by Matthew Smith
A prestigious grant from the National Institutes of Health will allow a University of North Carolina at Chapel Hill School of Social Work associate professor to test the effectiveness of mental health interventions in Tanzania.
Joy Noel Baumgartner and her colleagues secured the $3,735,788, five-year R01 grant earlier this spring from the National Institute of Mental Health. The awards are the NIH’s original and oldest grant program, providing support for institutes’ health-related research.
The project is an expansion of a pilot study Baumgartner led in from 2017-21.
“During that pilot study we saw significant findings on improvements of quality of life,” Baumgartner said. “Quantitatively, it was a successful pilot trial. Qualitatively, we heard great feedback from the patients living with schizophrenia, their families, and their health care providers. The Tanzanian government was interested in working with us to scale the project and test it.”
Cultural fit
Baumgartner and her long-term research partner, Sylvia Kaaya, knew they needed a culturally tailored family psychoeducation model. Kaaya, professor of psychiatry and mental health at Muhimbili University of Health and Allied Sciences in Dar es Salaam, Baumgartner, and other team members worked to turn an evidence-based practice from the U.S. into a model that would work in a low-resource setting with attention to the social context.
“The intervention is family-involved and group-based,” Baumgartner said. “The patient works together with a family member, caregiver or recovery partner during the intervention.”
The practice has been shown to help family well-being, reduce relapse rates, and increase participation in vocation rehabilitation.
During the trial, the patient and a family member will go through the intervention as a “pair.” The trial begins with pairs taking an all-day education workshop while learning more about schizophrenia and management issues while building a community. The pairs then participate in 12 group sessions focused on problem solving and tackling issues around their mental illness.
“The groups themselves are doing the problem solving,” she said. “These solutions aren’t just coming from a clinician, but from the entire group. That is what is unique about it.”
Traditionally, schizophrenia in Tanzania has been treated with just medication, if patients receive mental health services at all. Baumgartner said there have been “minimal to non-existent” levels of psychosocial support and “the families bear the entire financial burden.”
“In Tanzania, we have very few mental health professionals to meet recovery-focused interventions for persons with schizophrenia, and also low levels of community mental health literacy,” Kaaya said. “Multi-family psychoeducation groups (KUPAA) may not only improve functioning, but also allow primary caregivers involved in sessions to gain mental health literacy and to educate other family members. This provides much needed information on schizophrenia that may strengthen the patients’ support at the family level.”
Connecting with Tanzania
Baumgartner’s interest in Tanzania stemmed from a learning opportunity.
“There are not a lot of treatments for this very distressing illness,” she said. “A few decades ago, I read about studies that highlighted that perhaps the course for schizophrenia was better in lower-to-middle income countries and that’s what piqued my interest about working in Tanzania.
“I wanted to see if maybe they were doing something better than we were; if they were doing something that we could learn from them. So, it wasn’t me bringing something to them — it was me going there to see if there was something I could bring back.”
That’s why the family component was vital to include, Baumgartner said.
“Culturally, we needed to tailor the intervention to work in Tanzania,” she said. “That involved bringing in a layperson to help facilitate care. It had to be family based and we had to address their traditional ideas and beliefs about mental health into our education and workshop materials.”
Sharing knowledge
The study hopes to find ways to bring the family-centered care model back to the U.S.
“Some of my partners and I have been working on this topic for nearly 24 years,” Baumgartner said. “Treating and managing schizophrenia is hard. Family psychoeducation has not scaled in the U.S. We want to identify some of the implementation barriers that can help people not just in Tanzania, but in North Carolina as well.”
Baumgartner said the study hopes to enroll 432 patients into the study. The first year will focus on stakeholder and community engagement, while also setting up the clinical trial sites. Overall, there will be 14 health facilities across four regions in Tanzania. The trial is expected to run for five years.
Colleague Paul Sarea Lawala, executive director of Mirembe National Mental Health Hospital in Dodoma, Tanzania added, “The study sites have been carefully selected to increase the potential of going to scale in the study districts and regions, and perhaps nationally, since improving mental health care has become an important focus of Tanzanian health policy and psychosocial interventions have traditionally been ignored in our context.”
The trial will be held in collaboration with Duke University and four Tanzanian institutions including Muhimbili University of Health and Allied Sciences in Dar es Salaam, Mbeya Zonal Referral Hospital in Mbeya, Mirembe National Mental Health Hospital in Dodoma, and Kilimanjaro Christian Medical University College in Moshi.
Section member selection
Along with her recent grant award, Baumgartner was invited to serve as a study section member for the National Institutes of Mental Health’s Effectiveness of Mental Health Interventions Study Section.
As part of her role, Baumgartner will be responsible for reviewing applications that are focused on developing and testing interventions in community practice settings.
“I’ll be reviewing grant applications, everything from pilot to full scale studies,” she said.
Baumgartner was brought in for her global expertise, as the organizations seeks to expand funding into international spaces.
“It’s a good opportunity give back through service nationally,” Baumgartner said. “It’s an opportunity to give back to the scientific field and help others.”
Her appointment will last through 2028.
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