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10.1371/journal.pone.0310255
PONE-D-24-18093
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Health professionals’ attitudes towards traditional healing for mental illness: A systematic review protocol
Health professionals’ attitudes towards traditional healing for mental illness
https://orcid.org/0000-0001-5368-6665
Wollie Alemayehu Molla Conceptualization Methodology Writing – original draft Writing – review & editing 1 2 *
Usher Kim Supervision Validation Visualization Writing – review & editing 1
Maharaj Reshin Supervision Validation Visualization Writing – review & editing 1
Islam Md Shahidul Supervision Validation Visualization Writing – review & editing 1
1 Faculty of Medicine and Health, School of Health, University of New England, Armidale, NSW, Australia
2 Department of Psychiatry, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
Sahoo Madhulika Editor
Kalahandi University, INDIA
Competing Interests: The authors have declared that co competing interest exists.

* E-mail: alexmolla09@gmail.com
9 9 2024
2024
19 9 e03102558 5 2024
27 8 2024
© 2024 Wollie et al
2024
Wollie et al
https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Background

Mental illness is a global problem that receives less attention, particularly in developing countries. Integrating modern treatment with traditional healing approaches has been proposed as one way to address mental health problems, especially in developing countries. Despite health professionals’ participation in traditional healing being crucial to integrative approaches, their participation is limited to date. This review protocol is designed to explore the attitudes of health professionals towards traditional healing practices in mental health services.

Methods

The review will follow the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Searching databases, including PubMed/Medline, PsychINFO, EMBASE, Scopus, and the Web of sciences will be conducted. Additionally, Google and Google Scholar will be searched for other information, including grey literature. Moreover, a manual search of identified articles’ reference lists will also be conducted to help ensure all potential papers are included in the review. Qualitative, quantitative, and mixed study methods published in English between January 2014 and April 2024 will be included. The qualities of the included studies will be assessed using the Mixed Methods Appraisal Tool (MMAT) Version 2018. A mixed-method synthesis will be used to synthesis the results.

Discussion

It is crucial for healthcare professionals to provide culturally sensitive care to empower people to manage their health. This systematic review will summarize the attitudes of health professionals towards the adoption and delivery of traditional healing approaches to people experiencing mental illness. Therefore, the findings of this review will support integration between traditional healers and modern mental health practitioners for the treatment of mental illness.

Trial registration

Protocol registration number: CRD42024535136.

The author(s) received no specific funding for this work. Data AvailabilityAll data are in the manuscript.
Data Availability

All data are in the manuscript.
==== Body
pmcBackground

Mental health is the overall wellbeing and functioning of an individual, family, and community [1,2]. It is “a state of wellbeing in which the individual realizes his or her own abilities, is able to contribute to his or her environment, copes with the normal stress of life, works fruitfully, and is able to cooperate with others [3].” In contrast, mental illness has a substantial impact on a person’s feelings, thoughts, behaviour, and social interactions [4,5]. It is influenced by numerous factors, including psychological, physical, social, cultural, and spiritual [6,7].

Currently, mental illness is a major public health burden and accounts for 32.4% of years lived with disability worldwide [8]. Even though mental health issues are a global health concern, they are highly prevalent in low-income countries [9,10]. Developing nations have fewer health professionals [11], resulting in a treatment gap for people with mental illnesses in these countries [12]. Furthermore, negative attitudes, stigma, limited resources, and low priority are reasons for the high magnitude of mental illness, in addition to a shortage of health professionals [13–16].

People with mental health issues often seek care from indigenous or traditional healers [17–19]. Traditional healing practices include but are not limited to a set of beliefs that use culturally accepted spiritual treatments and plant products [20]. Traditional healers form a major part of the mental health workforce in developing countries [21]. Nearly 80% of people from Africa seek medical attention from traditional healers [21], largely because traditional healers provide culturally and socially accepted care for individuals and communities. This is the preferred treatment approach for most people due to its perceived effectiveness, affordability, and accessibility within communities [22–24]. In order to close the significant treatment gap in low-and middle-income countries, “the World Health Organization’s (WHO) 2003–2020 Mental Health Action Plan recommended that government health programs incorporate traditional healers as treatment resources [25].”

