Mental health literacy among primary healthcare workers in South Africa and Zambia

Barriers and facilitators to accessing mental health services among young people living with HIV and healthcare professionals in Mozambique: a content and sentiment analysis using the capability, opportunity, motivation and behaviour (COM-B) framework

BACKGROUND

Ensuring timely and effective access to mental health (MH) services is crucial in Mozambique, where the suicide rate is 13.7/100.000, twice that of sub-Saharan Africa. This is particularly significant for a MH at-risk group, such as young adults (YA) living with HIV. This study aimed to assess barriers/facilitators to access MH services for YAs, comparing by HIV status, in Beira, Mozambique.

METHODS

A cross-sectional study using focus groups and key-informant interviews was conducted between July and August 2023, involving YAs (18-24 years) with (YALHIV) and without HIV (YAHIV-) and MH staff of five health centres (HCs). A deductive approach was adopted using the COM-B framework to classify themes referring to barriers/facilitators to access MH services. Two researchers carried out the content analysis independently, assessing the inter-rater agreement through Cohen's K.

RESULTS

A total of 48 YAs (half with HIV), and 15 MH providers were involved. Of the 650 themes identified, 347 (53.4%) were labelled as barriers. Opportunities were the most frequent barrier (57.7%): social ones were related to community stigma, while physical ones to staff shortage, lack of community services, and distance from HCs. Physical opportunities were a more frequent barrier in YAHIV- (p < 0.001) and females (p = 0.013). Automatic motivation was related to self-stigma and preconceived distrust. It was more common as a barrier among YAHIV- (65.6% vs. 35.5%, p = 0.032). Reflective motivation was the most frequent facilitator (33.1%): YALHIV reported good knowledge of their MH risk factors, and YAHIV- had previous positive experiences with MH services for people close to them. Psychological capability was a barrier for both YAs and MH staff, related to a lack of knowledge of health services and MH in general.

CONCLUSIONS

Addressing community and self-stigma and scaling up community MH services, increasing MH staff, are the two main action points that emerged to improve access to MH services. More attention should be paid to YAHIV-, which showed significant access barriers.

Mental health literacy among basic healthcare providers and community health volunteers of Lalitpur Metropolitan City, Nepal

BACKGROUND

Mental health literacy (MHL) is particularly essential for primary healthcare providers for the early recognition and management of mental disorders. In Nepal, mid-level healthcare workers and Female Community Health Volunteers (FCHVs) play a vital role in community-based mental health services, yet their MHL remains insufficiently studied. This study assesses MHL among basic healthcare providers and health volunteers in Lalitpur Metropolitan City, Nepal and identifies factors associated with it.

METHODS

A cross-sectional study was conducted among 233 healthcare workers, including mid-level healthcare providers, FCHVs, and other community health volunteers. Participants were selected through simple random sampling. MHL was measured using the Mental Health Literacy Assessment Scale (MHLAS), with scores dichotomized at the median (≥ 75 = high MHL, < 75 = low MHL). Descriptive statistics summarized key variables, while Pearson's chi-square test and odds ratios (OR) with 95% confidence intervals (CI) were used to identify associations.

RESULTS

The MHLAS score ranged between 45 and 98, with a mean score of 76 ± 9.27 and a median of 75 (IQR: 11). Out of 233 participants, 129 (55%; 95% CI: 49-62%) were classified as having high MHL. Higher education levels (OR = 9.77, p < 0.001) and mid-level healthcare provider status (OR = 2.44, p = 0.020) were significantly associated with higher MHL. Participants with 5-10 years of experience (OR = 4.50, p = 0.029) and those who received mental health training during academic courses (OR = 1.99, p = 0.022) or on the job (OR = 1.90, p = 0.036) had significantly higher MHL. However, factors such as gender, marital status, and work experience beyond 10 years were not significantly associated with MHL.

CONCLUSION

Despite their critical role in community mental health, nearly half of the primary healthcare providers in Nepal had low MHL. This study highlights the urgent need to integrate MHL training into academic curricula and ensure continuous professional development among basic health care providers.

