Abstract
In low- and middle-income countries, mental health training often includes sending few generalist clinicians to specialist-led programs for several weeks. Our objective is to develop and test a video-assisted training model addressing the shortcomings of traditional programs that affect scalability: failing to train all clinicians, disrupting clinical services, and depending on specialists. We implemented the program -video lectures and on-site skills training- for all clinicians at a rural Nepali hospital. We used Wilcoxon signed-rank tests to evaluate pre- and post-test change in knowledge (diagnostic criteria, differential diagnosis, and appropriate treatment). We used a series of 'Yes' or 'No' questions to assess attitudes about mental illness, and utilized exact McNemar's test to analyze the proportions of participants who held a specific belief before and after the training. We assessed acceptability and feasibility through key informant interviews and structured feedback. For each topic except depression, there was a statistically significant increase (Δ) in median scores on knowledge questionnaires: Acute Stress Reaction (Δ = 20, p = 0.03), Depression (Δ = 11, p = 0.12), Grief (Δ = 40, p < 0.01), Psychosis (Δ = 22, p = 0.01), and post-traumatic stress disorder (Δ = 20, p = 0.01). The training received high ratings; key informants shared examples and views about the training's positive impact and complementary nature of the program's components. Video lectures and on-site skills training can address the limitations of a conventional training model while being acceptable, feasible, and impactful toward improving knowledge and attitudes of the participants.
Highlights
In low- and middle-income countries, mental health training often includes sending few generalist clinicians to specialist-led programs for several weeks
In low-resource settings where access to mental health specialists like psychiatrists is severely limited, nonspecialist clinicians often provide mental health services. This strategy, called ‘task-sharing’, is a widely-accepted model to address the large gaps in the availability of mental health providers in low- and middle-income countries (LMICs) (Kakuma et al 2011)
In research studies that have provided evidence for mental health-related task-sharing in LMICs, all clinicians in the program received in-person training from specialists, including psychiatrists (Araya et al 2003; Patel et al 2010, 2003)
Summary
In low- and middle-income countries, mental health training often includes sending few generalist clinicians to specialist-led programs for several weeks. Video lectures and on-site skills training can address the limitations of a conventional training model while being acceptable, feasible, and impactful toward improving knowledge and attitudes of the participants. In low-resource settings where access to mental health specialists like psychiatrists is severely limited, nonspecialist clinicians often provide mental health services This strategy, called ‘task-sharing’ ( called ‘task-shifting’), is a widely-accepted model to address the large gaps in the availability of mental health providers in low- and middle-income countries (LMICs) (Kakuma et al 2011). In research studies that have provided evidence for mental health-related task-sharing in LMICs, all clinicians in the program received in-person training from specialists, including psychiatrists (Araya et al 2003; Patel et al 2010, 2003). In real-life settings, there rarely is dedicated funding, time, or human resources for psychiatrists to conduct full-length, on-site, inperson training for all clinicians
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