Exploring the acceptability of a WHO school-based mental health program in Egypt: A qualitative study

Abstract

Mental health interventions should target critical developmental stages, such as childhood and adolescence; and be embedded into cross-sectoral settings including education. The World Health Organization, Eastern Mediterranean Regional office has developed a school-based mental health program (SMHP), encouraging implementation research to inform its scale-up. We contribute to this by exploring stakeholder acceptability of the SMHP as a key assumption underpinning successful program implementation.This qualitative study, conducted January to July 2019 in Al Obour, Egypt, explores stakeholder views of SMHP acceptability, the roles of teachers and school psychologists in supporting child mental health, and barriers to SMHP implementation and scale-up. Focus group discussions (n ​= ​4) and individual in-depth interviews (n ​= ​7) were conducted with 30 stakeholders (parents, teachers, psychologists, and support centre managers). Data were analysed thematically against the theoretical framework of acceptability.Our results indicate that the SMHP is highly acceptable to teachers, psychologists, parents, and other education professionals. Key findings indicate the SMHP fits with teachers' and school psychologists' values, and highlight the importance of collaboration among these stakeholders for program effectiveness. Program features such as a community-based centre and respect for privacy and confidentiality are recognised to reduce parents’ opportunity costs, and influence their affective attitudes, leading to increased engagement. Factors such as teacher burden require additional exploration and strategies to address them as potential impediments to successful SMHP implementation. This qualitative study yields important insights from multiple stakeholders into the acceptability of a school-based mental health intervention, providing support for scale-up of the SMHP in Egypt and the Region.