Friday, March 24, 2017

Research

The Faculty at the Department of Mental Health Education in collaboration with faculty of other departments and institutions conduct innovative research related public health issues. The focus has been on alcohol, reproductive and sexual health, psychosocial aspects HIV including stigma and the development of appropriate research methodologies especially the integration of qualitative and quantitative research methods. Research on school mental health, geriatrics, life skills education, community mental health, suicide prevention, to is planned.  We conduct research using multiple research designs and methods for evaluating interventions, applying research findings to program development, and involving community.
Ongoing and completed researches include:
Strengthening Supportive Supervision and Monitoring in Karnataka, 2007-2011, supported by Samastha. This project was carried out with major financing support from Samastha and support from UNICEF for one year.
Karnataka State AIDS Prevention Society (KSAPS) was a major partner.  Other partners included Belgaum Institute of Medical Sciences (BIMS) and KempeGowda Institute of Medical Sciences (K IMS).  Project also had collaboration with St. John’s Medical College & Hospital (SJMCH), Engender Health, SPRUHA, Samartha, Samraksha, SVYM and Snehadan.  Major activities included situation analysis development of a Learning Site (LS)to act as a demonstration centre for best practice  as well as a site for training different levels of health care workers.  Supportive supervision was the back bone of this project.  The project provided extensive technical assistance and support for system strengthening to Karnataka State Aids Prevention Society, Community Care Centres  (CCCs)and Integrated Counselling and Testing Centres ICTCs.  Health service research was inbuilt into the project – several products were developed on the basis of needs assessment and field research.
Health services research:
Situational assessment was conducted to assess knowledge and skills of the counsellors. In 2008, a knowledge survey was administered to 596 ICTC counsellors in 27 districts of Karnataka.  In addition to the survey, a limited number of counselling sessions were observed and exit interviews with patients held.  Several NGO personnel were interviewed to learn about the collaboration between counsellors and NGOs.  The knowledge survey revealed that the counsellors were not aware that the HIV viral load was high during the initial state of infection or about the dangers of recapping needles.  There was confusion about the ART regimen.  Negative attitudes and gender stereotypes prevailed. Counselling sessions were brief and focussed on information giving.  The results from this assessment were utilized to design interventions.
Assessment of intervention for infection prevention and prevention of stigma and discrimination
In order to involve all the health professionals in learning site activity and to improve the overall quality of services while protecting health professionals, infection prevention training was undertaken. Linking this to stigma and discrimination helped to address this sensitive topic in an acceptable way. A series of trainings  on  infection prevention and prevention of stigma and discrimination were held in the BIMS and were attended by 64 Doctors, 99 Nurses, 18 Group ‘D’ and 44 Laboratory Technicians.  The analysis of the post training assessments showed that there was an overall significant reduction in stigma and discrimination scores.  However, risk perceptions still remained high.  Infection prevention scores also improved.  . As a part of the training, the participants visited various sections of the hospital, assessed infection control measures, and noted corrective course of action. Subsequent to the training, an Infection Prevention Committee was formed and this Committee took decisions to improve infection control practices. Photo-documentation of this created a base line against which photos taken at the end of the intervention could be compared .To facilitate this, session on Supportive Supervision was held for the Nursing staff.
AIDS Stigma, Gender and Health in Urban India (NIH R01 grant).

This project is funded by the National Institutes of Health (NIH), USA and is conducted in collaboration with the Centre for AIDS Prevention Studies & the AIDS Research Institute, University of California, San Francisco, USA and the Tata Institute of Social Sciences (TISS), Mumbai. This project covers three population groups: ‘general population’ (530) health care workers (520) and 511 people living with HIV/AIDS (PLHA). Among the PLHA special effort was made to include marginalised people – 153 female sex workers and 54 men who have sex with men (MSM).  The highlights of the study findings are:

  • HIV Knowledge Among all groups knowledge about how HIV is transmitted in is high, however, knowledge regarding safe interactions or how HIV is not transmitted, and about preventive measures is much lower. On the whole the less educated and women have less knowledge; however women of all categories have better knowledge regarding HIV transmission through breast milk. 
  • Perception of Marginalised Groups on a Feeling Thermometer – all groups consistently give low scores to marginalised groups, even the marginalised positive people score other marginalised group members low.
  • Perceived Community Norms/Perceived Stigma – The perception of stigma is uniformly high in all the groups.
  • Reaction to HIV Test Result – Most people have a strong emotional reaction ranging from disbelief to deep sadness and hopeless with suicidal ideation.
  • Disclosure – With perception of high levels of stigma and consequent negative reactions, understandably most people fear disclosure. Disclosure avoidance behaviours place a high burden on the individual and isolate them from social support and deter health seeking. Strongly indicating the need for several sessions of counselling.
  • Behaviour Intentions – Among general population, stigmatising behavioural intentions and endorsement of punitive measures are strongly associated with less knowledge of how HIV is not transmitted, lower education (a proxy for social class) and a strong perception that stigma is high in the community. All HCWs reported that they would treat/provide services. Despite high knowledge  regarding how HIV is not transmitted health care workers feel vulnerable and take scientifically unwarranted precautions (such as wearing gloves for a routine physical examination/measurement of blood pressure) that are perceived by positive people to be stigmatising and discriminatory.
  • Internalised Stigma and Enacted Stigma – Internalised or self-stigma is high especially among marginalised groups and men, they also experience a sense of guilt. This internalised stigma affects their self-esteem and confidence and many of them do not disclose their HIV status and curtail interaction as they anticipate stigma. Enacted stigma is comparatively less, but some been abused and ostracised by their family and relatives. Overt discrimination in the health care field is less, but some report needless referral.
  • Quality of Life- Lower quality of life was related to lower education, being a female sex worker, having higher levels of stigma, especially self-stigma, less disclosure and adoption of disclosure avoidance behaviours, less social support and having more symptoms.

Some of our research initiatives are

    • Outcome of a School Based Health Education Programme for Epilepsy Awareness among Teachers and School Children [NIMHANS Funded]: An operational feasibility health education program is being carried out by the researcher for educating the teachers and school children about epilepsy and assessing their knowledge, attitude, beliefs and practices. The study would also assess the training of trainers methodology in School based Health education intervention program on epilepsy awareness for teachers and students.