Browsing by Author "Rai, Sauharda"

Now showing 1 - 4 of 4

Open Access
Eliciting recovery narratives in global mental health: Benefits and potential harms in service user participation.
(Psychiatric rehabilitation journal, 2019-07-29) Kaiser, Bonnie N; Varma, Saiba; Carpenter-Song, Elizabeth; Sareff, Rebecca; Rai, Sauharda; Kohrt, Brandon A
OBJECTIVE:The engagement of peers and service users is increasingly emphasized in mental health clinical, educational, and research activities. A core means of engagement is via the sharing of recovery narratives, through which service users present their personal history of moving from psychiatric disability to recovery. We critically examine the range of contexts and purposes for which recovery narratives are elicited in global mental health. METHOD:We present 4 case studies that represent the variability in recovery narrative elicitation, purpose, and geography: a mental health Gap Action Programme clinician training program in Nepal, an inpatient clinical service in Indian-controlled Kashmir, a recovery-oriented care program in urban Australia, and an undergraduate education program in the rural United States. In each case study, we explore the context, purpose, process of elicitation, content, and implications of incorporating recovery narratives. RESULTS:Within each context, organizations engaging service users had a specific intention of what "recovery" should constitute. This was influenced by the anticipated audience for the recovery stories. These expectations influenced the types of service users included, narrative content, and training provided for service users to prepare and share narratives. Our cases illustrate the benefit of these coconstructed narratives and potential negative impacts on service users in some contexts, especially when used as a prerequisite for accessing or being discharged from clinical care. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE:Recovery narratives have the potential to be used productively across purposes and contexts when there is adequate identification of and responses to potential risks and challenges. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Open Access
Gender and Child Behavior Problems in Rural Nepal: Differential Expectations and Responses.
(Scientific reports, 2019-05-21) Langer, Julia A; Ramos, Julia V; Ghimire, Lajina; Rai, Sauharda; Kohrt, Brandon A; Burkey, Matthew D
Whereas epidemiologic studies consistently identify different rates and types of problematic behavior in boys and girls, there has been little research examining the ecocultural context in which these gender differences in child behavior problems develop, especially in non-Western settings. This qualitative study in rural Nepal explored how behavioral expectations differed based on gender role, gender discrimination, inequity, and treatment of children based on their gender identity. We conducted semi-structured interviews with a total of 14 parents, school workers, and community leaders from a village in rural Nepal. Interview transcripts were coded by two authors using predetermined and emergent codes to identify expectations, behavior problems, and responses to behavior problems, stratified by gender. Authors then arranged codes into categories based on emergent themes. Four major themes in the interviews were identified: (1) self-reported gender non-bias; (2) differentiated role expectations; (3) gender, "goodness", and differential thresholds for problem behaviors; and (4) boys and girls require different responses for misbehavior. Results from our study in Nepal reflect nearly universal models of gender differences in behavior. Of particular importance in South Asia, patrilocal marital practices were used to frame gender differences in expectations. To protect girls' future potential to marry, local cultural practices provide girls with lesser opportunities and less cultural space to conduct themselves in a disruptive manner than boys. Greater understanding of differential expectations and responses to disruptive behaviors by gender will be important for culturally-appropriate equitable programming in child development.
Open Access
Procedures to Select Digital Sensing Technologies for Passive Data Collection With Children and Their Caregivers: Qualitative Cultural Assessment in South Africa and Nepal
(JMIR Pediatrics and Parenting) Kohrt, Brandon A; Rai, Sauharda; Vilakazi, Khanya; Thapa, Kiran; Bhardwaj, Anvita; van Heerden, Alastair
Open Access
Reducing stigma among healthcare providers to improve mental health services (RESHAPE): protocol for a pilot cluster randomized controlled trial of a stigma reduction intervention for training primary healthcare workers in Nepal.
(Pilot Feasibility Stud, 2018) Kohrt, Brandon A; Jordans, Mark JD; Turner, Elizabeth L; Sikkema, Kathleen J; Luitel, Nagendra P; Rai, Sauharda; Singla, Daisy R; Lamichhane, Jagannath; Lund, Crick; Patel, Vikram
Background: Non-specialist healthcare providers, including primary and community healthcare workers, in low- and middle-income countries can effectively treat mental illness. However, scaling-up mental health services within existing health systems has been limited by barriers such as stigma against people with mental illness. Therefore, interventions are needed to address attitudes and behaviors among non-specialists. Aimed at addressing this gap,REducingStigma amongHealthcAreProviders to ImprovEmental health services (RESHAPE) is an intervention in which social contact with mental health service users is added to training for non-specialist healthcare workers integrating mental health services into primary healthcare. Methods: This protocol describes a mixed methods pilot and feasibility study in primary care centers in Chitwan, Nepal. The qualitative component will include key informant interviews and focus group discussions. The quantitative component consists of a pilot cluster randomized controlled trial (c-RCT), which will establish parameters for a future effectiveness study of RESHAPE compared to training as usual (TAU). Primary healthcare facilities (the cluster unit,k = 34) will be randomized to TAU or RESHAPE. The direct beneficiaries of the intervention are the primary healthcare workers in the facilities (n = 150); indirect beneficiaries are their patients (n = 100). The TAU condition is existing mental health training and supervision for primary healthcare workers delivered through the Programme for Improving Mental healthcarE (PRIME) implementing the mental health Gap Action Programme (mhGAP). The primary objective is to evaluate acceptability and feasibility through qualitative interviews with primary healthcare workers, trainers, and mental health service users. The secondary objective is to collect quantitative information on health worker outcomes including mental health stigma (Social Distance Scale), clinical knowledge (mhGAP), clinical competency (ENhancing Assessment of Common Therapeutic factors, ENACT), and implicit attitudes (Implicit Association Test, IAT), and patient outcomes including stigma-related barriers to care, daily functioning, and symptoms. Discussion: The pilot and feasibility study will contribute to refining recommendations for implementation of mhGAP and other mental health services in primary healthcare settings in low-resource health systems. The pilot c-RCT findings will inform an effectiveness trial of RESHAPE to advance the evidence-base for optimal approaches to training and supervision for non-specialist providers. Trial registration: ClinicalTrials.gov identifier, NCT02793271.