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DR. P C SEN MEMORIAL AWARD FOR RURAL BASED ORIGINAL RESEARCH ARTICLE
Year : 2017  |  Volume : 61  |  Issue : 3  |  Page : 169-173  

A study on knowledge, attitude, and practice regarding mental health illnesses in Amdanga block, West Bengal


1 Assistant Professor, Department of Community Medicine, R. G. Kar Medical College, Kolkata, West Bengal, India
2 Junior Resident, Department of Community Medicine, R. G. Kar Medical College, Kolkata, West Bengal, India

Date of Web Publication15-Sep-2017

Correspondence Address:
Rivu Basu
Department of Community Medicine, R. G. Kar Medical College, Kolkata, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijph.IJPH_155_17

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   Abstract 

Background: The discourse of mental health is getting its due attention after all these years in India. A major threat to the mental health system is the demand side factors, namely, knowledge, attitude, and practice (KAP) of the general population toward this. In spite of growing concern regarding mental health in India, this kind of study to assess the mental health status has been very few in India, more so in West Bengal. Objectives: With this background, this study was carried out with the objectives to validate the Community Attitude to Mental Illness (CAMI), to assess the different sociodemographic factors among the study population, to assess the KAP regarding mental illness among the study population. Methods: It was an observational, descriptive study with cross-sectional design done at Amdanga Community Development Block, North 24 Parganas, West Bengal, India, in 2015-16. Questionnaire validation to assess the KAP was the primary objective with obtaining the descriptive data were the second one. CAMI questionnaire was used which was validated for the given area by validation methods such as Cronbach's alpha and structural equation modeling. The resultant questionnaire was used in the field on adult population after a single-stage survey design to collect 730 samples. Results: The test statistics showed that the questionnaire was reasonably valid after a few tweakings. SEM identified well-define domains in the attitude part. 94.9% says that they are willing to live with a people with mental illness. 14.9% has actually done so. Health-care seeking behavior shows that 19.2% will go to a GP in case of any mental illness. Furthermore, attitude toward mental illness showed mixed picture as also knowledge. This study correlated with various studies of developing countries and it was seen that these population showed markedly different attitudes for probability of the patients getting cured than many other countries. Furthermore, stigma was gradually decreasing, as evident from various other studies. Conclusion: This study will provide valuable insights into the cognitive and affective aspect of mental illness among these population and thus help in implementing better policies in this regard, as this is fast becoming the talk of the day.

Keywords: Attitude toward mental illness, Community Attitudes to Mentally Illness, structural equation model


How to cite this article:
Basu R, Sau A, Saha S, Mondal S, Ghoshal PK, Kundu S. A study on knowledge, attitude, and practice regarding mental health illnesses in Amdanga block, West Bengal. Indian J Public Health 2017;61:169-73

How to cite this URL:
Basu R, Sau A, Saha S, Mondal S, Ghoshal PK, Kundu S. A study on knowledge, attitude, and practice regarding mental health illnesses in Amdanga block, West Bengal. Indian J Public Health [serial online] 2017 [cited 2017 Dec 11];61:169-73. Available from: http://www.ijph.in/text.asp?2017/61/3/169/214810


   Introduction Top


The WHO defines health as “Health is a state of complete physical, mental and social well-being and not merely an absence of disease or infirmity.”[1]

From the above widely accepted definition of health, it is quite evident that it encompasses physical as well as mental health. The human mind is a set of cognitive faculties including consciousness, perception, thinking, judgment, and memory. It holds the power of imagination, recognition, and appreciation, and the same time is responsible for processing feelings and emotions, resulting in attitudes and actions.

With a sound mental health, a person can be logical and judgmental and has the ability to distinguish between the good and the evil of the society, so that, appropriate rewards and recognition of the good things of the society and at the same time punishment and derecognition of the evil matters are quite rightly taken care of to establish a state of equilibrium and harmony among the people of the society, a place where human beings can live in peace and at the same time perform certain responsibilities. A mentally ill person not only becomes a burden of the society but also at the same time becomes a potential threat for the society as they are quite often prone to indulge in antisocial activities.

