Browsing by Author "Knizek, Birthe Loa"

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Cultural responses towards the aftermath of suicide among the Acholi in northern Uganda
(International Journal of Social Psychiatry, 2018-07-02) Mugisha, James; Muyinda, Herbert; Hjelmeland, Heidi; Kinyanda, Eugene; Vancampfort, Davy; Knizek, Birthe Loa
Suicide is a public health problem in Uganda among indigenous societies, and different societies manage its aftermath differently. Aim: To explore how the Acholi in Northern Uganda manage the aftermath of suicide. Methods: We conducted a qualitative study in Gulu district, a post-conflict area in Northern Uganda. We conducted a total of four focus group discussions (FGDs) and 12 key informant (KI) interviews. KI interviews were conducted with community leaders, while the FGDs were conducted with members of the general population. We analysed the data by means of Grounded Theory. Results: Our findings indicate that rituals form a large part in managing suicide among the Acholi. Study communities practised distancing (symbolically and physically) as a way of dealing with the threat of suicide. Conclusion: Distancing was organized into two broad themes: affect regulation and securing future generations. It is recommended that public health interventions should utilize cultural institutions in the prevention of suicide.
The experience of mental health service users in health system strengthening: lessons from Uganda
(Springer Nature: International Journal of Mental Health Systems, 2019-09-06) Mugisha, James; Hanlon, Charlotte; Knizek, Birthe Loa; Ssebunnya, Joshua; Vancampfort, Davy; Kinyanda, Eugene; Kigozi, Fred
Mental, neurological and substance use disorders are a public health burden in Uganda. Mental health service user involvement could be an important strategy for advocacy and improving service delivery, particularly as Uganda redoubles its efforts to integrate mental health into primary health care (PHC). However, little is known on the most effective way to involve service users in mental health system strengthening. Methods: This was a qualitative key informant interview study. At national level, 4 interviews were conducted with national level health workers and 3 service user organization representatives. At the district level, 2 interviews were conducted with district level health workers and 5 service user organization representatives. Data were analyzed using content thematic analysis. Findings: Overall, there was low mental service user participation in health system strengthening at both national and district levels. Health system strengthening activities included policy development, implementation of programs and research. Informants mentioned several barriers to service user involvement in mental health system strengthening. These were grouped into three categories: institutional, community and individual level factors. Institutional level barriers included: limited funding to form, train and develop mental health service user groups, institutional stigma and patronage by founder members of user organizations. Community level barriers included: abject poverty and community stigma. Individual level barriers included: low levels of awareness and presence of self-stigma. Informants also recommended some strategies to enhance service user involvement. Conclusion: The Uganda Ministry of Health should develop a strategy to improve service user participation in mental health system strengthening. This requires an appreciation of the importance of service users in improving service delivery. To address the barriers to service user involvement identified in this study requires concerted efforts by the Uganda Ministry of Health and the district health services, specifically with regard to attitudes of health workers, dealing with stigma at all levels, raising awareness about the rights of service users to participate in health systems strengthening activities, building capacity and financial empowerment of service user organizations.
The experiences of caregivers of children living with HIV and AIDS in Uganda: a qualitative study
(Springer Nature: Globalization and Health, 2017-09-12) Osafo, Joseph; Knizek, Birthe Loa; Mugisha, James; Kinyanda, Eugene
Home-based care for HIV patients is popular in contexts severely affected by the epidemic and exacts a heavy toll on caregivers. This study aimed at understanding the experiences of caregivers and their survival strategies. Methods A total of 18 caregivers (3 males and 15 females) were interviewed using a semi-structured interview guide, and thematic analysis was used to analyse the data. Results Analysis suggests that the caregivers are burdened with insecure provisions for food and difficulties in accessing health care. They however survived these strains through managing their relationships, sharing burden with care-recipients, social networks and instrumental spirituality. These findings are discussed under two major themes: 1). Labour of caregiving and 2). Survivalism. Conclusions Home-based care presents huge opportunities for community response to the HIV/AIDS epidemic in African settings. It is however burdensome and thus should not be left for families alone to shoulder. There is therefore an urgent need for protecting home-based care for HIV children in Uganda. Implications for improving and strengthening social interventions in home-based care of HIV/AIDS in the Ugandan context are addressed.
