|Year : 2018 | Volume
| Issue : 2 | Page : 155-161
Sociodemographic profile and mental health orientation of self-help group members in rural Karnataka
Basavaraj Shrinivasa1, Navaneetham Janardhana2, Bergai Parthasarathy Nirmala2
1 PhD Scholar, Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
2 Additional Professor, Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
|Date of Web Publication||31-Dec-2018|
Dr. Bergai Parthasarathy Nirmala
Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bengaluru - 560 029, Karnataka
Source of Support: None, Conflict of Interest: None
Background: Perception of the people about mental illness will have a substantial impact on the treatment outcome and quality of life of people affected since it greatly influences the identification, help-seeking behavior, and stigma attached to it. To realize the goal of community-based mental health care, community needs to be educated on mental health issues.
Aims: The aim of the study is to ascertain the sociodemographic profile of the members enrolled in self-help group (SHG) and their orientation toward mental illness (OMI).
Materials and Methods: A cross-sectional research design was employed to assess the orientation of SHG members toward mental illness using OMI scale. Descriptive statistics and nonparametric tests were used for the analysis of the data.
Results: Overall, participants obtained score of 212.50 which was above than the cutoff score, indicating unfavorable orientation to mental illness.
Conclusion: Assessing and orienting the members of SHGs on mental health issues will aid in addressing the need to include an economic empowerment and social inclusion component while scaling up of mental health services in low- and middle-income countries. Further intervention model that is acceptable to the local community needs to be developed, and the efficacy of such intervention programs needs to be tested scientifically.
Keywords: Knowledge, literacy, mental health, orientation, self-help group
|How to cite this article:|
Shrinivasa B, Janardhana N, Nirmala BP. Sociodemographic profile and mental health orientation of self-help group members in rural Karnataka. Arch Ment Health 2018;19:155-61
|How to cite this URL:|
Shrinivasa B, Janardhana N, Nirmala BP. Sociodemographic profile and mental health orientation of self-help group members in rural Karnataka. Arch Ment Health [serial online] 2018 [cited 2019 May 26];19:155-61. Available from: http://www.amhonline.org/text.asp?2018/19/2/155/248884
| Introduction|| |
Reaching the unreached is a growing and vital concern of the professionals working in the field of mental health throughout the globe and more so in low- and middle-income (LAMI) countries. Poor awareness about psychiatric illnesses in the community, perceived social stigma attached to treatment seeking, priority not being given to health in general and mental health in particular, poor quality of health-care services, the scarcity of trained workforce in the field of mental health, and inequity in the regional and global distribution of these specialists are some of the reasons contributing to this.,, The shortage of human resources to cater to the needs of affected people considered to be a major barrier in order to address the global challenge of scaling up mental health services to reduce the substantial treatment gap. To overcome this, task sharing has been proposed as a main strategy., This approach has already proved that individuals with no mental health background can deliver psychological treatments effectively with relatively little training and continuous supervision,,, and it has been widely used throughout the globe in the field of maternal and child health,, to provide psychosocial interventions in common mental disorders, and while working with mental health issues among people with human immunodeficiency virus.
Understanding the orientation of particular group toward mental illness informs what they know and do not know at the outset, setting the direction for what needs to be done further. It is important to understand and take account of their views on mental health and illness before providing them with mental health training to improve their mental health literacy and utilize them further in the field of mental health. In this direction, number of studies were conducted for general community,,, medical, and paramedical professionals, community or village health workers, on assessment of various aspects of mental health, and interventions to improve the knowledge, attitudes, or literacy. However, to the best of our knowledge, such attempts were not made to tap the potentials of self-help groups (SHGs) primarily working for economic and developmental activities in the community by targeting its members through such programs. The SHGs are novel and innovative organizational setup in India for the upliftment and welfare of people from rural background, especially for women who are mostly invisible in the social structure. They are increasingly accepted as a vehicle to reach the underprivileged sections of the society as group becomes the medium for any action and change. The present study is a novel attempt to examine the mental health orientation (MHO) of SHG members so that they can be trained further in the field of mental health. Subsequently, they can be used in the respective communities in the identification and referral of the people with mental health issues to the specialists.
| Materials and Methods|| |
A cross-sectional research design was used to assess the MHO of SHG members.