Public stigma against mental health problems is damaging to people with mental illness and is associated with significant societal burden. It is a global phenomenon which is prevalent over time and place. A recent systematic review and meta-analysis of public attitudes have shown that despite improvements in mental health literacy, public attitudes and desire for social distance have remained stable over time.[2] Moreover, literature suggests that there is an association between public attitudes toward mental health and the individual stigma felt.[3] In spite of growing concern regarding mental health in India, this kind of study to assess the mental health status has been very few in India, more so in West Bengal. With this background, the study is being carried out with the objectives to validate the Community Attitude to Mental Illness (CAMI), to assess the different sociodemographic factors among the study population, and to assess the knowledge, attitude, and practice (KAP) regarding mental illness among the study population.


   Materials and Methods Top


It was an observational, descriptive study with cross-sectional design done at Amdanga Community Development Block, North 24 Parganas, West Bengal, India. It is the rural field practice area of the Department of Community Medicine, R. G. Kar Medical College and Hospital, Kolkata, West Bengal, India. Data were collected from December 1, 2015, to January 31, 2016.

Adult population (>18 years) of 81 villages of the Amdanga Community Development Block were the study population. The schedule that was applied stays valid for the adult populations only. As per record available from the Block Development Office at Amdanga, there were total 41,184 adult populations at that block in July 1, 2015. Individuals who were not able to comprehend the study schedule due to illness were excluded from the study. Those who expressed unwillingness to become a study participant were also excluded from the study. Pilot testing was done on one question only in October 2015, with 28 people, as there were no background data on prevalence, also questionnaires needed much important feedback for validity. “Consulting a general practitioner (GP) about a mental health problem” came out to be 22.8%, which was considered to be a major behavioral outcome of the study. With an allowable absolute error of 1% design effect of 1.4, the sample size came out to be 653. A 10% dropout rate raised the required sample size to 718. It was decided by the study team that all the villages should be included for better representation. Hence, a probability proportional to size strategy was adopted from villages. However, the numbers came as fractions. Thus, around nine persons were targeted to be obtained from each of the 81 villages in random order. The individual was selected by going to the center of a village and finding out the direction to start survey by lottery method. Going door to door in the direction ascertained by the lottery, nine adults for a village were interviewed consecutively. Seven hundred and thirty adults responded completely altogether.

A predesigned and pretested schedule was used for this study. The schedule had two sections. The first section comprised questions related to KAP about mental illness and the second part comprised sociodemographic information. The first part, Attitudes to Mental Illness Questionnaire was developed by the Department of Health, the United Kingdom, for this series of surveys, based on previous research in Toronto, Canada, and the West Midlands, UK. It included 26 items based on the 40-item CAMI scale and the opinions about Mental Illness Scale and an added item on employment-related attitudes. The questions covered a wide range of issues, from attitudes toward people with mental illness to opinions on services provided for people with mental health problems. The questionnaire was translated into Bengali and again retranslated and checked for consistency. A group of experts of Community Medicine and Psychiatrists from Medical College, Kolkata, gave their inputs on these questions and ascertaining face validity. The conceptual, cultural, and semantic equivalence were well judged as these questions may mean differently in different contexts. Kaiser–Meyer–Olkin (KMO) and Bartlett's test, Scree plot, factor loadings, correlation matrix, and structural equation modeling were done to ascertain discriminant validity on the attitude part only. Cronbach's alpha was done to ascertain convergent validity. Content validity (concurrent and predictive) could not be done due to paucity of the previous gold standard instruments in the area. Taking all these into account, some questions were dropped and some modified. There were five interviewers chosen to work in two different teams. They were trained to ensure reliability. A work plan was developed to cover the block in around 2 months. Supervisors from the Department of Community Medicine visited the sites regularly to check progress and assure quality.