Fostering Mental Health Literacy Among Primary School Professionals: Evaluating the Impact of an Online Training Program 'Well@School'

Mental health challenges among children and adolescents have become a pressing global concern, particularly in the wake of the COVID-19 pandemic and ongoing geopolitical instability. Addressing these issues requires innovative, cost-effective strategies, with schools serving as critical platforms for mental health promotion. This study evaluates the impact of an online training program, Well@School, designed to enhance Mental Health Literacy (MHL) among primary school professionals in Finland, Lithuania, Bulgaria, Slovenia, and Greece. Using a descriptive, cross-sectional design with pre- and post-test assessments, the study involved 223 health, education, and social care professionals. The revised Mental Health Literacy Scale (MHLS) was employed to measure changes in MHL. Results indicated a significant positive effect, with an average increase of 4 points (2.5%) in MHLS scores post-course. Bayesian analysis further confirmed this improvement, showing a high probability (99.92%) of a positive impact, with the most likely gain ranging between 3 and 5 points. The findings underscore the potential of online training programs to enhance MHL among school professionals, thereby improving their capacity to support students' mental health. This study highlights the importance of equipping primary school staff with the necessary skills to recognize and address mental health challenges, reduce stigma, and foster a supportive school environment.

Assessing the mental health literacy of healthcare workers at a Johannesburg tertiary hospital

Background

Good mental health literacy (MHL) has proven to aid in providing adequate and timely care, promote positive attitudes towards mental health and assist in the integration of mental healthcare with other services. Studies have shown that enhancing the MHL of healthcare workers (HCWs) can help alleviate the burden of mental illness.

Aim

The study aims to explore the MHL of HCWs at a tertiary hospital in Johannesburg.

Setting

The study was conducted at Helen Joseph Hospital.

Methods

A quantitative, descriptive, cross-sectional study via a self-administered questionnaire consisting of: (1) a demographic, work and exposure to mental illness and mental healthcare services questionnaire and (2) the Mental Health Literacy Scale (MHLS) was employed. The MHLS identifies people with low MHL who could benefit from further interventions.

Results

Two hundred and fifty-two HCWs participated in the study. The overall median MHLS score was 129, in keeping with a previous study conducted in SA and Zambia. Younger HCWs with less than 5 years of experience scored higher. Among the various professions, doctors scored highest and nurses lowest. The anaesthetic and psychiatric departments obtained the highest MHLS scores. Personal exposure to mental illness and mental health services was associated with higher MHLS scores.

Conclusion

This study highlighted areas where mental health awareness and education are lacking, which are crucial for improving MHL. Targeted interventions to fill these identified gaps are therefore recommended.

Contribution

To our knowledge, this was the first South African study to assess MHL among tertiary-level HCWs across various professions.

The capacity and training needs of primary health care workers in Nyeri and Nakuru counties of Kenya: a cross-sectional study

Background

Health systems based on primary healthcare (PHC) have reduced costs and are effective for improved health outcomes. Kenya's health system grapples with providing equitable access to essential health services, but there is increasing commitment by the government to strengthen primary healthcare. The aim of this paper is to provide a baseline assessment of the capacity and training needs of healthcare workers (HCWs) in Nakuru and Nyeri Counties and identify priorities for intervention.

Methods

A cross-sectional study was carried out among 171 healthcare workers in Nyeri and Nakuru counties. Multistage sampling was employed to select sub-counties in the first stage and health facilities by level within each sub-county in the second level. Systematic random sampling was then employed to select HCWs from each level of facility. We targeted healthcare workers of all cadres within the health facilities, and included all who consented to participating. Structured self-administered pen-and-paper questionnaires were used for data collection, and a five-point Likert scale was used to measure the perceived capacity of the healthcare workers to provide primary healthcare. As for the training needs data, the participants selected any of the 12 components that they needed training in. Descriptive statistics was employed, and stacked bar charts were used to visualize the capacity and training needs for the components of PHC adopted in Kenya.

Results

In total, we obtained questionnaires from 95 participants in Nakuru and 76 participants in Nyeri. Nakuru HCWs rated themselves higher than their Nyeri counterparts in maternal and newborn child healthcare, local endemic disease control, appropriate treatment of common diseases and injuries, provision of essential basic medication, dental health, HIV/AIDs & TB management, and primary eye care. In both counties, there were significant differences in capacity between the different levels of health facilities. We observed substantial capacity gaps for HIV/AIDs & TB management, mental health and dental health services in both counties.

Conclusion

This study found a substantial capacity gap in several of the elements of PHC, especially in Nyeri County. Critical areas for intervention are HIV/AIDs & TB management and mental health training for both counties. Within the health system, there is need to strengthen the capacity of HCWs in lower-level health facilities to reduce the volume of referrals to secondary care facilities. We strongly recommend training programs in dental health, mental health, primary eye care, nutritional services and HIV/AIDs &TB management, that are carefully designed to emphasize skills and abilities.

Mental Health Literacy Among Female Community Health Workers: A Multi-setting Cross-sectional Study

Background

Mental health literacy among lay community health workers (CHWs) is crucial to ensuring that mental health services are accessible to all. This research explores the mental health literacy of community health workers in Indonesia.