Participants and setting
Shri Kshetra Dharmasthala Rural Development Project (SKDRDP) is a charitable trust promoted by Dr. D. Veerendra Heggade, with the mission of sustainable inclusive rural development of poor and marginalized sections of society. For this purpose, they organize SHGs and are active throughout the state of Karnataka with its community development programs and have huge number of people as its members. SKDRDP has 332,000 active SHGs having total membership of 3,557,300 by 2015–2016.
Pandeshwara Federation of SHGs of Udupi district under SKDRDP, Karnataka, India, had 17 SHGs with an approximate of 10–12 members in each group. Although the majority of the groups are with females, there are few groups with only male members. A total of 30 SHG members aged above 18 years, being able to read and write the local vernacular language Kannada, were selected randomly using lottery method from the Pandeshwara Federation participated in this study before undergoing 2 days MHO program.
This study is part of the dissertation submitted as partial fulfillment of MPhil Degree in Psychiatric Social Work. The ethical considerations of the study were reviewed and approved by the Institute Ethics Committee. Formal permission from concerned authorities was obtained before approaching the participants. After explaining about the study, the written consent from the participants were taken. The participants had the option to opt out of the study at any time, and confidentiality was ensured.
Sociodemographic interview schedule
The sociodemographic interview schedule had the details pertaining to age, gender, education, marital status, religion, occupation, duration of the membership, and their experience with person having mental health issues.
Orientation toward mental illness scale
The tool developed by Prabhu, is a 67-item scale aims at measuring the individual's degree of unfavorable orientation to mental illness. The score range falls between 67 and 335. It taps various aspects of orientation to mental illness providing scores on 13 factors, subsumed under 4 domains. The respondents are required to indicate the degree of his or her agreement or disagreement on a five-point Likert scale ranging from disagree (1) to completely agree (5). The scores of each item are summated, and a total score on each factor is obtained; the higher total score indicating more unfavorable the orientation. There are no cutoff scores given by the author to decide on favorable or unfavorable orientation toward mental illness (OMI). Hence, it was decided based on the hypothetical mean which was calculated by adding the maximum scores that the respondent can get on a scale to the minimum scores divided by two. Further scale was translated into Kannada language and validated by experts.
Statistical data management and analyses of the data were carried out using the Statistical Package for the Social Sciences version 22 for Windows (IBM Corp; Armonk, New York, USA). Descriptive statistics such as frequency and percentage were used to explain the sociodemographic details of the participants. The domain-wise scores were analyzed using median and interquartile ratio. To see the differences in the OMI based on some of the sociodemographic variables, Mann–Whitney U-test and Kruskal–Wallis test were performed.
| Results|| |
[Table 1] depicts the sociodemographic profile of the participants. The mean age of the members participated was found to be 33.03 (±10.7), and majority of them were below the age of 40 (n = 21), belonging to female gender (n = 28; 93.3%), studied up to high school education (n = 22; 73.3%), and married (n = 20; 66.7%). In the occupational backgrounds of the SHG members, equal percentages (26.7%) of SHG members were coolies and factory workers. The same percentages of members were belonging to “not working” group which included homemakers and others who were not working but being productive otherwise. Another 20% of them were doing other works. In the category of income, about 23.3% of them were not having any monthly income as they constituted the group of “not working” or “homemakers.” Among them, 16 of the participants were earning lesser than 4000 and 7 of them more than 4000 on monthly basis. Last category of the table shows the duration of membership of the SHG members. In terms of duration of membership in years, around 46.6% of the participants were members of the SHG for >5 years, 9 of them were in the criteria of 2–5 years, and 7 of them were members for <2 years.
