Piloting a mental health training programme for community health workers in South Africa: an exploration of changes in knowledge, confidence and attitudes
Open accessAbstract
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.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Providers with higher education were perceived as being more receptive to training.
“Additionally, providers with higher education were perceived as being more receptive to training [55].”
From Barriers and facilitators to implementation of evidence-based task-sharing mental health interventions in low- and middle-income countries: a systematic review using implementation science frameworks (2022) · cites this paper as [55]
The Results (Training outcomes; page unavailable) find that higher education was associated with greater gains in knowledge after training. The Discussion links this to CHW trainability, but the paper does not report that providers with higher education were perceived as more receptive to training. (LLM, conf=0.84)
Experimental — accuracy not yet measuredSuch providers viewed clients as potentially dangerous to themselves and others, hampering effective implementation.
“Such providers viewed clients as potentially dangerous to themselves and others, hampering effective implementation [55].”
From Barriers and facilitators to implementation of evidence-based task-sharing mental health interventions in low- and middle-income countries: a systematic review using implementation science frameworks (2022) · cites this paper as [55]
The Discussion (page not supplied) links authoritarian attitudes to perceived danger from people with mental disorders, and the Results report no improvement in authoritarian attitudes after training. The paper does not establish that these providers viewed clients as dangerous to themselves and others, or that such views hampered effective implementation; it says patient outcomes were not evaluated. (LLM, conf=0.82)
Experimental — accuracy not yet measuredPrior depression and substance use trainings for community health workers did not incorporate contact with people with lived experience of substance use and depression treatment and recovery.
“Critically, these prior trainings did not incorporate contact with people with lived experience of SU and depression treatment and recovery.”
From Siyakhana: A Hybrid Type 2 Effectiveness-Implementation Stepped-Wedge Trial to Reduce Stigma Towards Substance Use and Depression Among Community Health Workers in HIV/TB Care in South Africa (2025) · cites this paper as Sibeko et al., 2018
The Methods sections ‘Training programme’ and ‘Delivery of the training’ describe the sessions and a social-worker facilitator, but do not state whether participants had contact with people with lived experience. The paper also does not establish that prior trainings lacked such contact. I searched for contact, lived experience, recovery, and previous training programmes; an omission from the session outline alone cannot verify the claim. (LLM, conf=0.72)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
R: A Language and Environment for Statistical Computing
R Core Team (2000) · doi:10.32614/r.manuals · Cited by 355,706 · see citing works
Vos, T., Barber, R. M., Bell, B., Bertozzi-Villa, A., Biryukov, S., Bolliger, I., Charlson, F., Davis, A., Degenhardt, L., Dicker, D., et al. (2015) · The Lancet · doi:10.1016/s0140-6736(15)60692-4 · Cited by 6,414 · see citing works
Self-citationTreatment gap in mental health care.
Abramowitz, M. Z., Greenberg, D., & Levav, I. (2008) · PubMed · Cited by 1,482 · see citing works
The treatment gap in mental health care.
