title: Development of a Community-Based Rehabilitation Intervention for People with Schizophrenia in Ethiopia.
abstract: BACKGROUND
  Community-based rehabilitation (CBR) is a multi-sectoral strategy to improve the functioning and quality of life of people with disabilities. The RISE (Rehabilitation Intervention for people with Schizophrenia in Ethiopia) trial will evaluate the effectiveness of CBR for people with schizophrenia in Ethiopia. Nevertheless, the components of CBR that are both feasible and likely to prove effective in low and middle-income countries such as Ethiopia are unclear.
  
  
  METHODS
  In this study intervention development work was undertaken to design a CBR intervention that is acceptable and feasible in the local context. The development work consisted of five phases. 1: Identify potential components of CBR for schizophrenia, 2: Situational analysis, 3: Determine feasibility of CBR (Theory of Change workshops with experts and local stakeholders), 4: Determine acceptability of CBR (16 in-depth interviews and five focus group discussions with people with schizophrenia, caregivers, health workers and community leaders) and 5: Synthesise results to finalise intervention. A Theory of Change map was constructed showing the causal pathway for how we expect CBR to achieve its impact.
  
  
  RESULTS
  People with schizophrenia in rural Ethiopia experience family conflict, difficulty participating in work and community life, and stigma. Stakeholders perceived CBR to be acceptable and useful to address these problems. The focus of CBR will be on the individual developing the skills and confidence to perform their previous or desired roles and activities. To ensure feasibility, non-health professionals will be trained to deliver CBR and provide supervision, rather than mental health specialists. Novel components of CBR for schizophrenia included family intervention and dealing with distressing symptoms. Microfinance was excluded due to concerns about stress and exploitation. Community mobilisation was viewed as essential to ensure the effectiveness and sustainability of CBR.
  
  
  CONCLUSIONS
  Extensive formative research using a variety of methods has enabled the design of a culturally appropriate CBR intervention for people with schizophrenia that is acceptable and feasible.
authors.affiliation: Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.|Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
authors.forename: Laura
authors.initials: L
authors.lastname: Asher
authors.affiliation: Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.|Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, United Kingdom.
authors.forename: Abebaw
authors.initials: A
authors.lastname: Fekadu
authors.affiliation: Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.|Center for Global Mental Health, Institute of Psychiatry, King's College London, London, United Kingdom.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Hanlon
authors.affiliation: RAPID (Rehabilitation And Prevention Initiative against Disabilities) CBR Project, Adama, Ethiopia.
authors.forename: Gemechu
authors.initials: G
authors.lastname: Mideksa
authors.affiliation: Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.|CBM West Africa Regional Office, Lome, Togo.
authors.forename: Julian
authors.initials: J
authors.lastname: Eaton
authors.affiliation: Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.|Sangath, Goa, India.
authors.forename: Vikram
authors.initials: V
authors.lastname: Patel
authors.affiliation: Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Mary J
authors.initials: MJ
authors.lastname: De Silva
mesh_terms: D003695:Delivery of Health Care / Q000379:methods*; D005002:Ethiopia; D005260:Female; D006801:Humans; D008297:Male; D012559:Schizophrenia / Q000534:rehabilitation*