Integrating community mental health within primary care in southern Malawi: A pilot educational intervention to enhance the role of health surveillance assistants

Wright, Jerome; Common, Stephanie; Kauye, Felix; Chiwandira, Chikayiko

doi:10.1177/0020764012471924

Cited by 24 publications

(29 citation statements)

References 20 publications

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“…The findings of this study add to the growing evidence for policy makers of the effectiveness of mental health training and supervision of primary care workers in improving knowledge, confidence and case detection in a resourceconstrained country. The results are consistent with other studies done in South Africa, Kenya and Malawi in which knowledge and/or confidence of primary health care workers have been found to improve significantly after a mental health training intervention [14,19,20]. The results are also consistent with another study in Malawi which found an increased number of diagnosed mental health cases after a training intervention [21].…”

Section: Discussionsupporting

confidence: 91%

“…Three self-administered questionnaires were used to collect information from participants. These were the Community Attitudes toward Mental Illness (CAMI) scale developed by Taylor and Dear [12], the WHO mhGAP pre-and-post knowledge test for mhGAP based training [13] and a confidence questionnaire [14].…”

Section: Instrumentsmentioning

confidence: 99%

“…To assess the confidence of the primary health workers, the researcher used a confidence questionnaire previously used in Malawi in a study which assessed the confidence of Health Surveillance Assistants in identifying mental disorders following a different mental health training [14] The questionnaire has 14 items rated on a Likert scale where response categories range from 1 (very confident) to 4 (not at all confident) The highest possible was 56. The higher the score, the more confident the participant was in identifying mental disorders.…”

Section: Instrumentsmentioning

confidence: 99%

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Evaluation of mhGAP training for primary healthcare workers in Mulanje, Malawi: a quasi-experimental and time series study

Kokota

Lund

Ahrens

et al. 2020

Int J Ment Health Syst

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Background: There has been a growing global movement championed by the World Health Organization (WHO) to integrate mental health into primary health care as the most effective way of reducing the mental health treatment gap. This study aimed to investigate the impact of WHO Mental Health Gap Action Programme (mhGAP) training and supervision on primary health workers' knowledge, confidence, attitudes and detection rate of major mental disorders in Mulanje, Malawi. Method:The study used a quasi-experimental method (single cohort pre-and post-measures) with an interrupted time-series design. A 2 day mhGAP training was delivered to 43 primary healthcare workers (PHWs) working in 18 primary care clinics serving the entire population of Mulanje, Malawi (population 684,107). Modules covered were psychosis, moderate-severe depression, and alcohol & substance use disorders. The PHWs completed pre and posttests to assess knowledge, confidence and attitudes. Number of diagnosed cases was obtained from clinic registers for 5 months prior to and 7 months following training. Data was analyzed using mean scores, t-test, one-way analysis of variance and linear regression. Results:The mean knowledge score increased significantly from 11.8 (SD: 0.33) before training to 15.1 (SD: 0.38) immediately after training; t (42) = 7.79, p < 0.01. Similarly, mean knowledge score was significantly higher 6 months post training at 13.9 (SD: 2.52) compared to before; t (42) = 4.57, p < 0.01. The mean confidence score also increased significantly from 39.9 (SD: 7.68) before training to 49.6 (SD: 06.14) immediately after training; t (84) = 8.43, p < 0.01. It was also significantly higher 6 months post training 46.8, (SD: 6.03) compared to before; t (84) = 6.60, p < 0.01. Oneway analysis of variance showed no significant difference in mean scores on all four components of the scale used to measure attitudes. A significant positive change in the trend in mental health service utilization after the intervention was demonstrated using a segmented linear regression (β = 2.43 (95% CI 1.02; 3.83) as compared to before (β = − 0.22 (95% CI − 2.67; 2.23) and immediately after (β = 1.63 (95% CI − 7.31; 10.57). Conclusion:The findings of this study add to the growing evidence for policy makers of the effectiveness of mhGAP training and supervision in a resource-constrained country.

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Section: Discussionsupporting

confidence: 91%

Section: Instrumentsmentioning

confidence: 99%

Section: Instrumentsmentioning

confidence: 99%

See 1 more Smart Citation

Evaluation of mhGAP training for primary healthcare workers in Mulanje, Malawi: a quasi-experimental and time series study

Kokota

Lund

Ahrens

et al. 2020

Int J Ment Health Syst

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“…Such an approach would not only be based on identifi cation of potential mental disorders, but should remain truly community-based and empowering (Wright et al, 2014). Tangible and concrete support is often of critical importance in community mental health interventions.…”

Section: Engaging Communities To Be Partners In Psychosocial Intervenmentioning

confidence: 99%

Integration of mental health into primary healthcare in low-income countries: Avoiding medicalization

Ventevogel

2014

International Review of Psychiatry

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Since 2008 the World Health Organization (WHO), through its mental health Gap Action Programme, has attempted to revitalize efforts to integrate mental health into non-specialized (e.g. primary) healthcare. While this has led to renewed interest in this potential method of mental health service delivery, it has also prompted criticism. Some concerns raised are that it would contribute to the medicalization of social and psychological problems, and narrowly focus on primary care without sufficient attention given to strengthening other levels of the healthcare system, notably community-based care and care on district levels. This paper discusses seven elements that may be critical to preventing inadvertently contributing to increasing a narrow biomedical approach to mental healthcare when integrating mental health into non-specialized healthcare: (1) using task shifting approaches within a system of stepped care, (2) ensuring primary mental healthcare also includes brief psychotherapeutic interventions, (3) promote community-based recovery-oriented interventions for people with disabling chronic mental disorders, (4) conceptualizing training as a continuous process of strengthening clinical competencies through supervision, (5) engaging communities as partners in psychosocial interventions, (6) embedding shifts to primary mental healthcare within wider health policy reforms, and (7) promoting inter-sectoral approaches to address social determinants of mental health.

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“…In Africa, alternative explanations for mental distress, such as bewitchment, taboos and the belief that it runs in families, reduce the chances of access to mental health care (Bird et al, 2011;Wright, Common, Kauye, & Chiwandira, 2014). Moreover, attitudes about mental illness are strongly influenced by traditional beliefs (e.g., supernatural causes) and remedies.…”

mentioning

confidence: 99%

Fostering Non-Cognitive Development of Underrepresented Students Through Rational Emotive Behavior Therapy: Recommendations for School Counselor Practice

Warren¹,

Hale²

2016

TPC

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The Mental Health Facilitator (MHF) program utilizes a population-based curriculum and has been implemented in Malawi for the past seven years. This article reports findings from an ethnographic study that explored how 40 MHF stakeholders have experienced the MHF program. This transdisciplinary program is a 30-hour training in community mental health that focuses on fundamental helping skills; identification of stress, distress and mental disorders; and appropriate community referral and followup. Results indicated four interrelated themes representing participants' beliefs about their experiences with the training, including the curriculum's responsiveness to the Malawian context, the availability and limitations of resources, the processes involved, and a variety of identified outcomes. Implications for community implementation and future directions are identified.

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Integrating community mental health within primary care in southern Malawi: A pilot educational intervention to enhance the role of health surveillance assistants

Cited by 24 publications

References 20 publications

Evaluation of mhGAP training for primary healthcare workers in Mulanje, Malawi: a quasi-experimental and time series study

Evaluation of mhGAP training for primary healthcare workers in Mulanje, Malawi: a quasi-experimental and time series study

Integration of mental health into primary healthcare in low-income countries: Avoiding medicalization

Fostering Non-Cognitive Development of Underrepresented Students Through Rational Emotive Behavior Therapy: Recommendations for School Counselor Practice

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