(2004) · Europe PMC (PubMed Central) · Cited by 1,419 · see citing works
Psychological Treatments for the World: Lessons from Low- and Middle-Income Countries
Singla, D. R., Kohrt, B. A., Murray, L. K., Anand, A., Chorpita, B. F., & Patel, V. (2017) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-032816-045217 · Cited by 913 · see citing works
Scaling Community Attitudes Toward the Mentally Ill
Taylor, S. M., & Dear, M. J. (1981) · Schizophrenia Bulletin · doi:10.1093/schbul/7.2.225 · Cited by 856 · see citing works
Mental health literacy measures evaluating knowledge, attitudes and help-seeking: a scoping review
Wei, Y., McGrath, P. J., Hayden, J., & Kutcher, S. (2015) · BMC Psychiatry · doi:10.1186/s12888-015-0681-9 · Cited by 500 · see citing works
Glenton, C., Colvin, C., Carlsen, B., Swartz, A., Lewin, S., Noyes, J., & Rashidian, A. (2013) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd010414.pub2 · Cited by 454 · see citing works
Reducing the treatment gap for mental disorders: a WPA survey
PATEL, V., MAJ, M., FLISHER, A. J., DE SILVA, M. J., KOSCHORKE, M., PRINCE, M., WPA Zonal and Member Society Representatives, Tempier, R., Riba, M., Sanchez, M., et al. (2010) · World Psychiatry · doi:10.1002/j.2051-5545.2010.tb00305.x · Cited by 420 · see citing works
Development and psychometric properties of the Mental Health Knowledge Schedule
Evans-Lacko, S., Little, K., Meltzer, H., Rose, D., Rhydderch, D., Henderson, C., & Thornicroft, G. (2010) · The Canadian Journal of Psychiatry · doi:10.1177/070674371005500707 · Cited by 402 · see citing works
Kok, M. C., Kane, S. S., Tulloch, O., Ormel, H., Theobald, S., Dieleman, M. A., Taegtmeyer, M., Broerse, J. E. W., & de Koning, K. A. (2015) · Health Research Policy and Systems · doi:10.1186/s12961-015-0001-3 · Cited by 324 · see citing works
Community Knowledge of Mental Illness and Reaction to Mentally Ill People
Wolff, G., Pathare, S., Craig, T., & Leff, J. (1996) · The British Journal of Psychiatry · doi:10.1192/bjp.168.2.191 · Cited by 280 · see citing works
Armstrong, G., Kermode, M., Raja, S., Suja, S., Chandra, P. S., & Jorm, A. F. (2011) · International Journal of Mental Health Systems · doi:10.1186/1752-4458-5-17 · Cited by 168 · see citing works
Stigma of Mental Illness-1: Clinical reflections
Shrivastava, A., Bureau, Y., & Johnston, M. (2012) · Mens Sana monographs · doi:10.4103/0973-1229.90181 · Cited by 120 · see citing works
Handley, M. A., Schillinger, D., & SHIBOSKI, S. C. (2011) · The Journal of the American Board of Family Medicine · doi:10.3122/jabfm.2011.05.110067 · Cited by 111 · see citing works
Mental health training for health workers in Africa: a systematic review
Liu, G., Jack, H. E., Piette, A., Mangezi, W. O., Machando, D., Rwafa, C., Goldenberg, M., & Abas, M. (2016) · The Lancet Psychiatry · doi:10.1016/s2215-0366(15)00379-x · Cited by 63 · see citing works
Bell, A., Horsfall, J. M., & Goodin, W. (1998) · PubMed · Cited by 63 · see citing works
Swartz, A., & Colvin, C. J. (2014) · Critical Public Health · doi:10.1080/09581596.2014.941281 · Cited by 57 · see citing works
Kawakatsu, Y., Sugishita, T., Tsutsui, J., et al. (2015) · BMC Health Services Research · doi:10.1186/s12913-015-1117-4 · Cited by 50 · see citing works
Sun, B., Fan, N., Nie, S., Zhang, M., Huang, X., He, H., & Rosenheck, R. A. (2014) · International Journal of Mental Health Systems · doi:10.1186/1752-4458-8-26 · Cited by 37 · see citing works
Aznar-Lou, I., Serrano-Blanco, A., Fernández, A., Luciano, J., & Rubio-Valera, M. (2015) · BMC Public Health · doi:10.1186/s12889-016-2815-5 · Cited by 37 · see citing works
Iheanacho, T., Kapadia, D., Ezeanolue, C. O., Osuji, A., Ogidi, A. G., Ike, A., Patel, D. V., Stefanovics, E. A., Rosenheck, R. A., Obiefune, M. C., et al. (2015) · International Journal of Culture and Mental Health · doi:10.1080/17542863.2015.1074260 · Cited by 36 · see citing works
Reducing the stigma of mental illness: Current approaches and future directions.