Growing up HIV-positive in Uganda: “psychological immunodeficiency”? A qualitative study
(Springer Nature: BMC Psychology, 2017) Knizek, Birthe Loa; Mugisha, James; Osafo, Joseph; Kinyanda, Eugene
This study is part of a longitudinal study among children and adolescents with HIV in both urban and rural Uganda: ‘Mental health among HIV infected CHildren and Adolescents in KAmpala and Masaka, Uganda (CHAKA)’. Method The study is constructed of both quantitative and qualitative components. In this article we report a qualitative study on the experiences of 21 adolescents (twelve to seventeen years) living with HIV in Uganda. The purpose of the study was to investigate both the protective and the risk factors in HIV-infected adolescents’ care environment in order to understand what might contribute to negative outcomes and what might provide a protective buffer against harmful life events. Semi-structured interviews with vignettes about mental disorders were employed and a phenomenological analysis was done. Results The findings uncovered that the adolescents’ families were mostly characterized by instability and diffuse relationships that provided an insecure basis for secure attachment and emotional support. Even in stable and secure family environments, there was no guarantee for getting sufficient emotional support in order to develop a positive self-concept due to the fate being the only infected child in the family. Both secure attachment and positive self-concept are known psychological protective mechanisms that provide the individual with resilience. The adolescents in this study seemed hampered in the development of protective mechanisms and consequently seemed psychologically vulnerable and badly equipped for coping with challenges, which paves the way for the possible development of mental disorders. Conclusion To change the focus towards strengthening the children and adolescents’ development of psychological protective mechanisms implicates a change in focus from illness to health and has consequences for both treatment and prevention. Psychological health promotion must be systemic and aim at strengthening the family environment, but also to establish peer group support.
Health care professionals’ perspectives on barriers to treatment seeking for formal health services among orphan children and adolescents with HIV/AIDS and mental distress in a rural district in central, Uganda
(Springer Link: Child and Adolescent Psychiatry and Mental Health, 2020-06-03) Mugisha, James; Kinyanda, Eugene; Osafo, Joseph; Nalukeng, Winfred; Knizek, Birthe Loa
Little/no research has been conducted in Uganda in particular and sub-Saharan Africa in general on the health professional’s perspectives on barriers to treatment seeking for formal health services among orphan children and adolescents with a double burden of HIV/AIDS and mental distress. Aim To explore health professionals’ perspectives on barriers to treatment seeking for formal health services among orphan children and adolescents with HIV/AIDS and mental distress in Masaka, Uganda. Method Qualitative research design using key informant interviews with health service managers and staff in agencies working with children and adolescents with HIV/AIDS in Masaka district, Uganda. Results Barriers to treatment seeking reported by health care professionals were quite enormous and are summarized under: family, individual, community and health systems level barriers. The crosscutting finding here is that the societal informal and formal systems of care had been affected by the HIV/AIDs epidemic, and, mental distress aggravates this challenge for the individuals afflicted and families affected by mental distress. Conclusion Children and adolescents with both HIV/AIDS and mental distress are vulnerable due to constraints at family, community and health systems levels. Effective public health interventions to address the double burden of HIV/AIDS and mental distress will be vital in the study communities addressing the constraints at family, community and institutional level. Public health interventions should aim at increased access and effective utilization of services for both HIV/AIDS and mental health services. Stigma reduction strategies at individual, family and community levels are also recommended.
Health care professionals’ perspectives on physical activity within the Ugandan mental health care system
(Elsevier: Mental Health and Physical Activity, 2019-03) Mugisha, James; De Hert, Marc; Knizek, Birthe Loa; Kwiringira, Japheth; Kinyanda, Eugene; Byansi, William; Winkel, Ruudvan; Myin-Germeys, Inez; Stubbs, Brendon; Vancampfort, Davy
Mental health care systems in Africa are faced with a high burden of mental disorders. There is need to explore evidence-based, scalable interventions to compliment the “traditional” health care system. Physical activity (PA) can augment the effectiveness of existing programs. However, little is known about the perspectives of health care professionals on PA. Understanding this is key to implementation. Methods This was a qualitative exploratory study based on 13 key informant interviews among experienced health care professionals working at Butabika National Referral and Teaching Hospital, Uganda. Data was analyzed through content thematic analysis. Results Participants reported PA benefits were: improved individual competences and engagement, social reintegration and reduced family and community burden. Self-stigma, lack of community support, lack of infrastructure and equipment, lack of monitoring capacity, human resource challenges and a focus solely on pharmacotherapy were among the most reported barriers to application of PA in management of mental health problems. Conclusion Despite the high level of understanding of PA among health care professionals, PA promotion largely depends on implementation of strategies to deal with community and health systems barriers. Although patients need to be empowered to deal with their individual barriers, greater support and action is needed by policy makers. Public health programs should support PA through community engagement and social re-integration programs. The government should promote a holistic mental health care perspective and provide adequate infrastructural and human resources to support PA in the existing primary and mental health care systems.
