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

Korhonen, Joonas; Axelin, Anna; Stein, Dan J.; Seedat, Soraya; Mwape, Lonia; Jansen, Ronelle; Groen, Gunter; Grobler, Gerhard; Jörns‐Presentati, Astrid; Katajisto, Jouko; Lahti, Mari; ,

doi:10.1002/brb3.2807

Cited by 9 publications

(6 citation statements)

References 70 publications

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“…It should be noted that participants in the control group also improved over time, possibly due to the potentially beneficial effects of the monitoring sessions (clinician and counsellor); particularly since participants in the control group had high levels of trauma exposure, and the majority did not receive treatment during the study treatment period (Appelbaum et al, 2004 ; Grant et al, 2021 ; Korhonen et al, 2022 ). Receipt of a PTSD diagnosis, accompanying symptom identification, and consequent monitoring could have normalised experiences for the first time and provided therapeutic benefit (Appelbaum et al, 2004 ; Whitworth 2016 ).…”

Section: Discussionmentioning

confidence: 99%

A counsellor-supported ‘PTSD Coach’ intervention versus enhanced treatment as usual in a resource-constrained setting: A randomised controlled trial

Bröcker,

Olff,

Suliman

et al. 2024

Camb. prisms Glob. ment. health

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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 selfadministered surveys. We conducted an intent-to-treat analysis and linear mixed models. A significant (group × time) effect for the CAPS-5 (F 3.136 = 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 posttreatment 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. Impact statementMany individuals in low-middle-income countries (LMICs), such as South Africa, often experience high trauma exposure rates and associated posttraumatic stress disorder (PTSD). PTSD can have harmful effects on the individual with their daily functioning often negatively impacted. Unfortunately, many individuals with PTSD in these settings do not access the needed support and treatment due to healthcare resource constraints. These resource constraints include overburdened public health care services and difficulty accessing these services when available. More feasible intervention alternatives are needed to widen access to support and treatment in the general population. Mobile-based interventions, such as the freely available PTSD Coach mobile application (app), is one such alternative. We evaluated the effectiveness of a four-session counsellor-supported PTSD Coach app (PTSD Coach-CS) intervention in reducing PTSD, depression, anxiety, and stress symptoms in a South African adult community sample. Our findings support that a low-cost, more accessible PTSD Coach-CS intervention is a feasible intervention alternative for adults with PTSD in a resourceconstrained setting such as South Africa. It also appears that it can reduce PTSD and stress symptoms; however, more research is needed to fully support this. Importantly, our findings indicate that the original version of the app, developed for veterans in the United States, can be used in a culturally different sett...

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Section: Discussionmentioning

confidence: 99%

A counsellor-supported ‘PTSD Coach’ intervention versus enhanced treatment as usual in a resource-constrained setting: A randomised controlled trial

Bröcker,

Olff,

Suliman

et al. 2024

Camb. prisms Glob. ment. health

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“…24 The findings with regard to the high levels of knowledge of depression contrast with studies among non-specialist health professionals in Africa that report limited knowledge of depression. 28,29 A study amongst PHC workers in South Africa and Zambia found moderate mental health literacy, 30 while a study amongst nonspecialist medical practitioners in the public and private sector in South Africa found adequate knowledge of mental illness. 31 The use of a self-rating tool in the study may have meant that participants could have overestimated their knowledge.…”

Section: Discussionmentioning

confidence: 99%

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

Moodley,

Wolvaardt,

Grobler

2023

South African Journal of Psychiatry

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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.

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“…In Malawi, a cross-sectional survey demonstrated that a majority of both providers and patients had limited mental health understanding, attributing causes of mental disorders to substance use or spiritual "punishment" [62]. As low mental health literacy exacerbates treatment gaps in the region, transformational leaders' ability to improve provider attitudes towards mental healthcare could serve as a valuable intervention [63]. Thus, engaging leadership to improve mental health literacy, address stigma, and underscore the public health importance of providing mental healthcare could improve the implementation climate for task-shifted mental health programming.…”

Section: Discussionmentioning

confidence: 99%

“…Conversely, without this handson support and supervision, providers may not have screened patients with the same rigor due to a lack of self-efficacy. In SSA, insufficient resources for mental health treatment, often compounded by low mental health literacy, undermines providers' ability to consistently deliver mental health treatment and reinforce negative attitudes [63][64][65]. However, mentoring programs can effectively increase health worker competence and institutional performance for a variety of clinical specialties [66].…”

Section: Discussionmentioning

confidence: 99%

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

Sansbury,

Pence,

Zimba

et al. 2023

BMC Health Serv Res

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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.

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

Cited by 9 publications

References 70 publications

A counsellor-supported ‘PTSD Coach’ intervention versus enhanced treatment as usual in a resource-constrained setting: A randomised controlled trial

A counsellor-supported ‘PTSD Coach’ intervention versus enhanced treatment as usual in a resource-constrained setting: A randomised controlled trial

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

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

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