[Table 2] describes the experience of the SHG members with persons having mental illness.
|Table 2: Experience of the self-help group members with persons having mental illness|
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The median score of the participants on different domains and subdomains of the OMI scale is reported in [Table 3]. Overall, participants obtained score of 212.50 which was above than the cutoff score of 201, indicating unfavorable OMI. This cutoff score to decide whether SHG members had a favorable or unfavorable attitude toward mental illness was calculated by adding the maximum scores that the respondent can get on a scale to the minimum scores divided by two.
|Table 3: Scores of the self-help group members on orientation toward mental illness scale|
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An examination of the findings in [Table 4]a reveals the result of Mann–Whitney U-test for the relationship between some of the sociodemographic variables and OMI. Findings suggest that except the participants' marital status (U = 37.500, Z = −2.751, P = 0.006), other variables such as family history of mental illness (U = 72.500, Z = −0.392, P = 0.695), encounter with mentally ill (U = 77.500, Z = −0.770, P = 0.441), and their education (U = 55.500, Z = −1.525, P = 0.127) did not make statistically significant difference in their OMI.
A Kruskal–Wallis test was used to find out the difference on the OMI among the participants based on their differences in the age, income, occupation, and duration of membership. However, there was no statistically significant difference in the OMI based on the different categories of participants' age, χ2 (2) = 3.758, P = 0.153. Duration of membership in the SHGs also did not make any statistically significant difference in their OMI, χ2 (2) = 3.502, P = 0.174. The same test was run once again to see if the monthly income of the participants had made any difference in their OMI. Result revealed that income earned by members on monthly basis did have statistically significant influence on their OMI, χ2 (2) = 10.437, P = 0.005. However, when members' OMI was assessed based on their occupation, it revealed that their occupation did not influence their OMI significantly, χ2 (3) = 7.704, P = 0.053 [Table 4]b.
| Discussion|| |
Since mental health problems occur in the psychosocial context, the perception of general public about mental illness will have a substantial impact on the treatment-seeking behavior and stigma attached to the illness which ultimately impacts the treatment outcome and quality of life of people affected. Hence, there is a strong need to understand the local context before developing appropriate interventions that are acceptable to the local community. The present study is a preliminary effort in that direction to utilize the underutilized SHG population in the field of mental health.
The sociodemographic profile of the participants of the study reveals that the mean age was 33.03 (±10.7) and majority of them were below the age of 40, belonging to female gender (93.3%). These SHGs are primarily involved in developmental activities in the community for poor and marginalized through providing the microfinancial services. The members who get enrolled in the SHGs usually will be in their productive age of 18–40 since they are involved in income-generating activities through these SHGs. The ratio of females compared to males is high as the representation of SHGs with female members under the SKDRDP was more compared to SHGs with male members and it also true with most of the other SHGs run under different banners.
In the current study, among 30 SHG members, 7 (23.3%) of them reported that they had someone in the family with the history of mental illness which is almost in line with the previous study conducted in the same district in which around 18% of the participants had known at least one family member or relative having mental illness either currently or in the past. One possible reason for this could be the difficulty participants had in differentiating between mental illness and mental retardation. Although 21 from the total number of participants had reported of seeing mentally ill around them in their community, only 10% of them offered psychological help by referring them to mental health professionals. It could be due to the fact that these SHGs are primarily working for economic and developmental activities and mental health issues might not have been covered under the programs of the SHGs.
Few studies were attempted to assess the community perception toward mental illness,,,,, and the results of all these studies largely revealed stigmatizing attitude toward mental illness and mentally ill people were valued negatively by most of the participants of those studies. In the current study, overall, on OMI scale, participants scored a median score of 212.50, indicating that they were unfavorable in their OMI. The findings of our current study are in accordance with the result of the previously quoted studies.
In the area of causation domain of OMI, the participants were more in favor of psychosocial stressors such as suffering from the personal tragedy, loss of close relative, issues in the family or marital life, frustration in love, and excessive drinking of alcohol as causative factors for mental illness than supporting the generally prevailing folk beliefs in the community or organic causes such as nervous disease or brain damage as reasons for mental illness. This is in line with findings of the study conducted in rural Maharashtra, India, assessing the community beliefs about the causes and risk factors for mental disorders which found that participants primarily subscribed to a social model of mental health and illness and acknowledged ranges of socioeconomic factors such as conflict with family, at work and with neighbors, an addicted family member, bereavement, financial difficulties, and problems in childhood as cause for the mental problems. Stressful conditions of day-to-day life as reasons for the development of mental illness have also been reported by studies conducted at Jhansi and South Delhi, India, which is similar to the observations in the current study.