Casados, A. T. (2017) · Clinical Psychology Science and Practice · doi:10.1111/cpsp.12206 · Cited by 35 · see citing works
Hofmann-Broussard, C., Armstrong, G., Boschen, M. J., & Somasundaram, K. V. (2016) · International Journal of Culture and Mental Health · doi:10.1080/17542863.2016.1259340 · Cited by 31 · see citing works
Witchcraft and Soul Loss: Implications for Community Psychiatry
Warner, R. (1977) · Psychiatric Services · doi:10.1176/ps.28.9.686 · Cited by 16 · see citing works
(2001) · PsycEXTRA Dataset · doi:10.1037/e360882004-001 · Cited by 5 · see citing works
Mental Health Training For Community Health Workers In The Western Cape
Sibeko, G. (2017) · Open University of Cape Town (University of Cape Town) · doi:10.13140/rg.2.2.26782.23367 · Cited by 3 · see citing works
Self-citation
Flagged first, then by citations
Research works printed but not linked: 1
- [7]Bhutta ZA Lassi ZS Pariyo G Luis H Global experience of community health Workers for Delivery of health related millennium development goals: a systematic review, country case studies, and recommendations for integration into National Health Systems World Heal Organ 2010 2017 8/3/ 377
Cited by
Sorted by citations
Le, P. D., Eschliman, E. L., Grivel, M. M., Tang, J., Cho, Y. G., Yang, X., Tay, C., Li, T., Bass, J., & Yang, L. H. (2022) · Implementation Science · doi:10.1186/s13012-021-01179-z · Cited by 233 · see citing works
“Additionally, providers with higher education were perceived as being more receptive to training [55].”
BackgroundClay, J., Eaton, J., Gronholm, P. C., Semrau, M., & Votruba, N. (2020) · Epidemiology and Psychiatric Sciences · doi:10.1017/s2045796020000797 · Cited by 103 · see citing works
Myers, B., Regenauer, K. S., Rose, A., Johnson, K., Ndamase, S., Ciya, N., Brown, I., Joska, J., Bassett, I. V., Belus, J. M., et al. (2024) · Implementation Science Communications · doi:10.1186/s43058-023-00537-w · Cited by 11 · see citing works
Self-citationMagidson, J. F., Regenauer, K. S., Johnson, K., Ma, T., Belus, J. M., Rose, A. L., Brown, I., Ciya, N., Ndamase, S., Sacko, C., et al. (2025) · Journal of substance use and addiction treatment · doi:10.1016/j.josat.2025.209634 · Cited by 2 · see citing works
Self-citation
- Authors
- Sibeko, G., Milligan, P. D., Roelofse, M., Molefe, L., Jonker, D., Ipser, J., Lund, C., & Stein, D. J.
- Affiliations
- University of Cape Town (ZA)
- Western Cape Department of Health (ZA)
- South African Medical Research Council (ZA)
- Corresponding author
- Sibeko, Goodman
- Venue
- BMC Psychiatry
- Published
- 2018-06-14
- Volume
- 18
- Issue
- 1
- Pages
- 191-191
- ISSN
- 1471-244X (ISSN-L)
- PMC
- PMC6001068
- OpenAlex
- W2808380477
- Cited by
- 72
- References
- 27
- Citations by year
- 2026: 4 · 2025: 15 · 2024: 16 · 2023: 5 · 2022: 11 · 2021: 14 · 2020: 5 · 2019: 2
- FWCI
- 7.12
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Psychiatry (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Open University of Cape Town (University of Cape Town) (submittedVersion)
- Funders
- Government of the United Kingdom
- South African Medical Research Council
- Medical Research Council
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Health Professions › Emergency Medical Services › Global Health Workforce Issues
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Keywords
- community health workers, mental health training, task shifting, mental health workforce shortage, mental health knowledge, clinical confidence, attitudes toward mental illness, training acceptability, training feasibility, Western Cape
- MeSH terms
- Adult, Mental Disorders, Community Health Workers, Community Mental Health Services, Delivery of Health Care, Female, Humans, Inservice Training, Health Knowledge, Attitudes, Practice, Male, Mental Health, Middle Aged, South Africa, Needs Assessment, Quality Improvement
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