Studies indicate that traditional healers can offer efficacious therapies that may be beneficial for prevalent mental illnesses such as depression and anxiety [26,27]. Healers usually come from extended family branches with experience providing care like counselling, bible interpretation, and using prayer aids such as holy water and oil for treatment [27,28]. They either obtain experience through on-the-job training or apply their practices through ancestors who serve as mediators by providing access to spiritual guidance and power [15,29,30].

Rationale

Despite the fact that traditional healing approaches are practiced by large groups of people, particularly in low-income countries, modern health professionals tend to differ in their opinions about this approach [31,32]. Studies indicate that some health professionals hold a positive view of traditional healing modalities [33], while many others express doubt about the effectiveness of traditional treatments. Furthermore, there is a negative attitude among health professionals regarding the integration of traditional healing with biomedical therapies [34,35]. Traditional healers are known to consult with modern health professionals when faced with problems beyond their ability to treat, but it is not common for biomedical professionals to refer back to healers [27]. This is often due to their negative attitudes toward traditional healing practices, including the belief that traditional healers do not incorporate a human right approach and/or compassionate care when dealing with people with mental health problems [35,36]. Their negative attitudes have a detrimental effect on the WHO’s recommended collaboration of biomedical treatment and traditional healing to close the treatment gap in low and middle-income countries because cooperation between the two needs mutual respect and recognition. In addition to providing biological therapies, it is good to emphasize spiritual and cultural approaches for mental illness since mental illness is due to multidimensional factors like spiritual, social, psychological, and physical. Moreover, it is crucial for healthcare providers to understand their patients’ cultural beliefs and practices in order to manage and counsel them appropriately [34] and empower them towards healthful healing. There is no summarized research regarding the attitudes of health professionals toward traditional healing approaches for mental illness, despite the existence of numerous singe studies. Therefor, this review protocol is aimed to explore the summarized evidences on health care providers’ attitudes toward traditional healing for mental illness, and this will be crucial in developing appropriate guidelines for holistic treatment.

Research question

What are the health professionals’ attitudes towards traditional healing for mental illness?

Methods and materials

The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020 guidelines will be used to conduct this review [37]. This protocol is also prepared in accordance with the PRISAM-Protocol guidelines (Supporting Information). Primary studies conducted using quantitative, quantitative, and mixed-methods will be included. The review protocol is registered with the International Prospective Register of Systematic Reviews (PROSPERO) with a registration number of CRD42014535136.

Eligibility criteria

The eligibility assessment format will be used to select articles to be included in the systematic review. Globally published original articles focusing on health professionals’ attitude and/or perception towards traditional healing of mental illness will be considered. Qualitative, quantitative, and mixed-method studies will be considered without restrictions in their study design. Studies published in English between January 2014 and April 2024 will be considered to summarize contemporary evidence on the topic. Conference summaries, reviews, dissertations, case studies, governmental and non-government reports, and letters will be excluded from the study.

Searching strategy

A literature search of databases such as PubMed/Medline, PsychINFO, EMBASE, Scopus, and the Web of Sciences will be conducted. The key terms will be searched by connecting Boolean operators OR/AND to specifically address published studies. Searching words will be (attitude) OR (perception) OR (belief) OR (opinion) OR (view) AND (health professionals) OR (health practitioners) OR (health personnel) OR (nurses) OR (medical doctors) OR (psychiatrist) OR (psychologist) AND (traditional healing) OR (traditional medicine) OR (herbal medicine) OR (indigenous treatment) OR (spiritual therapy) OR (religious healing) AND (mental illness) OR (mental disorder) OR (mental health) OR (psychological distress) OR (psychiatric disorder). In addition to database and manual searches, we will use references to articles obtained from the database to filter the remaining studies. Database searching and the initial screening process will be finalized in consultation with a senior health librarian from the University of New England (UNE) Dixon Library and other authors.