In the perception of abnormality domain of OMI, participants endorsed the public stereotype of persons with mental disorders and perceived persons with mental illness as violent and dangerous to people around them, speaking irrelevantly and appeared saliva dribbling from their mouth. Likewise in a study conducted by Gureje et al. in Nigeria, people's view about the mental illness were generally negative and they believed mentally ill to be a retarded, public nuisance and considered to be dangerous. They were also considered to be unpredictable and different from other people and difficult to engage in a conversation with.
Since most of the participants of this study felt that psychosocial stressors are the major reasons for people to have mental illnesses, they believed that the manipulation in the psychosocial environment of the persons with mental illness is the best way to handle their problems than the folk therapy or physical methods of treatment. Participants from the study conducted in India on mental health training for community health workers also considered psychosocial interventions such as physical activities for the affected and listening to the person suffering from illness helpful in getting better from the condition. In another study, one-third of the participants felt that mental health issues can be prevented by having a friendly environment at home, sharing one's problems with others, and practicing yoga and meditation to relieve the stress.
Although participants of our study did not have major hopeless attitude toward mental illness, they did have the rejection feeling toward mentally ill people and believed that once people are affected with mental illness, they will not be able to function like earlier. It accords with the observations of other study where public felt that very few people could work in regular jobs and most would be afraid to have a conversation and work with a person with mental illness.
In the current study, participants' marital status and monthly income were the only two variables which had significant influence on their OMI whereas other sociodemographic variables such as age, education, occupation, duration of membership in the SHGs, family history of mental illness, and encounter with mentally ill people did not make any difference. The study conducted by Yuan et al. which included participants with Indian ethnic background found that married and people with lower socioeconomic status were associated with more prejudice and misconception toward people with mental illness and appears to be less tolerant of mentally ill patients. The findings of the current study are in consonance with that. This could be due to the fact that unmarried participants usually are of younger age that tends to be more educated than the older counterparts.
In this study, participants' OMI did not differ based on the age category which is in agreement with the findings of the previous studies,, where no significant association was found between age and community perception toward mental illness. Unlike in other studies,,,, participants' literacy level and occupation did not made any difference in their MHO here. Earlier studies on the influence of personal experience with mental illness,, on the attitude toward mentally ill revealed of having an informed and positive public views which is contrast with the findings of the current study where contact of participants with mentally ill or having someone in family with mental illness made no difference in their attitude toward mentally ill. It is believed that the effect of contact with mentally ill person on one's attitude largely depends on the nature of the contact and nature of the illness. Similarly, the duration of membership in the SHGs also did not make difference in the participants' MHO. It might be attributed to the fact that mental health issues not being given due importance such as other economic empowerment or developmental activities of the SHGs.
The findings of the study have its share of limitations, so it should be interpreted with caution. One of the main limitations of the study being the small sample size which increases the chances of assuming a false premise as true and limits the generalizability of the study findings. Since the data were collected in a group format, the chances of participants giving socially desirable response cannot be undermined.
| Conclusion and Recommendation|| |
Overall findings of the study reveal that the SHG members as participants of the study had unfavorable attitude toward mental illness. The Lancet Global Mental Health Group has already highlighted the need to include an economic empowerment and social inclusion component while scaling up of mental health services in LAMI countries. In this direction, assessing and orienting the members of SHGs primarily involved in economic and developmental activities on mental health issues will go a long way. Further, intervention studies to address the knowledge and attitude need to be framed, and the efficacy of such intervention programs needs to be tested scientifically to make the community-based mental health care a reality.
This article is based on the dissertation entitled “Mental Health Orientation for Self-Help Group Members – A Feasibility Study” submitted by the first author under the guidance of the corresponding author to the National Institute of Mental Health and Neurosciences, Bangalore, India, in the year 2013, for the degree of MPhil in Psychiatric Social Work.
Financial support and sponsorship
This work is supported by Junior Research Fellowship awarded by the University Grant Commission, Government of India, New Delhi (Ref No. 1290/NET-June, 2013), to the first author of the manuscript.
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]