Abstract
BackgroundUptake of clinical guideline recommendations into routine practice requires changes in attitudes and behaviors of the health care providers. The World Health Organization (WHO) has heavily invested in public health and health promotion globally by developing policy recommendations to guide clinical practice; however, clinical guidelines are often not applied. The success of the implementation of any guidelines depends on consideration of existing barriers and adequately addressing them. Therefore, exploring the context specific barriers and facilitators affecting the primary care providers (PCPs) in Mbarara district, Uganda may provide a practical way of addressing the identified barriers thus influence the PCPs action towards integration of mental healthcare services into PHC.MethodsWe adopted a theoretical model of behavior change; Capability, Opportunity and Motivation developed to understand behavior (COM-B). This was a cross-sectional study which involved using a semi-structured qualitative interview guide to conduct in-depth interviews with PCP’s (clinical officers, nurses and midwives).ResultsCapability - inadequacy in knowledge about mental disorders; more comfortable managing patients with a mental problem diagnosis than making a new one; knowledge about mental health was gained during pre-service training; no senior cadre to consultations in mental health; and burdensome to consult the Uganda Clinical Guidelines (UCG). Opportunity - limited supply of hard copies of the UCG; guidelines not practical for local setting; did not regularly deal with clients having mental illness to foster routine usage of the UCG; no sensitization about the UCG to the intended users; and no cues at the health centers to remind the PCPs to use UCG. Motivation - did not feel self-reliant; not seen the UCG at their health facilities; lack of trained mental health specialists; conflicting priorities; and no regulatory measures to encourage screening for mental health.ConclusionsEfforts to achieve successful integration of mental health services into PHC need to fit in the context of the implementers; thus the need to adapt the UCG into local context, have cues to enforce implementation, and optimize the available expertize (mental healthcare providers) in the process.
Highlights
Uptake of clinical guideline recommendations into routine practice requires changes in attitudes and behaviors of the health care providers
Integration of mental health services into primary healthcare (PHC) has been embraced by various countries and in different forms [12,13,14,15] including a) training primary care providers (PCPs) in identifying mental health problems; b) Primary care provider (PCP) assessing for mental illnesses during medical standard of care; c) PCPs/ Community Health Workers (CHWs) and health care managers working together to address mental health related illnesses; and d) availing psychotropic medications to PHC centers [16]
While we proposed to consider age, gender, occupation and seniority/experience when selecting participants, we found on the ground that the health facilities had a smaller health workforce than we had anticipated, we recruited all PCPs we found at the facilities and only interviewed those who provided signed consent
Summary
Uptake of clinical guideline recommendations into routine practice requires changes in attitudes and behaviors of the health care providers. Integration of mental health services into PHC has been embraced by various countries and in different forms [12,13,14,15] including a) training primary care providers (PCPs) in identifying mental health problems; b) PCPs assessing for mental illnesses during medical standard of care; c) PCPs/ Community Health Workers (CHWs) and health care managers working together to address mental health related illnesses; and d) availing psychotropic medications to PHC centers [16] Despite all these efforts, PHC for mental health has not been realized in most countries of the world; it is estimated that the treatment gap is widest among people with severe mental disorders in least resourced countries [11, 17,18,19]
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