COllaborative Shared care to IMprove Psychosis Outcome (COSIMPO): study protocol for a randomized controlled trial

Area of Science:

• Global Mental Health
• Psychiatry
• Public Health Policy

Background:

• Psychotic disorders cause significant disability and burden in low- and middle-income countries (LMICs).
• Traditional and faith healers are primary care providers for individuals with psychosis in many LMICs.
• Collaboration between complementary and conventional health providers for psychosis care is under-researched.

Purpose of the Study:

• To evaluate the effectiveness of a collaborative shared care (CSC) intervention for patients with psychosis in Nigeria and Ghana.
• To compare CSC, involving traditional healers and primary health care providers, against care as usual (CAU).
• To assess if CSC improves clinical outcomes and reduces harmful treatment practices.

Main Methods:

• A single-blind, cluster randomized controlled trial (RCT) involving 296 participants across 51 clusters.
• The CSC intervention included regular visits by primary health care providers (PHCPs) to complementary and alternative health provider (CAP) facilities.
• Outcomes measured included the Positive and Negative Symptom Scale (PANSS), disability, harmful practices, victimization, stigma, and caregiver burden at 3 and 6 months.

Main Results:

• The study hypothesizes that CSC will lead to better clinical outcomes and fewer harmful treatment practices compared to CAU at 6 months.
• Primary outcome is improvement on the Positive and Negative Symptom Scale (PANSS) at 6 months.
• Secondary outcomes include reduced disability, harmful practices, victimization, stigma, and caregiver burden.

Conclusions:

• Findings on the feasibility and effectiveness of collaboration between traditional and conventional health providers are crucial for policy development.
• This research informs policies for integrating traditional and faith healers into public health systems for psychosis care.
• Evidence on improved patient outcomes from collaborative care models can guide mental health service delivery in LMICs.