Methods

A cross-sectional study was carried out among 454 female community health workers from various villages. Their understanding of mental illness was assessed through questionnaires, exploring their overall belief about the cause and consequence of mental illness, the symptom and the treatment of mental illness, and their perception of relapse.

Results

Most participants have false beliefs about the causes and consequences of mental illness. For instance, the majority of respondents agreed that severe stress leads to mental illness (80%), while 60.4% believed personal weakness to be a cause. Cognitive impairments and brain disease were associated with mental illness by 67.2% and 57.3%, respectively, although only 32.6% attributed it to hereditary factors. Regarding treatment, 83.9% of respondents believed that consistent medication could fully cure mental disorders, while 81.1% associated mental illness with strange behavior. Additionally, 90.7% of respondents emphasized the importance of regular medication to prevent relapse, with 81.5% stating that lack of medication leads to relapse.

Conclusion

A significant level of misinformation and misconception among participants regarding mental illness was unveiled. This misunderstanding can contribute to the stigmatization of individuals experiencing stress, as it may lead to unwarranted assumptions about their mental health. These findings underscore the importance of targeted mental health education campaigns to address misconceptions.

Exploring Managers' Insights on Integrating Mental Health into Tuberculosis and HIV Care in the Free State Province, South Africa

The integration of mental health (MH) services into tuberculosis (TB) and HIV care remains a significant challenge in South Africa's Free State province. This study seeks to understand the perspectives of public health programme managers on the barriers to such integration and to identify potential strategies to overcome these challenges. Data were collected between February and October 2021 using qualitative methods including four individual semi-structured interviews and two focus group discussions with a total of 15 managers responsible for the MH, primary healthcare, TB, and HIV programmes. Thematic data analysis was guided by an adapted version of the World Health Organization's "building blocks" framework encompassing "service delivery", "workforce", "health information", "essential medicines", "financing", and "leadership/governance". Additionally, the analysis underscored the crucial role of "people", acknowledging their significant contributions as both caregivers and recipients of care. Managers highlighted significant concerns regarding the insufficient integration of MH services, identifying structural barriers such as inadequate MH management structures and staff training, as well as social barriers, notably stigma and a lack of family treatment adherence support. Conversely, they recognised strong management structures, integrated screening, and social interventions, including family involvement, as key facilitators of successful MH integration. The findings emphasise the need for a whole-system approach that addresses all building blocks while prioritising the role of "people" in overcoming challenges with integrating MH services into TB and HIV care.

Testing the feasibility, acceptability, and exploring trends on efficacy of the problem management plus for moms: Protocol of a pilot randomized control trial

Mental health disorders are one of the most common causes that limit the ability of mothers to care for themselves and for their children. Recent data suggest high rates of distress among women in charge of young children in Zambia. Nevertheless, Zambia's public healthcare offers very limited treatment for common mental health distress. To address this treatment gap, this study aims to test the feasibility, acceptability, and potential efficacy of a context-adapted psychosocial intervention. A total of 265 mothers with mental health needs (defined as SRQ-20 scores above 7) were randomly assigned with equal probability to the intervention or control group. The intervention group will receive a locally adapted version of the Problem-Management Plus and "Thinking Healthy" interventions developed by the World Health Organization (WHO), combined with specific parts of the Strong Minds-Strong Communities intervention. Trained and closely supervised wellbeing-community health workers will provide the psychosocial intervention. Mental health distress and attendance to the intervention will be assessed at enrollment and 6 months after the intervention. We will estimate the impact of the intervention on mental health distress using an intention-to-treat approach. We previously found that there is a large necessity for interventions that aim to address mother anxiety/depression problems. In this study, we tested the feasibility and efficacy of an innovative intervention, demonstrating that implementing these mental health treatments in low-income settings, such as Zambia, is viable with an adequate support system. If successful, larger studies will be needed to test the effectiveness of the intervention with increased precision. Trial registration: This study is registered at clinicaltrials.gov as NCT05627206.

