Improving access to psychological treatments: lessons from developing countries

Even though psychological treatments have been advocated as treatments for a range of mental disorders by the WHO for scaling up through primary care globally, the vast majority of potential beneficiaries are unable to access these treatments. Two major barriers impede the path between evidence based treatments and improved access: the lack of skilled human resources and the acceptability of treatments across cultures. This essay synthesizes the experiences of programs which developed and evaluated psychological treatments for depression in three resource poor developing countries. These programs addressed the human resource barrier by training lay or community health workers to deliver the treatments and addressed the acceptability barrier by systematically adapting the treatment to contextual factors. All programs demonstrated significant benefits in recovery rates when compared with usual care demonstrating the effectiveness of the approach. The implications for these experiences to improving access to psychological treatments in the global context are discussed.     

Special Section Epilogue: A Call to Action

The purpose of this article is to offer specific recommendations and a call to action for counselors who engage in social justice work. Recommendations regarding the philosophical, ethical, spiritual, and religious aspects of social justice work are emphasized in this call to action based on articles presented in this special section.     

The relation of economic status to subjective well-being in developing countries: a meta-analysis

The current research synthesis integrates the findings of 111 independent samples from 54 economically developing countries that examined the relation between economic status and subjective well-being (SWB). The average economic status-SWB effect size was strongest among low-income developing economies (r = .28) and for samples that were least educated (r = .36). The relation was weakest among high-income developing economies (r = .10) and for highly educated samples (r = .13). Controlling for numerous covariates, the partial r effect size remained significant for the least-educated samples (pr = .18). Moderator analyses showed the economic status-SWB relation to be strongest when (a) economic status was defined as wealth (a stock variable), instead of as income (a flow variable), and (b) SWB was measured as life satisfaction (a cognitive assessment), instead of as happiness (an emotional assessment). Findings were replicated with a meta-analysis of the World Values Survey data. Discussion centers on the plausibility of need theory, alternative explanations of results, interpretation of moderators, and directions for future research.     

Determinants of achievement motivation for women in developing countries

A number of studies on women compared with men in Iran (as an example of a fast developing country) relating to achievement and vocational behavior showed results quite similar to those reported on American women. Iranian women emphasized external attribution of cause of success/failure, and were less sex discriminatory than men. Femininity scores correlated with social desirability scores, and women who scored higher on masculinity also had higher risk taking scores. Socioeconomic background besides sex differences affected vocational aspiration. It is suggested that while the psychological make-up of women in developing and developed countries might be similar, the different social environment and concrete opportunities available to women in different societies more significantly affect their actual vocational behavior.     

HIV counselling in developing countries: the link from individual to community counselling for support and change

Counselling in developing countries can extend from individual to family and community, can be implemented as a means of facilitating changes or support, and in the community context can be used to measure as well as sustain behaviour change. Contrasts between developed and developing countries include the capacity of communities in developing countries to acknowledge loss and find hope. Community involvement in counselling, and capacity for confidential sharing, are building blocks for strategic participatory response to AIDS and HIV, that can link inclusive care to prevention by community-determined change in attitudes, behaviours and environment. The premise that there can be a positive link from the individual to the community through confidential sharing and that it can give rise to prevention through counselling the community is illustrated by reference to programme examples from Brazil, Sri Lanka, North-Eastern India, Zambia and Zimbabwe. Community hope exists through recognition of loss, inclusion of suffering people, and capacity and action for change. One transferable tool for community development is community counselling in relation to HIV and AIDS. A visible and expected outcome is increased community capacity to care and hope.     

Mathematical models of foreign policy decision-making: Compensatory vs. noncompensatory

There are presently two leading foreign policy decision-making paradigms in vogue. The first is based on the classical or rational model originally posited by von Neumann and Morgenstern to explain microeconomic decisions. The second is based on the cybernetic perspective whose groundwork was laid by Herbert Simon in his early research on bounded rationality. In this paper we introduce a third perspective — thepoliheuristic theory of decision-making — as an alternative to the rational actor and cybernetic paradigms in international relations. This theory is drawn in large part from research on heuristics done in experimental cognitive psychology. According to the poliheuristic theory, policy makers use poly (many) heuristics while focusing on a very narrow range of options and dimensions when making decisions. Among them, the political dimension is noncompensatory. The paper also delineates the mathematical formulations of the three decision-making models.The authors thank Raymond Dacey for his helpful comments.     

Reducing AIDS-related stigma in developing countries: the importance of theory- and evidence-based interventions

In many developing countries persons living with HIV and AIDS experience strong stigma and discrimination, and AIDS-related stigma has an enormous negative impact on their social relationships, access to resources, and psychological well being. Moreover, AIDS-related stigma hampers HIV-related health promotion, including voluntary HIV counselling and testing. In this article, we will argue that programs to reduce AIDS-related stigma are most likely to be effective if these programs are based upon thorough needs assessments, theory- and evidence-based intervention strategies and collaborative planning. A protocol for health promotion programs design is outlined. Furthermore, psychosocial correlates of AIDS-related stigma in developing countries, social-psychological theories that might be useful in designing intervention strategies to reduce stigmatisation and successful elements of previous interventions aimed at stigma reduction are discussed. It is concluded that psychological theory does provide guidelines for the development of stigma-reducing intervention programs, but that such programs can only be effective when based upon context-specific needs assessment and collaborative planning.     

Basic and applied research in developing countries: The search for an evaluation strategy

Although activities in basic and applied research in developing countries (DCs) are guided by universal scientific principles, there are important differences in the way in which science is practiced from that of the industrialized world. Isolation from the mainstream of scientific activity, the need for the development of an indigenous scientific capacity, the lack of a critical mass of researchers with respect to most fields of knowledge, and the urgency of developing better and more efficient communication channels, are some of the aspects that set apart the scientific activity of the developing world. In particular, the need to develop local "new" science aimed at solving pressing problems of a local nature suggests the existence of a different set of conditions from those found in scientifically-advanced countries. In the present article we look at the ways the special circumstances of science in DCs will affect the application of evaluation criteria, using bibliometric data on research in Mexico as an example.     

New agendas for agricultural research in developing countries: Policy analysis and institutional implications

This article argues that the goals of agricultural research in poor countries have changed substantially over the last four decades. In particular they have broadened from the early (and narrow) emphasis on food production to a much wider agenda that includes poverty alleviation, environmental degradation, and social inclusion. Conversely, agricultural research systems have proved remarkably resistant to the concomitant need for changes in research focus. As a result many, at both the national and international level, are under great strain. In terms of public policy the article goes on to suggest that shortcomings of existing conceptual approaches to technology development could be supplemented by adopting analytical principles that view innovation in systemic terms. An approach where flows of knowledge between institutional nodes is a key to innovative performance (the “National Systems of Innovation” approach) is suggested as one such conceptual framework that might help supplement conventional policy analysis. An earlier version of this paper was presented at a workshop “New Policy Agendas for Agricultural Research: Implications for Institutional Arrangements” held on 28 March 2000 at the International Crops Research Institute for the Semi-Arid Tropics (ICRISAT), Patancheru, India. The workshop was supported by the UK Department of International Development (DFID) Crop Post-Harvest Programme as an output of the project “Optimising Institutional Arrangements.”