Meaning-making and health
(Health Behavior and Environmental Health. Springer, 2024-08-19) Knizek, Birthe Loa; Hagen, Julia; Hjelmeland, Heidi; Mugisha, James
During the last decades, meaning-making has come into focus as a valuable resource for health. Through life, a person might face different challenges such as bereavement, loss of abilities, and unemployment, among others, and the ability to cope with these is decisive for the person’s health and well-being. Making-meaning is a way of coping with difficult situations and can enhance a healing process of the biopsychosocial individual. As nobody lives in a vacuum, meaning-making is dependent on the cultural, social, and relationship context of a person and is an ever-ongoing process as both the individual, the context, and the interaction with the environment are constantly changing. This chapter discusses different models of meaning-making and provides examples of how they work in suicidality, illness, and loss. On this background, the chapter presents a new way of approaching individuals in difficult situations: the power threat meaning framework (PTMF). PTMF was developed as an alternative to diagnostic and medicalized thinking to provide a more contextual understanding of various challenges, emotional distress, and unusual or troubling behavior. The PTMF also offers practical guidance, which is presented briefly.
A patchwork of good intentions: a critical look at different perspectives regarding ethics-based mental health care in under-resourced settings
(Foundation of Ethics-Based Practices : Springer Nature, 2022-01-01) Knizek, Birthe Loa; Mugisha, James; Kinyanda, Eugene; Hjelmeland, Heidi
Currently, there is an overall focus on mental health as a global health priority in the United Nations (Sustainable developmental Goals), World Health Organization (WHO), and Global Mental Health (movement and study field). As “mental disorder” is constructed as universal, the consequence is that the focus is on the treatment gap as a result of the huge inequalities regarding access to mental health care and treatment (Mills and Fernando, Disability and the Global South 1:188–202, 2014). UN’s Report of the Special Rapporteur on the Right of Everyone to the Enjoyment of the Highest Attainable Standard of Physical and Mental Health (UN Human Rights Council, https://reliefweb.int/sites/reliefweb.int/files/resources/G1707604.pdf, 2017) urges the promotion of mental health for all ages in all settings as a general human right. In the historical basis for Global Mental Health, we find efforts to improve mental health for people living in under-resourced settings. According to mainstream, this means that the Global South should get better access to staff trained after standards and evidence-based treatment from the Global North. Critics rebut this approach since evidence-based practices developed in a Western setting transferred to different contexts might have unethical consequences, due to the ruling idea of a universal human, by pathologizing individuals rather than their sociopolitical-economic conditions. Attempts have been made to bypass or solve the discussion on the possibility of combining culture and the notion of a universal human which is implicit in Western evidence-based practice. Human rights and ethics-based practices are the ideals of all approaches, but all seem to have unforeseen consequences that go against these ideals. In this chapter, we take a critical look at different perspectives and the debate around ethics-based practice in mental health care in under-resourced settings.
“When you are alone you have a narrow mind, but when you are with others you think broader into the other aspects”. A qualitative study on the role of sense of belonging and mattering in attempted suicide in Uganda
(International Journal of Qualitative Studies on Health and Well-being, 2024-11-02) Knizek, Birthe Loa; Mugisha, James; Kinyanda, Eugene; Hagen, Julia; Hjelmeland, Heidi
Introduction: Suicide is globally a severe problem with an estimated 700.000 deaths annually. Six of the 10 countries with the highest suicide rates worldwide are in Africa, though, reliable statistics are scarce. Method: In this qualitative interview study in Uganda, we analysed the stories of 16 people admitted to hospital following a serious suicide attempt. We focussed especially on each person’s decision process towards their resolution to attempt suicide. Findings: Despite the huge heterogeneity of the narratives, we could identify problems regarding the sense of belonging and mattering in all the stories. Both the sense of belonging and mattering have been related to suicidal behaviour in earlier theories, but they were never studied together or under consideration of the influence of this specific cultural context. We found that the participants’ sense of belonging and mattering to a large degree was influenced by their traditional communalistic context with a worldview where the line between the natural and spiritual world was blurry. Conclusion: This kind of knowledge could be a valuable source for health professionals in their treatment of suicidal persons; it could direct their approach to the core of each person’s relational problems and meaning-making, which is crucial for their decisions with regard to suicide.