“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
Open accessAbstract
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.
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- Authors
- Spagnolo, J., Champagne, F., Leduc, N., Melki, W., Piat, M., Laporta, M., Bram, N., Guesmi, I., & Charfi, F.
- Affiliations
- Université de Montréal (CA)
- Tunis University (TN)
- Douglas Mental Health University Institute (CA)
- McGill University (CA)
- Manouba University (TN)
- Tunis El Manar University (TN)
- Corresponding author
- Spagnolo, Jessica
- Venue
- BMC Public Health
- Published
- 2018-12
- Volume
- 18
- Issue
- 1
- Pages
- 1398-1398
- ISSN
- 1471-2458 (ISSN-L)
- PMC
- PMC6302293
- OpenAlex
- W2904201987
- Cited by
- 19
- References
- 66
- Citations by year
- 2025: 3 · 2024: 1 · 2022: 4 · 2021: 5 · 2020: 3 · 2019: 3
- FWCI
- 3.73
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Public Health (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)
- Funders
- Fonds de Recherche du Québec - Santé (33774)
- Mitacs (IT06835)
- Institut de recherche en santé publique de l'Université de Montréal
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Innovations in Medical Education
- Keywords
- Mental Health Gap Action Programme, primary care physicians, mental health training, contextual factors, barriers and facilitators, implementation outcomes, non-specialist mental health care, mental health knowledge, treatment confidence, Tunisia, low- and middle-income countries
- MeSH terms
- Mental Disorders, Clinical Competence, Female, Humans, Inservice Training, Male, Mental Health, Middle Aged, Tunisia, Program Evaluation, Treatment Outcome, Organizational Case Studies, Qualitative Research, Physicians, Primary Care
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