Perspectives and concerns of clients at primary health care facilities involved in evaluation of a national mental health training programme for primary care in Kenya

Abstract

BackgroundA cluster randomised controlled trial (RCT) of a national Kenyan mental health primary care training programme demonstrated a significant impact on the health, disability and quality of life of clients, despite a severe shortage of medicines in the clinics (Jenkins et al. Submitted 2012). As focus group methodology has been found to be a useful method of obtaining a detailed understanding of client and health worker perspectives within health systems (Sharfritz and Roberts. Health Transit Rev 4:81–85, 1994), the experiences of the participating clients were explored through qualitative focus group discussions in order to better understand the potential reasons for the improved outcomes in the intervention group.MethodsTwo ninety minute focus groups were conducted in Nyanza province, a poor agricultural region of Kenya, with 10 clients from the intervention group clinics where staff had received the training programme, and 10 clients from the control group where staff had not received the training during the earlier randomised controlled trial.ResultsThese focus group discussions suggest that the clients in the intervention group noticed and appreciated enhanced communication, diagnostic and counselling skills in their respective health workers, whereas clients in the control group were aware of the lack of these skills. Confidentiality emerged from the discussions as a significant client concern in relation to the volunteer cadre of community health workers, whose only training comes from their respective primary care health workers.ConclusionEnhanced health worker skills conferred by the mental health training programme may be responsible for the significant improvement in outcomes for clients in the intervention clinics found in the randomised controlled trial, despite the general shortage of medicines and other health system weaknesses. These findings suggest that strengthening mental health training for primary care staff is worthwhile even where health systems are not strong and where the medicine supply cannot be guaranteed.Trial registrationISRCTN 53515024.

Health system challenges to integration of mental health delivery in primary care in Kenya- perspectives of primary care health workers

“…Thus the questions were designed to elicit open ended discussion about mental health care issues rather than to specifically focus on generic health system challenges, and the information thus obtained has been reported elsewhere [12,13]. It is therefore noteworthy that the generic health system issues highlighted in this paper arose spontaneously in discussions with both the intervention group and the control group, and not in response to leading questions about specific health service problems.…”

“…This paper is the third in a series reporting the results of the focus groups, the first presented the experiences and perspectives of the clients [12]; the second presented the experiences and perspectives of the health workers and their ability to understand, assess, and treat mental disorder [13]; and this third paper explores the generic health system difficulties encountered by health workers when trying to integrate mental health care into routine primary care practice.…”

Exploring the perspectives and experiences of health workers at primary health facilities in Kenya following training

“…Further limitations of the study include the fact that most of the research team for the focus group study were also involved in the randomised controlled trial. The use of both clients and health workers affords some triangulation of the findings (see accompanying papers [4,5]).…”

“…During the course of the trial Kenya, and especially Nyanza Province, experienced a severe shortage of medicines, and this was reflected in the research findings on medicine availability in the clinics participating in the trial. Nonetheless, the trial found significant improvement in the clients of the trained health workers in the intervention group compared with those in the control group [5]. Since focus group methodology has been found to be an effective way to explore health worker and client views within health system contexts [6], and at the request of the funder (the UK Department for International Development), we therefore conducted focus groups with some health workers and clients from the trial to better understand their perspectives and experiences.…”

Therapist competence in global mental health: Development of the ENhancing Assessment of Common Therapeutic factors (ENACT) rating scale

“…Barriers to applying these tools include experts required for scoring, narrow focus on content, reliance on patient feedback, length of tools, and high costs to administer some copyrighted tools. Moreover, although common factors are important across cultures (Frank & Frank, 1991; Othieno et al, 2013), instruments developed for use by educated professionals in HICs might overly represent values and treatment philosophies that are not associated with outcomes across cultures, such as an emphasis on biomedical models (Kleinman, 1988). …”