Background: About 76% and 85% of people in low and middle-income countries with severe mental illness did not get management because of fear of expected discrimination. Studying the intention to seek help for mental illness will, therefore, help to know their intended plan for help that would have a vital role to access patients with mental illness. Despite this, literature is limited in the area and community-based studies are scarce in Africa in general and Ethiopia in particular concerning help-seeking intention towards mental illness and its associated factors. Therefore, we assessed the pattern of intention to seek help and associated factors for mental illness among residents of Mertule Mariam town that would fill the gap in evidence and serve as baseline information for public health intervention. Methods: A community-based cross-sectional study design was conducted from May to June 2017 at Mertule Mariam town. General Help-Seeking Questionnaire (GHQ) was used to assess the intention of help sought. Focus group discussion had also been employed to obtain qualitative data. A multi-stage sampling technique was used to obtain a total sample of 964 participants. Data were fed into Epi Info 7 and analyzed using SPSS version 21. The binary logistic regression method was used and an odds ratio with its 95% confidence interval was computed. Variables in multi-variable logistic regression were considered as an independent predictor of help-seeking intention to mental illness if their P value was less than 0.05. Result: About 81.5% of respondents had the intent to seek help from healthcare workers. But 44.6% of participants had the intention to seek from traditional healers. Variables that had an association with help-seeking intention were having an idea that mental illness needs treatment (AOR = 3.42, 95% CI 1.1-10.55), age group of 25-34 years (AOR = 1.46, 95% CI 1.02-2.09), mild social support (AOR = 1.85, 95% CI 1.25-2.72), and perceived severity of mental illness. Conclusion: Community help-seeking intent for mental health problems was still inadequate. So strengthening to deliver information about mental illness through media like radio and television to advance help-seeking intention of the community was mandatory.
This study assessed the magnitude of help-seeking intention and its associated factor for mental illness among residents of Mertule Mariam town. The study utilized both quantitative and qualitative methods and was conducted in Mertule Mariam town from May to June 2017. Mertule Mariam town is located 364 km far from Addis Ababa, the capital city of Ethiopia. The town has a total population of 12,082(30), 6028 males and 6054 females. Regarding health facilities the town, has one hospital, one health center, and four private clinics. Moreover, the town has been geographically demarcated into two administrative kebele with 2848 households in kebele one and 2833 households in kebele two. The Mertule Mariam primary hospital provides multiple services like chronic care service, inpatient and outpatient services, ophthalmic services, maternal and child health series, Human Immune Deficiency Virus treatment, and prevention service. Mental health service is also one of the services delivered in this hospital. The psychiatric unit of the hospital has both outpatient service and inpatient service which are staffed by four BSc psychiatric professionals. According to the staff report, the traditional healers link the psychiatric patients to a psychiatric unit of Mertule Mariam Primary hospital. The sample size had been estimated with a single population proportion formula. The assumptions taken into consideration during the estimation of the sample size include the magnitude of help-seeking intention 59% [14] from a previous Ethiopian study and z-value of 1.96, margin of the error to be tolerated to be 0.05, design effect of 2 and non-response rate of 10%. So the total estimated sample size was 794. However, we also considered sample size calculation for the associated factors of help-seeking intention towards mental illness. So in this case, we calculated sample size using stat calc of Epi Info version 7 by taking confidence interval = 95%, power = 80%, design effect = 2 and an odds ratio of 0.55 for family history of mental illness which yielded the highest sample, 964 which was the final sample size for this study. A total of 964 adult people in the town aged 18 years and above who were available at home during the data collection period were joined in this study. A multi-stage sampling technique was employed. A systematic sampling method was also used to select households. If two or more adults were living in the households, to select the adult who participates in data collection, the lottery method was employed. The study excludes those who were severely ill due to any form of medical illness that prevents them from giving an interview. The dependent variable was help-seeking intention, whereas the independent variables include socio-demographic factors (age, sex, ethnicity, religion, marital status, educational status, occupational status, and family income), and illness perception factors. Data were collected by interviews using a semi-structured questionnaire by using the translated Amharic version of the questionnaire. General Help-Seeking Questionnaire (GHSQ) had been implemented for the assessment of help-seeking intention for their perceived mental illness [16]. In addition to this, Community Attitude Towards Mental Illness Inventory (CAMI) was utilized to assess community attitude towards mental illness [17]. The overall reliability of CAMI was a = 0.84. Moreover, the Mental Health Knowledge Schedule (MAKS), Oslo 3-item social support scale and illness perception questionnaire were employed to assess knowledge about mental illness, social support level of participants and illness perception about mental illness, respectively. The questionnaire was pre-tested on 5% (49) of the total sample size participants and we did not include the results of the pretest in the final analysis. Focus group discussion which had a member of religious leaders, health workers and community participants who were selected purposely was also conducted to obtain the qualitative part of the data. The principal investigator moderated the discussion of focus group discussion. Audio records and hand notes were used during the discussion. Data collectors and supervisors were trained for 2 days. The collected data were reviewed and checked for completeness daily. The quantitative data were entered using Epi info 7th version and exported to SPSS version 21 for analysis. Data were explored using descriptive statistical measures. Bivariate and multi-variable binary logistic regression analyses were used. A P-value of less than 0.2 on bivariate logistic regression was used to screen variables to be entered into multi-variate logistic regressions. Then independent variables with a p-value less than 0.05 on the final model were considered as determinants of help-seeking intention. The strength of the association has been illustrated by the odds ratio (OR) with its 95% confidence interval. Thematic analysis was also enrolled in the analysis of the qualitative part. Attitude: measured based on four subscales of CAMI; authoritarianism, benevolence, social restrictiveness, and community mental health ideology. Attitude scores are dichotomized by their mean score [17]. Good knowledge: was defined if the participants answer the knowledge questions greater than the mean score [18]. Good help-seeking intention: was defined if the participants intend to seek help from health workers for personal or family mental illness when they thought they have a problem. Social support: was categorized as poor if the score is 3–8, moderate if between 9 and 11 and strong if an overall score was between 12 and 14 [19]. Ethical clearance was obtained from the institutional review board of the University of Gondar College of medicine and health science and review committee of Amanuel Mental Specialized Hospital. Permission letter from the Mertule Mariam town administration was also requested and obtained so that distributed to the two kebele administrations before the starting of the study. Written consent was obtained from each participant after full information regarding the study was supplied. The name of the participants was not included in the questionnaire and therefore the information gathered from the participants was kept confidential.
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