Piloting a mental health training programme for community health workers in South Africa: an exploration of changes in knowledge, confidence and attitudes.

Autor: Sibeko G; Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa. goodmansibeko@gmail.com., Milligan PD; Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa., Roelofse M; Western Cape Department of Health, Western Cape Province, South Africa., Molefe L; Western Cape Department of Health, Western Cape Province, South Africa., Jonker D; Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa., Ipser J; Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa., Lund C; Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.; Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK., Stein DJ; Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.; South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Cape Town, South Africa.
Jazyk: angličtina
Zdroj: BMC psychiatry [BMC Psychiatry] 2018 Jun 14; Vol. 18 (1), pp. 191. Date of Electronic Publication: 2018 Jun 14.
DOI: 10.1186/s12888-018-1772-1
Abstrakt: Background: There is a shortage of trained mental health workers in spite of the significant contribution of psychiatric disorders to the global disease burden. Task shifting, through the delegation of health care tasks to less specialised health workers such as community health workers (CHWs), is a promising approach to address the human resource shortage. CHWs in the Western Cape province of South Africa provide comprehensive chronic support which includes that for mental illness, but have thus far not received standardized mental health training. It is unknown whether a structured mental health training programme would be acceptable and feasible, and result improved knowledge, confidence and attitudes amongst CHWs.
Methods: We developed and piloted a mental health training programme for CHWs, in line with the UNESCO guidelines; the WHO Mental Health Gap Action Programme and the South African National framework for CHW training. In our quasi-experimental (before-after) cohort intervention study we measured outcomes at the start and end of training included: 1) Mental health knowledge, measured through the use of case vignettes and the Mental Health Knowledge Schedule; 2) confidence, measured with the Mental Health Nurse Clinical Confidence Scale; and 3) attitudes, measured with the Community Attitudes towards the Mentally Ill Scale. Knowledge measures were repeated 3 months later. Acceptability data were obtained from daily evaluation questionnaires and a training evaluation questionnaire, while feasibility was measured by participant attendance at training sessions.
Results: Fifty-eight CHWs received the training, with most (n = 56, 97.0%) attending at least 7 of the 8 sessions. Most participants (n = 29, 63.04%) demonstrated significant improvement in knowledge, which was sustained at 3-months. There was significant improvement in confidence, along with changes in attitude, indicating improved benevolence, reduced social restrictiveness, and increased tolerance to rehabilitation of the mentally ill in the community but there was no change in authoritarian attitudes. The training was acceptable and feasible.
Conclusions: Mental health training was successful in improving knowledge, confidence and attitudes amongst trained CHWs. The training was acceptable and feasible. Further controlled studies are required to evaluate the impact of such training on patient health outcomes.
Trial Registration: PACTR PACTR201610001834198 , Registered 26 October 2016.
Databáze: MEDLINE
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