An example of a search strategy for Scopus ( (ALL ("health professional") OR TITLE-ABS-KEY ("health personnel") OR TITLE-ABS-KEY ("medical doctor") OR TITLE-ABS-KEY ("medical practitioner") OR TITLE-ABS-KEY (nurse) OR TITLE-ABS-KEY (psychiatrist) OR TITLE-ABS-KEY (psychologist) ) ) AND ( (ALL (perception) OR TITLE-ABS-KEY (attitude) OR TITLE-ABS-KEY (belief) OR TITLE-ABS-KEY (view) OR TITLE-ABS-KEY (opinion) ) ) AND ( (ALL ("traditional healing") OR TITLE-ABS-KEY ("traditional medicine") OR TITLE-ABS-KEY ("indigenous treatment") OR TITLE-ABS-KEY ("spiritual therapy") OR TITLE-ABS-KEY ("religious healing") OR TITLE-ABS-KEY ("herbal medicine") ) ) AND ( (ALL ("mental illness") OR TITLE-ABS-KEY ("mental disorder") OR TITLE-ABS-KEY ("mental health") OR TITLE-ABS-KEY ("psychiatric disorder") OR TITLE-ABS-KEY ("psychological distress") ) ) AND PUBYEAR > 2013 AND PUBYEAR < 2025 AND (LIMIT-TO (DOCTYPE, "ar") ) AND (LIMIT-TO (LANGUAGE, "English") )

Study selection process

PRISMA (preferred reporting items for the systematic review and meta-analysis) guidelines [37] will be followed to ensure the quality and transparency of the review process. After critically searching articles from databases, we will start the selection process by importing all records to an Endnote library. Duplicates will be detected and removed automatically. At the beginning, the selection process will be carried out by the first author (AMW), and it will be checked by one of the co-authors (KU, RM, and SI). The reviewer will evaluate article titles and abstracts for relevance, keeping those that are relevant to the outcome variable attitudes, and/or perceptions of health professionals towards traditional healing. The full texts of possible relevant papers will then be screened for eligibility. Any disagreements will be handled through a discussion to finalize the selection of the papers.

Data extraction or collection process

With the use of a predetermined, uniform data extraction structure, the first author will extract important data, and then it will be confirmed by another author. Any significant differences will be discussed, and if a consensus cannot be reached, a third author will adjudicate on the decision. The first author’s name, the year of publication, the country where the study is conducted, the methodology used, the health professional type, the data collection and analysis method, the major findings, and the conclusions will be included in the standardized data extraction form.

Quality assessment

Each study’s methodological quality and bias risk will be assessed to determine the validity of the findings. The qualities of the included articles will be assessed using the Mixed Methods Appraisal Tool (MMAT) Version 2018 Checklist [38]. This tool is designed to assess the methodological qualities of different types of studies, like qualitative, quantitative, and mixed studies. The differences in quality evaluation scores will be resolved by through discussion within a team.

Data synthesis

An integrated mixed-method synthesis technique will be used to summarize all quantitative, qualitative, and mixed-method data in one combined synthesis [39]. Quantitative data will be described qualitatively to facilitate integration with qualitative data. The overall nature of the articles will be presented in a table. Themes and subthemes will be formulated based on the data generated. All the data will be analysed and reported as a narrative summary. To minimize bias, the research team will thoroughly evaluate and discuss the entire process, and any disagreements will be resolved through discussion.

Discussion

The review will be conducted to summarize the attitudes of health professionals towards traditional healing approaches for mental illness in a global context. Even though independent studies have been undertaken on health professionals’ attitudes and/or perceptions towards traditional healing, there is no globally summarized general evidence on the topic. Some previous studies present opposing evidence on the attitudes of health professionals towards traditional healing practices. Even if some health professionals encourage traditional methods, there are other studies that show negative attitudes of health professionals towards traditional healing [34,35]. Traditional healing practices are considered appropriate options for mental illness, particularly in low-income countries where there is a scarcity of modern mental health professionals [21]. Most people with mental health problems seek these treatments because they provide culturally and socially accepted care for individuals and the community [22–24]. But there is limited collaboration between modern treatment and traditional healing. Therefore, this review will summarize all the literature and clearly show the positions of health professionals toward traditional healing approaches. The findings of this review will be important in developing directions for governmental organizations and other concerned bodies to strengthen communication and integration of traditional healing with biomedical treatment options for mental illness.

