Assessing capability for implementing mental health counselling within primary care facilities in a middle‐income country: A feasibility study

Abstract

Accessible summary What is already known about this topic? Integrating mental health counselling into primary care services is a recommended strategy for reducing the mental health treatment gap in low‐ and middle‐income countries. To support this strategy, potential barriers to counselling integration must be identified and addressed. Organizational preparedness for implementation may influence the extent to which the introduction of counselling is successful. Features of primary care facilities associated with preparedness for the implementation of mental health counselling have not been explored. What the paper adds to existing knowledge? This study uses a novel approach to explore variations in preparedness of primary care services to implement counselling and factors potentially associated with these variations. Findings suggest there is considerable variation in the preparedness of facilities to implement counselling. Organizational factors such as resource availability, management style and facility environment are potentially associated with capability for implementing mental health counselling. What are the implications for practice? Health planners could use this method to identify poorly functioning services that may benefit from additional interventions to build preparedness for counselling implementation. Future research should examine whether differences in facility preparedness impact on the implementation and outcomes of this service. AbstractIntroductionDifferences in primary care facilities' preparedness for implementing mental health counselling may affect the implementation process but have rarely been studied.AimTo assess the feasibility of using a novel methodological approach to explore variations in capability for implementing mental health counselling and factors potentially associated with this variation among primary care services in the Western Cape, South Africa.MethodsStaff from 26 facilities participated in discussions about their facility's mental health implementation capability. Three researchers conducted observations of the facility's environment, staff–patient interactions and resources. We used qualitative comparative analysis to identify factors potentially associated with implementation capability.ResultsFacilities appeared to vary in their capability for implementing counselling services. The availability of person‐centred health services, a therapeutic environment and sufficient human resources may be requirements for implementation preparedness. Other factors that seem to support preparedness include the availability of confidential space for counselling and an adequately managed facility.DiscussionThis study identified several features of well‐functioning primary care facilities. Facilities with these features may be better prepared to implement a new counselling service.Implications for practiceThis method may identify facilities that are poorly prepared for implementation that could benefit from preparedness‐building interventions. Whether differences in p...

Integration of mental health counselling into chronic disease services at the primary health care level: Formative research on dedicated versus designated strategies in the Western Cape, South Africa

“…Finally, our findings suggest that simply integrating a counselling programme into chronic disease care without addressing contextual and service delivery constraints is unlikely to be effective and requires other elements to be in place for integration to be successful. Other work in the South African context has highlighted the importance of creating an enabling environment in health care facilities 22,27,28 and the community 29 to support integration. Factors such as facility management, degree of facility organization, organizational readiness to change need to be considered.…”

“…Factors such as facility management, degree of facility organization, organizational readiness to change need to be considered. 22,28 Low levels of mental health literacy and mental health prioritisation among health care workers, patients and the community as a whole remain a significant barrier to counselling access and uptake. It will thus be critical to educate health care workers and raise mental health awareness in the community.…”

“Moving Forward with Life”: Acceptability of a Brief Alcohol Reduction Intervention for People Receiving Antiretroviral Therapy in South Africa

“…In the current study, the intervention content was delivered over two occasions, primarily due to initial concerns about the feasibility of retaining participants in an intervention spread over four weeks. While PLWH in South Africa have reported structural barriers to retention in alcohol counselling [36,37], and providing fewer but longer and more intensive sessions is one way of addressing these barriers, structuring the intervention in this way arguably provided participants with fewer opportunities to test their problem-solving skills and review these with their counsellor. Lengthier counselling sessions may also raise concerns about the feasibility of implementing this intervention at scale with high patient caseloads generally limiting the amount of time health workers are able to spend with patients [38].…”

Adaptation of the Texas Christian University Organisational Readiness for Change Short Form (TCU-ORC-SF) for use in primary health facilities in South Africa

“…These included good patient information systems, organised services and a strong management team (all supporting the provision of patient-centred cared). 10 The variability across facilities observed in this work indicates the need for feasible ways to assess readiness and identify barriers to implementation for these service innovations.…”

“… 12 For example, psychosocial interventions can be complex in nature (eg, multiple sessions, psychological content); community contexts where patients live may challenge participation in sessions (eg, poverty, violence) 13 14 ; and importantly, the organisational setting of primary care facilities presents a complex environment for introducing mental health and other behavioural health innovations (eg, heavy workloads, resource shortages, skills limitations, poor staff morale). 10 15–21 Innovations need to be implemented by individuals embedded in complex organisations and difficult social contexts. 22–24 This may help explain why many effective interventions do not transition to sustained routine practice in primary health organisations, 25 26 and why reducing the evidence-to-practice gap remains a priority for health services research.…”