Perceptions and understandings about mental health problems of children and adolescents in Zambia : implications for innovative curriculum development for PHC practitioners.
An exploratory study covering phase 1 stages 1, 2 and 3 only was undertaken in this large hybrid research project to determine perceptions and understandings of the practitioners and the community about mental health problems of children and adolescents in Zambia because so far there is little known about this phenomenon. The aim of this exploratory study was to gain new insights into the phenomenon by undertaking a preliminary investigation to determine priorities for the future post doctoral research before a more structured study to develop the PHC innovative curriculum. The process first 'explored' social reality on the ground to better comprehend the perceptions and understandings of mental health problems of CA and the curricula model preferences as perceived by the practitioners and the community respectively. This was done to appreciate the "reality of practice" on the ground using the Systems, Ecological, and Biopsychosocial theories which underpinned the four field areas of the study which are: Mental Health, Curriculum Development, INSET and Action Research (AR). The total project is open-ended with three (3) phases and eight (8) stages, from the initial exploration of perceptions (phase 1), through reports to government and stakeholders, curriculum development and piloting with health educators (phase 2) and finally implementing the reconstructed curriculum and integration (phase 3) in such a way as to empower primary health workers to themselves do further research. This thesis, covering the initial explorations of perception, encompasses ONLY the first phase and three stages of this larger qualitative research project because of the Higher Education requirements and funding to try to complete in 4 years. This entails literature review of all 4 field areas because in order to orientate the first phase and three stages of such research and to see the implications of results, it is necessary to have a good grounding in all four. The research study process commenced with an orientation and introduction of the context and purpose of the study, followed by the search conferences and focus group meetings using Qualitative Research Design and Methodology. Search conferences, focus group discussions, hospital registers and clinic records were the three sources of data collection. Analysis of Qualitative and Quantitative Data used NVIVO and SPSS 13.0 Statistical Data Analysis Soft ware respectively. The study showed that mental health problems of Children and Adolescents perceived by the community and the practitioners were also referred and recorded in various hospital registers. The analysis of data from hospital records on referred cases further showed that there are serious psychotic mental health disorders in children and adolescents referred for further consultations to hospitals from the community, some of which are: acute psychotic states, with some associated with HIV/Aids. In addition to these psychotic states, epilepsy, drug and alcohol abuse, child defilement, rape cases, mental retardation and conversion disorders particularly in female children/adolescents appeared to be relatively significant mental health concerns and problems in the researched community sites. The conclusion of the study suggests that there were more environment related factors perceived to cause mental health challenges to children and adolescents. This finding further suggests that there are similarities of cases referred from the community with those seen in clinical practice areas. The significance of these findings in the reality of practice, implies that the preferred PRISMS curriculum model to be developed later as a post doctoral activity for 'INSET' of PHC practitioners in Zambia should have deliberate blending of curriculum content with more socio-environment related issues than the current traditional curricula models which are more clinical in structure, process and content.