Building capacity in mental health care in low- and middle-income countries by training primary care physicians using the mhGAP

A randomized controlled trial

Dados Bibliográficos

ID11492081
AutoresJessica Spagnolo (0000-0002-1125-3121, Université de Montréal, autor correspondente), François Champagne (Université de Montréal), Nicole Leduc (Université de Montréal), Michèle Rivard (Université de Montréal), Wahid Melki (Hôpital Razi, Manouba, Tunisia), Myra Piat (0000-0002-5933-0974, Douglas Mental Health University Institute, 6875 Boulevard LaSalle, Verdun, QC H4H 1R3, Canada), Marc Laporta (Department of Psychiatry, McGill University, 1033 Avenue des Pins, Montréal, QC H3A 1A1, Canada), Imen Guesmi (Centre médico-scolaire et universitaire de Manouba, Manouba, Tunisia), Nesrine Bram (Hôpital Razi, Manouba, Tunisia), Fatma Charfi (0000-0002-5171-2767, Faculté de médecine, Université de Tunis El-Manar, Tunis, Tunisia)
Ano2020
Volume35
Fascículo2
Páginas186-198
Data de publicação2020-03-01
Peer ReviewedSim
Open AccessSim
TipoARTICLE
PeriódicoHealth Policy and Planning (JOURNAL)
Identificadores do periódicoISSN: 0268-1080 • E-ISSN: 1460-2237
EditoraOxford University Press (PUBLISHER • GB)
DOI10.1093/heapol/czz138
PMID31794027
OpenAlexW2992749638
IdiomaEN
Citações recebidas3
Referências citadas48

To address the rise in mental health conditions in Tunisia, a training based on the Mental Health Gap Action Programme (mhGAP) Intervention Guide (IG) was offered to primary care physicians (PCPs) working in the Greater Tunis area. Non-specialists (such as PCPs)’ training is an internationally supported way to target untreated mental health symptoms. We aimed to evaluate the programme’s impact on PCPs’ mental health knowledge, attitudes, self-efficacy and self-reported practice, immediately following and 18 months after training. We conducted an exploratory trial with a combination of designs: a pretest–posttest control group design and a one-group pretest–posttest design were used to assess the training’s short-term impact; and a repeated measures design was used to assess the training’s long-term impact. The former relied on a delayed-intervention strategy: participants assigned to the control group (Group 2) received the training after the intervention group (Group 1). The intervention consisted of a weekly mhGAP-based training session (totalling 6 weeks), comprising lectures, discussions, role plays and a support session offered by trainers. Data were collected at baseline, following Group 1’s training, following Group 2’s training and 18 months after training. Descriptive, bivariate and ANOVA analyses were conducted. Overall, 112 PCPs were randomized to either Group 1 (n = 52) or Group 2 (n = 60). The training had a statistically significant short-term impact on mental health knowledge, attitudes and self-efficacy scores but not on self-reported practice. When comparing pre-training results and results 18 months after training, these changes were maintained. PCPs reported a decrease in referral rates to specialized services 18 months after training in comparison to pre-training. The mhGAP-based training might be useful to increase mental health knowledge and self-efficacy, and decrease reported referral rates and negative mental health attitudes among PCPs in Tunisia and other low- and middle-income countries. Future studies should examine relationships among these outcome variables

Family medicine · Intervention (counseling) · Mental health · Physical therapy · Psychiatry · Randomized controlled trial · Health, psychology, and well-being · Internal Medicine · Medicine · Mental Health Treatment and Access · Nursing · Primary Care and Health Outcomes