Expected limitations

This systematic review has the limitation of excluding articles that are not published in English. In addition, the exclusion of conference reports, letter, short communications, and review articles may be a reason to miss important data.

Publication status

This protocol is prepared for the ongoing systematic review of articles entitled “The health professionals’ attitude towards traditional healing approaches to mental illness.” If there is any change during the review, an updated version will be published with a final systematic review.

Supporting information

S1 Checklist PRISMA-Protocol guidelines.

(DOCX)

10.1371/journal.pone.0310255.r001
Decision Letter 0
Sahoo Madhulika Academic Editor
© 2024 Madhulika Sahoo
2024
Madhulika Sahoo
https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Submission Version0
23 Jul 2024

PONE-D-24-18093Perceptions of health professionals towards traditional healing for mental illness: A systematic review ProtocolPLOS ONE

Dear Dr. Wollie,

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Does the manuscript provide a valid rationale for the proposed study, with clearly identified and justified research questions?

The research question outlined is expected to address a valid academic problem or topic and contribute to the base of knowledge in the field.

Reviewer #1: Yes

Reviewer #2: Partly

**********

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The manuscript should describe the methods in sufficient detail to prevent undisclosed flexibility in the experimental procedure or analysis pipeline, including sufficient outcome-neutral conditions (e.g. necessary controls, absence of floor or ceiling effects) to test the proposed hypotheses and a statistical power analysis where applicable. As there may be aspects of the methodology and analysis which can only be refined once the work is undertaken, authors should outline potential assumptions and explicitly describe what aspects of the proposed analyses, if any, are exploratory.

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**********

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Reviewer #1: The research will address an important area covering traditional healing practices for mental health illness.

Reviewer #2: 1. The article needs to be proofread and might require a thorough review of its English language usage to enhance clarity and readability.

2. The article overall lacks clarity on the relevance even though the protocol mentioned is good.

3. The article is missing on the novelty of the subject.

**********

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Reviewer #1: Yes: Dr. Aradhana Panigrahi

Reviewer #2: No

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10.1371/journal.pone.0310255.r002
Author response to Decision Letter 0
Submission Version1
31 Jul 2024

Response to reviewers

“PONE-D-24-18093: Perceptions of health professionals towards traditional healing for mental illness: A systematic review protocol”

Dear editor,

Thank you very much for giving us the chance to revise this study protocol. We have tried to update the study protocol and are happy to write this response letter to comments.

Reviewers comments

Reviewer #1:

Comment: “The research will address an important area covering traditional healing perspectives for mental illness.”

Response:

Dear reviewer #1,

We sincerely appreciate you taking the time to provide feedback on this study protocol. As you mentioned, we have gathered large numbers of studies and will try to publish the full systematic review soon, which will include significant summarized data and provide direction to decision-makers and other interested parties.

Reviewer #2:

Comment: “The article needs to be proofread and might require thorough review of its English language usage to enhance clarity and readability.”

Response:

Dear reviewer #2,

We greatly appreciate your significant input. We have proofread the entire study protocol and rewritten some sections of it in accordance with your comment. We hope the updated version is clear and understandable.

