecting mental health promotion in the community include family socioeconomic status, limited access to care, stigma, and inadequate government funding. The knowledge and skills of health workers are also vital for effectively reaching and supporting patients in promoting mental health. Conclusion: Enhancing collaboration between families and primary care is vital in promoting mental health. By actively engaging families and communities, primary care can improve mental health literacy and reduce the stigma associated with mental health issues. Implementing mental health lay workers can help address the shortage of professionals and improve service delivery in the community.
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World Health Organization. World Mental Health Report: Transforming Mental Health for All. 2022.
GBD 2019 Mental Disorders Collaborators. Global, Regional, and National Burden of 12 Mental Disorders in 204 Countries and Territories, 1990–2019: A Systematic Analysis for the Global Burden of Disease Study 2019. The Lancet Psychiatry. 2022;9(2):137–50. Available from: https://doi.org/10.1016/S2215-0366(21)00395-3.
WHO. The WHO Special Initiative for Mental Health (2019-2023): Universal Health Coverage for Mental Health. WHO Spec Initiat Ment Heal [Internet]. 2019;1–4. Available from: WHO official site.
Abdullah A, Hort K, Abidin AZ, Amin FM. How Much Does it Cost to Achieve Coverage Targets for Primary Healthcare Services? a Costing Model from Aceh, Indonesia. Int J Health Plann Manage. 2012;27(3):226–45. doi: 10.1002/hpm.2099.
KEMENKES RI. Situasi Kesehatan Jiwa Di Indonesia. InfoDATIN. 2019. p. 12.
Badan Penelitian dan Pengembangan Kesehatan. Riset Kesehatan Dasar (RISKESDAS) 2013. Lap Nas 2013. 2013;1–384.
Riskesdas. Laporan Nasional: Riskesdas 2018. 2018.
Setiyawati D, Blashki G, Wraith R, Colucci E, Minas H. Australian Experts’ Perspectives on a Curriculum for Psychologists Working in Primary Health Care: Implication for Indonesia. Heal Psychol Behav Med [Internet]. 2014;2(1):970–82. Available from: http://dx.doi.org/10.1080/21642850.2014.951937.
Patel V, Saxena S, Lund C, Thornicroft G, Baingana F, Bolton P, et al. The Lancet Commission on Global Mental Health and Sustainable Development. Lancet. 2018;392(10157):1553–98. doi:10.1016/S0140-6736(18)31612-X.
Patel V, Weiss HA, Chowdhary N, Naik S, Pednekar S, Chatterjee S, et al. Lay Health Worker Led Intervention for Depressive and Anxiety Disorders in India: Impact on Clinical and Disability Outcomes over 12 Months. 2011;459–66. doi:10.1192/bjp.bp.111.092155.
Patel V, Weobong B, Weiss HA, Anand A, Bhat B, Katti B, et al. The Healthy Activity Program (HAP), a Lay Counsellor-Delivered Brief Psychological Treatment for Severe Depression, in Primary Care in India: a Randomised Controlled Trial. Lancet [Internet]. 2016;6736(16):1–10. Available from: http://dx.doi.org/10.1016/S0140-6736(16)31589-6.
Ajzen I. The theory of planned behavior. Organ Behav Hum Decis Process. 1991;50(2):179–211. Available from: https://doi.org/10.1016/0749-5978(91)90020-T.
Myers DG, Twenge JM. Social Psychology Thirteen Edition. 2018. 656 p.
Ajzen I. Perceived Behavioral Control, Self-Efficacy, Locus of Control, and the Theory of Planned Behavior. J Appl Soc Psychol. 2002;32(4):665–83. Available from: https://doi.org/10.1111/j.1559-1816.2002.tb00236.x.
Creswell JW. Qualitative Inquiry and Research Design: Choosing among Five Approaches. Second Edi. Thousand Oaks: SAGE Publications Inc.; 2007.
Bowling A. Research Methods in Health-Investigating Health and Health Services. Open University Press. 2014.