Data were assembled in Microsoft Excel 2010 software. Results were described in terms of absolute numbers and percentage.


   Results Top


Scree plot corresponded with the idea that there are probably four domains in the attitude questionnaire. Domain-wise Cronbach's alpha revealed that fear and exclusion of persons living with mental illness has a value of 0.721, integration with health services (0.426), tolerance toward patients having mental illness (0.531), and causes of mental illness (0.61). Furthermore, knowledge and practice part had a value of 0.73 KMO and Bartlett's test. [Figure 1] shows the structural equation model of the variables. This showed that the domains have poor correlation and the goodness of fit index as 0.935 (acceptable). In [Table 1], it can be seen that out of the total 730 study population, 345 (47.3%) were male and 385 (52.7%) were female. Highest number of respondents belonged to age group of 20–40 years were 389 (53.29%). Most of them had primary education 283 (38.8%) and majority of them were unskilled workers 340 (46.6%). [Table 2] shows the distribution of the study population according to the knowledge regarding mental illness. A substantial population (73.3%) still feels that the mental health patients should be kept in mental hospitals. 78.1% feels that they are prone to violence. However, 71% believes that it can be cured through medication. [Table 3] shows distribution of the study population according to attitude regarding mental illness. Regarding fear about mental illness, 52.5% of population still believes that a woman would be foolish to marry a man who has suffered from mental illness even though he seems fully recovered. However, tolerability seems to be better with 90% supporting that mentally ill patients need to be responsibly looked on, and need to adopt a far more tolerant attitude toward people with mental illness in our society. Integration showed a good response with 77.4% saying that residents have nothing to fear from people coming into their neighborhood to obtain mental health services. However, 62.1% still believe that mental illness is caused due to the lack of willpower.
Figure 1: Structural equation model of attitude part of the questionnaire.

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Table 1: Distribution of the study population according to sociodemographic characteristics (n=730)

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Table 2: The knowledge regarding mental health among the study population (n=730)

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Table 3: Distribution of the study population according to attitude regarding mental illness (n=730)

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About the reported and intended behavior of persons toward mental illness [Table 4], 94.9% says that they are willing to live with a people with mental illness. 14.9% has actually done so. Health-care seeking behavior shows that 19.2% will go to a GP in case of any mental illness [Table 5].
Table 4: The reported and intended behavior of persons toward mental illness (n=730)

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Table 5: Health-care seeking behavior of participants (n=730)

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   Discussion Top


The KAP regarding metal health illness among adult population in rural area in the Amdanga Block, West Bengal, were studied by us. In our study, we did not focus any particular type of mental illness rather we considered every kind of mental illnesses in general. A large-scale, community-based study had been done regarding mental health so that any appropriate policy can be prepared for promotion attitude, knowledge, and practice of community toward the mental illnesses.

In our study, it was found that there was a positive participation of community regarding socially acceptance of mentally ill patients, about treatment outcome and also modest attitude toward mentally ill patients. Most of the participants agreed that mental illnesses were similar like other diseases and it can be treated by proper medicine and normal day-to-day involvement. They also considered the need of mental health care to be a community-based service. There were different studies in different countries such as South Africa and also in India showing similar type of result.[4] A study in India showing that almost 40.2% of participants in rural area, 33.3% of participant in urban area believed that mental illnesses were untreatable.[5] However, in our study, it is showing that the condition is different. Almost 70.96% people were accepting the fact that mental diseases can be curable. Different studies in India were showing that there was stigmatic attitude of community toward mentally ill patients. The people of community think that mentally ill patients were dangerous, harmful, unpredictable, and worthless.[6],[7],[8] Another study in India reflecting that 36.9% of rural participate and 43.2% of urban participate unwilling to marriage with a person recovered from mental illness.[5] Many study showing that mentally ill patients were ignored and neglected and considered as social burden.[9] However, in our study, it is showing that social stigma among community toward mentally ill patients is gradually decreasing. Almost 90% of participants considered that mentally ill patients should be accepted cordially in society. Our study findings tally with some study in India showing the decreasing trends of community stigma toward mentally ill patients.[10] However, still some stigma were present in our study participants also. Almost 10% of participants still believe that mentally ill patients are burden of society, and almost half of the participants (50.96) do not want to give any responsible work to mentally ill patients. Almost 73.15% of participants feel uncomfortable about discussing their mental health problems if ever occur. However, by comparing with various previous studies which showing many stigmatic attitude of community toward mentally ill patients,[11],[12] we can say that our study definitely showing some improving conditions regarding the acceptance of mentally in patients in society.