A counsellor-supported 'PTSD Coach' intervention versus enhanced Treatment-as-Usual in a resource-constrained setting: A randomised controlled trial

To widen treatment access for posttraumatic stress disorder (PTSD) in resource-constrained South Africa, we evaluated the feasibility and effectiveness of a counsellor-supported PTSD Coach mobile application (app) (PTSD Coach-CS) intervention on PTSD and associated sequelae in a community sample. Participants (female = 89%; black = 77%; aged 19-61) with PTSD were randomised to PTSD Coach-CS (n = 32) or enhanced Treatment-as-Usual (n = 30), and assessed with the Clinician-Administered PTSD Scale (CAPS-5), PTSD Checklist (PCL-5) and Depression, Anxiety and Stress Scale-21 items, at pre- to post-treatment and follow-up (1 and 3 months). We also collected data on user experiences of the PTSD Coach app with self-administered surveys. We conducted an intent-to-treat analysis and linear mixed models. A significant (group × time) effect for the CAPS-5 (F3.136 = 3.33, p = 0.02) indicated a greater reduction in PTSD symptom severity over time for the intervention group with a significant between-group effect size detected at 3-month follow-up. Significant between-group effect sizes were detected in self-reported stress symptom reduction in the intervention group at post-treatment and 3-month follow-up. Participants perceived the app as helpful and were satisfied with the app. Findings suggest PTSD Coach-CS as a suitable low-cost intervention and potential treatment alternative for adults with PTSD in a resource-constrained country. Replication in larger samples is needed to fully support effectiveness. Pan African Trial Registry: PACTR202108755066871.

Improving integrated depression and non-communicable disease care in Malawi through engaged leadership and supportive implementation climate

BACKGROUND

Low- and middle-income countries often lack access to mental health services, leading to calls for integration within other primary care systems. In sub-Saharan Africa, integration of depression treatment in non-communicable disease (NCD) settings is feasible, acceptable, and effective. However, leadership and implementation climate challenges often hinder effective integration and quality of services. The aim of this study was to identify discrete leadership strategies that facilitate overcoming barriers to the integration of depression care in NCD clinics in Malawi and to understand how clinic leadership shapes the implementation climate.

METHODS

We conducted 39 in-depth interviews with the District Medical Officer, the NCD coordinator, one NCD provider, and the research assistant from each of the ten Malawian NCD clinics (note one District Medical Officer served two clinics). Based on semi-structured interview guides, participants were asked their perspectives on the impact of leadership and implementation climate on overcoming barriers to integrating depression care into existing NCD services. Thematic analysis used both inductive and deductive approaches to identify emerging themes and compare among participant type.

RESULTS

The results revealed how engaged leadership can fuel a positive implementation climate where clinics had heightened capacity to overcome implementation barriers. Effective leaders were approachable and engaged in daily operations of the clinic and problem-solving. They held direct involvement with and mentorship during the intervention, providing assistance in patient screening and consultation with treatment plans. Different levels of leadership utilized their respective standings and power dynamics to influence provider attitudes and perceptions surrounding the intervention. Leaders acted by informing providers about the intervention source and educating them on the importance of mental healthcare, as it was often undervalued. Lastly, they prioritized teamwork and collective ownership for the intervention, increasing provider responsibility.

CONCLUSION

Training that prioritizes leadership visibility and open communication will facilitate ongoing Malawi Ministry of Health efforts to scale up evidence-based depression treatment within NCD clinics. This proves useful where extensive and external monitoring may be limited. Ultimately, these results can inform successful strategies to close implementation gaps to achieve integration of mental health services in low-resource settings through improved leadership and implementation climate.

TRIAL REGISTRATION

These findings are reported from ClinicalTrials.gov, NCT03711786. Registered on 18/10/2018. https://clinicaltrials.gov/ct2/show/NCT03711786 .

Knowledge, confidence, and practices of clinical associates in the management of mental illness

Background

Additional human resources are needed to provide mental health services in underserved areas in South Africa (SA). Clinical associates, the mid-level medical worker cadre in SA, could potentially be used to deliver these services.

Aim

The study explored the self-reported knowledge, confidence, and current practices of clinical associates related to mental health assessment and management.

Setting

South Africa.

Methods

A cross-sectional study was conducted. The link to the electronic questionnaire was distributed to clinical associates via databases and social media. Data were analysed with Stata v17.

Results

Of the 209 participants, 205 (98.1%) indicated they had training on management of patients with mental illness during their undergraduate degree and 192 (91.9%) had a mental health rotation. Few (10.7%) had any additional mental health training. Most participants rated their knowledge of priority mental disorders as 'good' or 'excellent'. Only 43.2% of the participants felt quite or very confident to perform a mental health examination. Participants who felt quite or very confident to manage patients presenting with suicide risk, aggression, and confusion were 44.9%, 46.9% and 53.1%, respectively. Factors associated with a confidence score of 75% and higher were male gendered, working in Gauteng or Northern Cape provinces, and in a rural area. The majority of participants were already involved in mental health assessment and management in their current work.

Conclusion

Clinical associates have a contribution to make in mental health service provision, but this may need to be supplemented by additional practical training.

Contribution

Potential gaps in training have been identified.