Miles MB, Huberman AM. Drawing Valid Meaning from Qualitative Data: Toward a Shared Craft. 1983.
Subu MA, Holmes D, Arumugam A, Al-Yateem N, Maria Dias J, Rahman SA, et al. Traditional, Religious, and Cultural Perspectives on Mental Illness: a Qualitative Study on Causal Beliefs and Treatment Use. Int J Qual Stud Health Well-being [Internet]. 2022;17(1). Available from: https://doi.org/10.1080/17482631.2022.2123090.
Vaingankar JA, Subramaniam M, Chong SA, Abdin E, Orlando Edelen M, Picco L, et al. The Positive Mental Health Instrument: Development and Validation of a Culturally Relevant Scale in a Multi-ethnic Asian Population. Health Qual Life Outcomes. 2011;9:1–18. Available from: https://doi.org/10.1186/1477-7525-9-92.
Karanci AN. Concerns about Schizophrenia or Possession? J Relig Health. 2014;53(6):1691–2. Available from: https://doi.org/10.1007/s10943-014-9910-7.
Carbonell Á, Navarro-Pérez JJ, Mestre MV. Challenges and barriers in mental healthcare systems and their impact on the family: A systematic integrative review. Heal Soc Care Community. 2020;28(5):1366–79. Available from: https://doi.org/10.1111/hsc.12968.
Naeim M, Rezaeisharif A. The Role of the Family in Preventing Addiction. Addict Disord their Treat. 2021;20(4):479–85. Available from: https://doi.org/10.1097/ADT.0000000000000277.
Febriana B, Susanto W, Rochmawati DH, Setiawati WE. Family Support is the Key to Compliance with the Treatment of Relapsing Schizophrenia Patients. J Ners. 2020;15(1 Special Issue):457–61. Available from: https://doi.org/10.20473/jn.v15i1Sp.20361.
Tlhowe TT, du Plessis E, Koen MP. Strengths of Families to Limit Relapse in Mentally Ill Family Members. Heal SA Gesondheid [Internet]. 2017;22:28–35. Available from: http://dx.doi.org/10.1016/j.hsag.2016.09.003.
Rickwood D, Thomas K, Bradford S. Help-seeking Measures in Mental Health: a Rapid Review. Sax Inst [Internet]. 2012;(August):1–35. Available from: SaxInstitute official site.
Gulliver A, Griffiths KM, Christensen H, Brewer JL. A systematic review of help-seeking interventions for depression, anxiety and general psychological distress. BMC Psychiatry. 2012;12. Available from: https://doi.org/10.1186/1471-244X-12-81.
Brown JSL, Evans-Lacko S, Aschan L, Henderson MJ, Hatch SL, Hotopf M. Seeking Informal and Formal Help for Mental Health Problems in the Community: a Secondary Analysis from a Psychiatric Morbidity Survey in South London. BMC Psychiatry. 2014;14(1):1–15. Available from: https://doi.org/10.1186/s12888-014-0275-y.
Chronister J, Fitzgerald S, Chou CC. The Meaning of Social Support for Persons with Serious Mental Illness. Rehabil Psychol. 2021;66(1):87–101. Available from: https://doi.org/10.1037/rep0000369.
Eckardt JP. Comment on: Family Engagement as Part of Managing Patients with Mental Illness in Primary Care. Singapore Med J. 2021;62(10):561. Available from: https://doi.org/10.11622/smedj.2021057.
Subandi MA. The Role of Family Empowerment and Family Resilience on the Recovery from Psychosis. Procedia-Social Behav Sci. 2010;1–16.
Moges S, Belete T, Mekonen T, Menberu M. Lifetime Relapse and its Associated Factors among People with Schizophrenia Spectrum Disorders Who are on Follow Up at Comprehensive Specialized Hospitals in Amhara region, Ethiopia: a Cross-sectional Study. Int J Ment Health Syst [Internet]. 2021;15(1):1–12. Available from: https://doi.org/10.1186/s13033-021-00464-0.