   Conclusion Top


We had a large sample size and covered a block extensively; thus, the representation of this block has been done extensively. However, a multi-centric study can give a better external validity. The schedule used was validated previously, we checked for judgmental validity of the Bengali version, but not the validity metrices. Furthermore, a detailed look at the covariates could have been done, but this kind of KAP studies, often these factors are of less importance.

This study will provide valuable insights into the cognitive and affective aspect of mental illness among these population and thus help in implementing better policies in this regard, as this is fast becoming the talk of the day.

Financial support and sponsorship

Nil.

Conflicts of interest

The first author is a member of Editorial Board of the Indian Journal of Public Health.

 
   References Top

1.
Preamble to the Constitution of the World Health Organization as Adopted by the International Health Conference. 19-22 June, 1946; signed on 22 July 1946, by the representatives of 61 States and entered into force on 7 April. New York: World Health Organization; 1948. p. 100.  Back to cited text no. 1
    
2.
Schomerus G, Schwahn C, Holzinger A, Corrigan PW, Grabe HJ, Carta MG, et al. Evolution of public attitudes about mental illness: A systematic review and meta-analysis. Acta Psychiatr Scand 2012;125:440-52.  Back to cited text no. 2
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Evans-Lacko S, Malcolm E, West K, Rose D, London J, Rüsch N, et al. Influence of Time to Change's social marketing interventions on stigma in England 2009-2011. Br J Psychiatry Suppl 2013;55:S77-88.  Back to cited text no. 3
    
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Hugo CJ, Boshoff DE, Traut A, Zungu-Dirwayi N, Stein DJ. Community attitudes toward and knowledge of mental illness in South Africa. Soc Psychiatry Psychiatr Epidemiol 2003;38:715-9.  Back to cited text no. 4
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Kishore J, Gupta A, Jiloha RC, Bantman P. Myths, beliefs and perceptions about mental disorders and health-seeking behavior in Delhi, India. Indian J Psychiatry 2011;53:324-9.  Back to cited text no. 5
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Raguram R, Weiss MG, Channabasavanna SM, Devins GM. Stigma, depression, and somatization in South India. Am J Psychiatry 1996;153:1043-9.  Back to cited text no. 6
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Charles H, Manoranjitham SD, Jacob KS. Stigma and explanatory models among people with schizophrenia and their relatives in Vellore, south India. Int J Soc Psychiatry 2007;53:325-32.  Back to cited text no. 7
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Crisp AH, Gelder MG, Rix S, Meltzer HI, Rowlands OJ. Stigmatisation of people with mental illnesses 2000;177:4-7.  Back to cited text no. 8
    
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Kumar A. District mental health programmme in India: A case study. J Health Dev 2005;1:24-35.  Back to cited text no. 9
    
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Chong SA, Verma S, Vaingankar JA, Chan YH, Wong LY, Heng BH. Perception of the public towards the mentally ill in developed Asian country. Soc Psychiatry Psychiatr Epidemiol 2007;42:734-9.  Back to cited text no. 10
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Sayce L. Stigma, discrimination and social exclusion: What's in a word? J Ment Health 1998;7:331-43.  Back to cited text no. 11
    
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Salve H, Goswami K, Sagar R, Nongkynrih B, Sreenivas V. Perception and attitude towards mental illness in an urban community in South Delhi – A community based study. Indian J Psychol Med 2013;35:154.  Back to cited text no. 12
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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