Development and validation of a contextual measure of functioning for people living with severe mental disorders in rural AfricaReportar como inadecuado

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BMC Psychiatry

, 16:311

Psychotic disorders


BackgroundMost measures of functioning in people with severe mental disorders SMD have been developed in Western societies. Many of the questions in these scales are culture-bound, fail to capture differentiation of tasks by gender and are difficult to adapt to other contexts. The aim of this study was to develop a measure of functioning for people with SMD which is contextually appropriate for a rural African setting.

MethodsA review of existing scales, a qualitative study, free listing and pile sorting exercises, and expert consensus were used to establish a pool of items. Cognitive interviewing guided initial item reduction and refinement. The resulting scale was pilot-tested in people with SMD n = 200 and their caregivers n = 200 to inform further item reduction based on psychometric properties. The final Butajira Functioning Scale BFS comprised 33 items that were common to both men and women, and an additional eight items for women only, covering the following domains: self-care, work, and family and community participation. Psychometric properties of the finalized BFS were examined in a facility-based sample of 150 people with SMD and their caregivers n = 150, with longitudinal follow-up of n = 84.

ResultsThe BFS in people with SMD had excellent internal consistency Cronbach’s α = 0.99, acceptable convergent validity r = 0.88 with the World Health Organization Disability Assessment Schedule WHODAS-2.0 and r = 0.32 with the Brief Psychiatric Rating Scale BPRS-E and was sensitive to change following treatment effect size =0.50. Addition of the items specific to women did not improve the psychometric properties. The caregiver version had similar psychometric properties but higher mean values for each item and better responsiveness to change. Exploratory factor analysis of the BFS provided evidence of construct validity, with four underlying dimensions.

ConclusionsWe have developed a measure of functioning for people with SMD in a rural, low income country setting with acceptable psychometric properties. The BFS is easy to administer, sensitive to changes following treatment and has content, construct and convergent validity. The BFS includes domains from existing measures, but has more emphasis on social and occupational domains, which reflects priorities in the setting.

KeywordsFunctioning Disability Validation Sensitivity to change Factor analysis Africa Ethiopia Mental disorders AbbreviationsBFSButajira functioning scale

BPRSBrief psychiatric rating scale

DSMDiagnostic and statistical manual for mental disorders

DSSDemographic surveillance site

ESEffect size

LMICsLow and middle income countries

SMDSevere mental disorders

SNNPRSouthern Nations, Nationalities and People’s Region

SRMStandardized response mean

WHODASWorld Health Organization Disability Assessment Schedule

Electronic supplementary materialThe online version of this article doi:10.1186-s12888-016-1022-3 contains supplementary material, which is available to authorized users.

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Autor: Kassahun Habtamu - Atalay Alem - Girmay Medhin - Abebaw Fekadu - Martin Prince - Charlotte Hanlon


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