A Biomedical Educational Intervention to Change Explanatory Models of Psychosis among Community Health Workers in South India

Article excerpt

Byline: D. Joel, M. Sathyaseelan, R. Jayakaran, C. Vijayakumar, S. Muthurathnam, K. Jacob

Background: Community health workers in developing countries commonly hold indigenous beliefs about mental illness which differ markedly from biomedical models. Aim: To test the effect of a biomedical intervention on explanatory models (EMs) of community health workers. Methods: Indigenous beliefs about chronic psychosis were elicited from community health workers. The Short Explanatory Model Interview formed the basis of the interview. Half the workers were taught about the biomedical model after discussing their EMs of chronic psychosis. The others did not receive education. The beliefs of all community health workers were reassessed 2 weeks after the initial assessment. Results: A variety of indigenous beliefs, which contradicted the biomedical model, were elicited at the baseline evaluation. Seeking biomedical help at follow up was significantly related to receiving education about the biomedical aspects of chronic psychosis (OR 17.2; 95% CI: 18.75, 15.65; p< 0.001). This remained statistically significant (OR 9.7; 95% CI: 82.28, 1.14; p< 0.04) after using logistic regression to adjust for baseline variables. Conclusion: The high prevalence of non-medical beliefs among community health workers suggests the need to elicit and discuss beliefs before imparting knowledge about biomedical models of mental disorders. Biomedical educational intervention can change EMs of mental illness among health workers.


Local culture and beliefs influence many aspects of human behaviour such as idioms of distress, help-seeking, treatment compliance, patient satisfaction and coping. Perspectives of mental illness, also called explanatory models (EMs), play an important role in health-related behaviours and in patient- health worker interaction.[1],[2],[3],[4],[5] Diverse explanations are offered to explain mental illness including social circumstances, relationship difficulties, witchcraft or sorcery, or a broken taboo.[5] Eliciting local EMs in routine clinical psychiatric practice gives a better understanding of the subjective experience of illness,[1],[2],[3],[4],[5] attitude towards and compliance with treatment, and thus promote therapeutic adherence and improve clinical outcomes.

Despite the past few years having witnessed an increase in literature regarding local beliefs about causes of schizophrenia,[6],[7],[8],[9],[10] there is paucity of studies evaluating local EMs and the efficacy of intervention to change EMs.[11] Consequently, there is a need to understand not only the local perspectives but also to evaluate the efficacy of inter-ventions based on biomedical models of schizophrenia.

Understanding local perspectives is crucial for establishing culturally sensitive healthcare for a community. Community health workers are part of the World Health Organization's plan to integrate mental health component into primary healthcare in developing countries.[12],[13],[14],[15] However, many community health workers hold indigenous beliefs about mental illness which differ markedly from the biomedical models emphasized by mental health professionals.[16] Most education programmes have not evaluated local perspectives and the role of training in changing indigenous beliefs held by health workers. This study attempted to evaluate a structured intervention programme used to educate health workers about the biomedical aspects of psychosis in changing indigenous beliefs.


The setting

The Rural Unit for Health and Social Affairs (RUHSA), a community health programme of the Christian Medical College Hospital, Vellore, India, serves the K.V. Kuppam Block in the Vellore district in the state of Tamil Nadu. The block has an area of 180 sq. km. The programme operates in all 84 villages in the area. The total population served is about 120,000. The majority of the population speaks Tamil, is involved in agriculture and animal husbandry and belongs to the lower socioeconomic strata. …


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