Comment: “The article overall lacks clarity on the relevance even though the protocol mentioned is good”

Response: Regarding the relevance of the study, we have attempted to mention the importance or rationale for our plan on page 2 of this protocol. In addition, please consider the following issues regarding the necessity of doing a systematic review on this topic and the outcome after this protocol:

First, some biomedical professionals are against the traditional healing approaches and collaborative work, even though the WHO recommends them to bridge the treatment gaps for mental illness. These attitudinal problems are obstacles to counselling and empowering patients towards a good recovery process. This is due to the possibility that, in the absence of mutual communication, transparency, and task sharing with healers, they may be less able to comprehend cultural understandings and widely utilized community healing techniques. Improved communication and collaboration between health professionals and traditional healers are necessary to provide holistic treatment for mental illness.

Second, unless there is effective and open communication, separately delivered treatment approaches may pose risks because patients may have a chance of developing adverse effects while mixing medications from two treatment modalities without clear consultation.

Lastly, this protocol is planned to produce summarized evidence incorporating globally conducted studies on health professionals’ attitudes and/or perceptions toward traditional healing for mental illness. This is highly pertinent to many stakeholders in providing comprehensive and cost-effective mental health care.

Comment: “The article is missing on the novelty of the subject.”

Response: Regarding the novelty of the study, we initially carried out a detailed search to locate related studies. But, as per our knowledge and search strategy, we were unable to identify globally published summarized review articles on health professionals’ attitudes and/or perceptions toward traditional healing approaches for mental illness. Following thorough searching, this protocol is then registered with the International Prospective Register of Systematic Reviews (PROSPERO) with a registration number CRD42014535136. After submitting this protocol to the journal, we have collected globally published single studies, and we have found important contemporary evidence for our final systematic review.

If further revision is needed, we are happy to update it.

Kind regards!

Mr. Alemayehu Molla Wollie alexmolla09@gmail.com

Professor Kim Usher: kusher@une.edu.au

Dr. Reshin Maharaj: Reshin.Maharaj@une.edu.au

Dr. Md Shahidul Islam: mislam27@une.edu.au

Attachment Submitted filename: Response to reviewers.docx

10.1371/journal.pone.0310255.r003
Decision Letter 1
Sahoo Madhulika Academic Editor
© 2024 Madhulika Sahoo
2024
Madhulika Sahoo
https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Submission Version1
28 Aug 2024

Health professionals’ attitudes towards traditional healing for mental illness: A systematic review Protocol

PONE-D-24-18093R1

Dear Dr. Wollie ,

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Kind regards,

Madhulika Sahoo, Ph.D

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Does the manuscript provide a valid rationale for the proposed study, with clearly identified and justified research questions?

The research question outlined is expected to address a valid academic problem or topic and contribute to the base of knowledge in the field.

Reviewer #2: Yes

**********

2. Is the protocol technically sound and planned in a manner that will lead to a meaningful outcome and allow testing the stated hypotheses?

The manuscript should describe the methods in sufficient detail to prevent undisclosed flexibility in the experimental procedure or analysis pipeline, including sufficient outcome-neutral conditions (e.g. necessary controls, absence of floor or ceiling effects) to test the proposed hypotheses and a statistical power analysis where applicable. As there may be aspects of the methodology and analysis which can only be refined once the work is undertaken, authors should outline potential assumptions and explicitly describe what aspects of the proposed analyses, if any, are exploratory.

Reviewer #2: Yes

**********

3. Is the methodology feasible and described in sufficient detail to allow the work to be replicable?

Descriptions of methods and materials in the protocol should be reported in sufficient detail for another researcher to reproduce all experiments and analyses. The protocol should describe the appropriate controls, sample size calculations, and replication needed to ensure that the data are robust and reproducible.

Reviewer #2: Yes

**********

4. Have the authors described where all data underlying the findings will be made available when the study is complete?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception, at the time of publication. The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #2: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #2: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above and, if applicable, provide comments about issues authors must address before this protocol can be accepted for publication. You may also include additional comments for the author, including concerns about research or publication ethics.

You may also provide optional suggestions and comments to authors that they might find helpful in planning their study.

(Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #2: The necessary changes have been done in revision 1. The authors have clearly answered to all the concerns raised in the 1st revision. The manuscript can be accepted in the revised form.

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #2: Yes: Salini Rosaline

**********
==== Refs
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