Lin D, Joshi K, Keenan A, Shepherd J, Bailey H, Berry M, et al. Associations Between Relapses and Psychosocial Outcomes in Patients With Schizophrenia in Real-World Settings in the United States. Front Psychiatry. 2021;12(October):1–12. Available from: https://doi.org/10.3389/fpsyt.2021.695672.
Miklowitz DJ, Simoneau TL, George EL, Richards JA, Kalbag A, Sachs-Ericsson N, et al. Family-focused Treatment of Bipolar Disorder: 1-Year Effects of a Psychoeducational Program in Conjunction with Pharmacotherapy. Biol Psychiatry. 2000;48(6):582–92. Available from: https://doi.org/10.1016/s0006-3223(00)00931-8.
Pharoah F, Mari J, Rathbone J, Wong W. Family Intervention for Schizophrenia. Cochrane database Syst Rev. 2010 Dec;(12):CD000088. Available from: https://doi.org/10.1002/14651858.CD000088.pub2.
Putri AK, Gustriawanto N, Rahapsari S, Sholikhah AR, Prabaswara S, Kusumawardhani AC, et al. Exploring the Perceived Challenges and Support Needs of Indonesian Mental Health Stakeholders: a Qualitative Study. Int J Ment Health Syst. 2021;15(1):1–9. Available from: https://doi.org/10.1186/s13033-021-00504-9.
She R, Wang X, Zhang Z, Li J, Xu J, You H, et al. Mental Health Help-Seeking and Associated Factors Among Public Health Workers During the COVID-19 Outbreak in China. Front public Heal. 2021;9:622677. Available from: https://doi.org/10.3389/fpubh.2021.622677.
Breedvelt JJF, Tiemeier H, Sharples E, Galea S, Niedzwiedz C, Elliott I, et al. The effects of neighbourhood social cohesion on preventing depression and anxiety among adolescents and young adults: rapid review. BJPsych Open. 2022;8(4):1–12. Available from: https://doi.org/10.1192/bjo.2022.57.
Goodson BD, Mackrain M, Perry DF, O’brien K, Gwaltney MK. Enhancing home visiting with mental health consultation. Pediatrics. 2013;132(SUPPL.2). Available from: https://doi.org/10.1542/peds.2013-1021S.
Palmer Molina A, Traube DE, Kemner A. Addressing maternal mental health to increase participation in home visiting. Child Youth Serv Rev [Internet]. 2020;113(December 2019):105025. Available from: https://doi.org/10.1016/j.childyouth.2020.105025.
Matarazzo BB, Forster JE, Hostetter TA, Billera M, Adler G, Ganzini LK, et al. Efficacy of the home-based Mental Health Evaluation (HOME) program for engaging patients in care after hospitalization. Psychiatr Serv. 2019;70(12):1094–100. Available from: https://doi.org/10.1176/appi.ps.201900002.
Iredale C, Fornells-Ambrojo M, Jolley S. Psychological interventions for housebound people with psychosis: service user and therapist perspectives in South East London. J Ment Heal. 2016;25(3):204–11. Available from: https://doi.org/10.3109/09638237.2015.1078882.
Kohn R, Saxena S, Levav I, Saraceno B. The Treatment Gap in Mental Health Care. Bull World Health Organ. 2004;82(11):858–66.
Hunter Revell SM, McCurry MK. Nursing Science, Mental Illness, and the Family: A Conceptual Framework to Break the Cycle of Suffering. Nurs Sci Q. 2021;34(1):59–66. Available from: https://doi.org/10.1177/0894318420965230.
Setiyawati D, Blashki G, Wraith R, Colucci E, Minas H. Indonesian experts ’ perspectives on a curriculum for psychologists working in primary health care in Indonesia. Heal Psychol Behav Med [Internet]. 2014;2(1):623–39. Available from: http://dx.doi.org/10.1080/21642850.2014.912946.