"We find what we look for, and we look for what we know": factors interacting with a mental health training program to influence its expected outcomes in Tunisia.

Publisher: BioMed Central Country of Publication: England NLM ID: 100968562 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2458 (Electronic) Linking ISSN: 14712458 NLM ISO Abbreviation: BMC Public Health Subsets: MEDLINE

Original Publication: London : BioMed Central, [2001-

Inservice Training/*organization & administration ; Mental Disorders/*therapy ; Mental Health/*education ; Physicians, Primary Care/*education; Clinical Competence ; Female ; Humans ; Male ; Middle Aged ; Organizational Case Studies ; Physicians, Primary Care/psychology ; Physicians, Primary Care/statistics & numerical data ; Program Evaluation ; Qualitative Research ; Treatment Outcome ; Tunisia

Background: Primary care physicians (PCPs) working in mental health care in Tunisia often lack knowledge and skills needed to adequately address mental health-related issues. To address these lacunas, a training based on the Mental Health Gap Action Programme (mhGAP) Intervention Guide (IG) was offered to PCPs working in the Greater Tunis area between February and April 2016. While the mhGAP-IG has been used extensively in low- and middle-income countries (LMICs) to help build non-specialists' mental health capacity, little research has focused on how contextual factors interact with the implemented training program to influence its expected outcomes. This paper's objective is to fill that lack.
Methods: We conducted a case study with a purposeful sample of 18 trained PCPs. Data was collected by semi-structured interviews between March and April 2016. Qualitative data was analyzed using thematic analysis.
Results: Participants identified more barriers than facilitators when describing contextual factors influencing the mhGAP-based training's expected outcomes. Barriers were regrouped into five categories: structural factors (e.g., policies, social context, local workforce development, and physical aspects of the environment), organizational factors (e.g., logistical issues for the provision of care and collaboration within and across healthcare organizations), provider factors (e.g., previous mental health experience and personal characteristics), patient factors (e.g., beliefs about the health system and healthcare professionals, and motivation to seek care), and innovation factors (e.g., training characteristics). These contextual factors interacted with the implemented training to influence knowledge about pharmacological treatments and symptoms of mental illness, confidence in providing treatment, negative beliefs about certain mental health conditions, and the understanding of the role of PCPs in mental health care delivery. In addition, post-training, participants still felt uncomfortable with certain aspects of treatment and the management of some mental health conditions.
Conclusions: Findings highlight the complexity of implementing a mhGAP-based training given its interaction with contextual factors to influence the attainment of expected outcomes. Results may be used to tailor structural, organizational, provider, patient, and innovation factors prior to future implementations of the mhGAP-based training in Tunisia. Findings may also be used by decision-makers interested in implementing the mhGAP-IG training in other LMICs.

Soc Sci Med. 2014 Oct;118:33-42. (PMID: 25089962)
Bull World Health Organ. 2004 Nov;82(11):858-66. (PMID: 15640922)
Soc Sci Med. 2013 Nov;97:82-6. (PMID: 24161092)
Lancet. 1994 Oct 22;344(8930):1129-33. (PMID: 7934497)
Bull World Health Organ. 2011 Mar 1;89(3):184-94. (PMID: 21379414)
Glob Ment Health (Camb). 2018 May 09;5:e17. (PMID: 29868237)
Int J Public Health. 2016 Dec;61(9):995-1002. (PMID: 27193575)
Br J Psychiatry. 2016 Jan;208 Suppl 56:s21-8. (PMID: 26447173)
PLoS One. 2011;6(5):e19590. (PMID: 21611123)
PLoS Med. 2006 Nov;3(11):e442. (PMID: 17132052)
World Psychiatry. 2010 Oct;9(3):169-76. (PMID: 20975864)
Implement Sci. 2013 Feb 17;8:22. (PMID: 23414420)
Health Serv Insights. 2017 Mar 28;10:1178632917694350. (PMID: 28469456)
Br J Psychiatry. 2016 Jan;208 Suppl 56:s1-3. (PMID: 26447177)
Glob Ment Health (Camb). 2017 Apr 18;4:e7. (PMID: 28596908)
Br J Psychiatry. 2006 Jan;188:81-2. (PMID: 16388075)
JAMA. 2004 Jun 2;291(21):2581-90. (PMID: 15173149)
Front Psychiatry. 2015 Mar 11;6:38. (PMID: 25814959)
World Psychiatry. 2007 Oct;6(3):177-85. (PMID: 18188443)
BMJ. 2007 Mar 3;334(7591):455-9. (PMID: 17332585)
Implement Sci. 2009 Aug 07;4:50. (PMID: 19664226)
Am J Community Psychol. 2008 Jun;41(3-4):327-50. (PMID: 18322790)
Lancet. 2011 Nov 5;378(9803):1654-63. (PMID: 22008420)
J Ment Health. 2014 Dec;23(6):303-6. (PMID: 24959924)
Int J Ment Health Syst. 2018 Oct 26;12:63. (PMID: 30386422)
Cerebrum. 2016 Jul 01;2016:. (PMID: 28058091)
Evid Based Ment Health. 2018 Feb;21(1):30-34. (PMID: 28903977)
Cochrane Database Syst Rev. 2011 May 11;2011(5):. (PMID: 24143128)
Burns. 2016 Nov;42(7):1593-1599. (PMID: 27211362)
Lancet. 2007 Sep 22;370(9592):1061-77. (PMID: 17804052)
Community Ment Health J. 2019 Jan;55(1):137-143. (PMID: 30229347)
Cochrane Database Syst Rev. 2013 Nov 19;(11):CD009149. (PMID: 24249541)
Lancet. 2007 Sep 8;370(9590):878-89. (PMID: 17804062)
Public Health. 2001 Sep;115(5):328-37. (PMID: 11593442)
BMC Health Serv Res. 2017 Jan 17;17(1):38. (PMID: 28095850)
N Engl J Med. 2013 Jul 4;369(1):66-73. (PMID: 23822778)
Int J Ment Health Syst. 2016 Feb 27;10:12. (PMID: 26925160)
BMJ. 2000 Sep 16;321(7262):694-6. (PMID: 10987780)
Hum Resour Health. 2009 Dec 19;7:87. (PMID: 20021682)
BMC Med Res Methodol. 2011 Jun 27;11:100. (PMID: 21707982)

33774 Fonds de Recherche du Québec - Santé; IT06835 Mitacs

Keywords: Case study; Implementation; Mental health; Physicians; Primary care; Training; Tunisia; mhGAP

Date Created: 20181222 Date Completed: 20190206 Latest Revision: 20231005

20231005

PMC6302293

10.1186/s12889-018-6261-4

30572941