A health promotion intervention to address youth violence among students in a technical college in Sri Lanka guided by the participatory action research approach: a study protocol.

BACKGROUND: Youth violence is a global public health issue and the highest rates are reported in Low and Middle-Income Countries (LMICs). Higher rates of youth violence are reported in Sri Lanka as well. Students who fail to continue higher studies in schools or enter the universities in Sri Lanka, enroll in technical colleges and are associated with a higher number of risk factors of violence. This study aims to empower youth (15-29 years old) of a technical college in Matale district, Sri Lanka, to carry out activities among themselves to improve their knowledge, change perceptions, and violence-related behaviours. METHODS: The Participatory Action Research (PAR) approach will be used. The study participants will be eighty students in a technical college in Matale district, Sri Lanka. The study period will be three years. Study participants will also be collaborators and they will involve actively in all stages of the study. A health promotion intervention will be implemented to identify determinants of youth violence and to design and implement actions while monitoring the changes. The data will be collected mainly through focus group discussions and key informant interviews both before and after the health promotion intervention. Additionally, a self-administered questionnaire will be used and the principal investigator will maintain a reflective diary. The qualitative data will be analysed thematically whereas quantitative data will be analysed using descriptive statistics. Data will be triangulated to increase the rigour of the study. DISCUSSION: According to literature, PAR is not widely used in health promotion. The enabling and empowerment goals of health promotion are fulfilled in PAR. Thus, this will be a novel experience for researchers and this will stimulate discussion on the combination of PAR and health promotion. This study design itself promotes active participant involvement and it may generate effective youth-led, culturally appropriate actions to address youth violence. The findings will describe what works and why it works and will help Sri Lanka and similar LMICs to create safe environments for youth in educational institutes or training colleges.

In this protocol paper, we propose a participatory action research based on the health promotion approach to address youth violence in Sri Lanka which has hitherto not been addressed effectively. We selected this topic in the context where youth violence has become a major public health issue in low and middle-income countries. Since, empowering young people in preventing violence is vital, this study aims to empower the youth of a technical college in Matale district, Sri Lanka to carry out activities among themselves to address youth violence. Thus, we will select eighty students from a Sri Lankan technical college for the study. The students will involve themselves in all stages of the study as research collaborators. We will collectively identify the risk factors of youth violence, design and implement actions to address those risk factors with active youth involvement. The data will be mainly collected before and after the actions to identify the changes in knowledge, perceptions and behaviours that have been taken following the actions. The students who participate in the study will ultimately gain knowledge and skills to address violence in their college and other settings. Further, it will reduce their risk of becoming an offender or a victim of violence. This study is expected to generate effective youth-led, culturally appropriate actions to address youth violence in a selected setting. The findings will be helpful for Sri Lanka and similar low and middle-income countries to create safe environments for youth in educational institutes.

Perceived Impact of the COVID-19 Pandemic on Psychiatric Training Among Final-Year Medical Undergraduates in Sri Lanka: an Online Survey of Students from Eight Universities.

OBJECTIVE: This study aimed to assess the perceived impact of the COVID-19 pandemic on undergraduate psychiatry training in Sri Lanka and to explore several potentially associated factors. METHODS: An online survey was distributed among students from eight medical schools who recently faced their final exam. Their perceptions on the impact of the pandemic on the psychiatry training and exam performance were rated on a 10-point scale. Resilience was assessed using a two-item scale. RESULTS: A total of 644 students responded (69.5% female, mean age=27.5 years). Among them, 164 (25.5%) reported being quarantined; 25 (4%) reported becoming infected with COVID-19; and 170 (28.6%) reported ward closure for over a week during the clerkship. Greater impact was reported for patient availability (mean=7.08), mental status assessments (mean=6.3), developing rapport (mean=6.2), and diagnostic skills (mean=5.9), whereas the impact on peer-learning (mean=5.5) and self-study (mean=3.6) was relatively lower. Impact on clinical components of the final exam (mean=6) was rated higher than on theory components (mean=4.5). The majority (70.3%) reported that COVID-19-related stress affected their exam preparations. Higher resilience predicted lower perceived impact on all aspects of training/exam performance. Female gender and ward closure predicted greater impact on diagnostic skills, overall training, and clinical exam performance, whereas being quarantined predicted greater impact on peer-learning and self-study. CONCLUSION: The pandemic has significantly affected the undergraduate psychiatry training in Sri Lanka, particularly its clinical components. Increasing clinical exposure to patients, managing students' stress, and building their resilience should be key concerns for medical educators during the pandemic.

Direct and indirect cost of schizophrenia in outpatients treated in a tertiary care psychiatry unit.

OBJECTIVE: To estimate the direct and indirect cost of care incurred by patients with schizophrenia attending a tertiary care psychiatry unit in Colombo. METHODS: Study was carried out at the National Hospital of Sri Lanka. Systematic sampling selected every second patient with an ICD-10 clinical diagnosis of schizophrenia presenting to the clinic during a two month period. Investigator administered semi-structured questionnaire was used for data collection. RESULTS: Sample consisted of 91 patients. Direct cost was defined as cost incurred by the patient (out of pocket expenditure) for outpatient care. Mean cost of a clinic visit was Rs. 500. Of the clinic visit cost, highest proportions were travel cost (39.8%) and medication (26.4%). Sixty four (70.3%) had received informal care. The mean cost of informal care during the entire course of the illness was Rs. 33, 540. Mean indirect cost was Rs. 150,190. CONCLUSIONS: Despite low direct cost of care, indirect cost and cost of informal treatment results in substantial economic impact on patients and their families. It is recommended that economic support should be provided for patients with disabling illnesses such as schizophrenia, especially when patients are unable to engage in full time employment. There is a need to educate the public regarding higher cost of care by traditional healers and other informal modes of treatment compared to Western medical care.