Training needs and perspectives of community health workers in relation to integrating child mental health care into primary health care in a rural setting in sub-Saharan Africa: a mixed methods study

Abstract

BackgroundCommunity health workers can help to address the substantial unmet need for child mental health care in low and middle income countries. However, little is known about their training needs for this potential role. The aim of this study was to examine training needs and perspectives of community health extension workers (HEWs) in relation to providing child mental health care in rural Ethiopia.MethodsThe study was conducted in the Southern Nations, Nationalities and Peoples’ Region of Ethiopia. A mixed methods approach was used. A total of 104 HEWs who had received training in child mental health using the Health Education and Training (HEAT) curriculum were interviewed using a structured survey. In-depth interviews were then conducted with 11 HEWs purposively selected on the basis of the administrative zone they had come from. A framework approach was used for qualitative data analysis.ResultsMost of the HEWs (88.5%; n = 93/104) reported that they were interested in the training provided and all respondents considered child mental health to be important. The perceived benefits of training included improved knowledge (n = 52), case identification (n = 14) and service provision (n = 22). While most of the participants had their training four months prior to the interview, over a third of them (35.6%; n = 37) had already organized mental health awareness-raising meetings. Participants in the qualitative interviews considered the problem of child mental disorders to be widespread and to cause a large burden to the family and the affected children. They reported that improving their competence and knowledge was important to address the problem and to tackle stigma and discrimination. Participants also listed some barriers for service provision, including lack of competence, stigma and institutional constraints. Opportunities mentioned included staff commitment, high levels of interest and a positive attitude towards providing the service.ConclusionsAlthough the HEAT training on child mental health was brief, it appears to have had some impact in improving knowledge and care provision. If the key barriers to service provision are addressed and supported by policy guidance, community health workers may contribute substantially in addressing the treatment gap for children with mental health needs.

Personal attributes and competencies required by community health workers for a role in integrated mental health care for perinatal depression: voices of primary health care stakeholders from Surabaya, Indonesia

“…CHWs in these studies completed secondary school and were trained in communication skills, psychoeducation on perinatal depression, and intervention technique using stress/anger management [ 14 ] and/or cognitive behaviour therapy [ 16 ]. However, very few studies have investigated the personal characteristics and competencies required for CHWs to carry out these tasks [ 17 , 18 ] despite acknowledgement that knowledge to specific mental health issues and communication skills is important in improving competencies to deliver support.…”

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“…One of the major challenges facing CHW programs is the maintenance of skills and knowledge [ 7 , 8 , 27 ]. The traditional approach to training involves CHWs attending a 5-day in-person iCCM training course often held in a central location.…”

“…Despite the need for refresher training, many challenges surround its provision, including a shortage of trained personnel to deliver training, lack of attention from government-level policy makers, financial constraints and long gaps between initial and refresher training [ 7 , 8 ]. Lack of refresher training is one factor that has been identified as contributing to the failure of CHW programs over time [ 9 , 10 ].…”

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“…Shibre et al , 2006 ) indicated that completion of a questionnaire through a face-to-face interview with a lay interviewer is a culturally appropriate alternative. The local researchers in our team guided the design of these study aspects, including appropriate training for the lay interviewers (Tilahun et al , 2017a , b ).…”