Abstract
Background: The Mental Health First Aid (MHFA) training program has been widely implemented in many high-income countries. Evidence on the adaptation of this and other similar programs in resource-constrained settings like China is very limited. This study aimed to explore the views of key stakeholders on the implementation issues and contextual factors relevant to the scale-up of MHFA in China.Methods: Informed by the Consolidated Framework for Implementation Research, five implementation domains of intervention characteristics, characteristics of individuals, contextual adaptation, outer and inner setting, and implementation process were investigated through semi-structured in-depth interviews. Twenty-four stakeholders with diverse expertise in the Chinese mental health system were interviewed. Transcripts were coded using NVivo 12 software and thematically analyzed.Results: Fifteen themes and 52 sub-themes were identified in relation to the five domains. Participants saw MHFA as meeting the need for more evidence-based interventions to improve population mental health. Previous participants in MHFA training were satisfied with the course, but their intentions to help and levels of self-efficacy varied. Contextual adaptation of course content, delivery formats, and financing models, was seen as essential. External health policies and some socioeconomic factors (e.g., improved living conditions) were perceived as potential enablers of scalability. Low levels of engagement in health interventions and lack of supportive social norms were identified as potential barriers while executive support, quality control, and sustainable funding were viewed as facilitators of implementation.Conclusion: MHFA training meets some very important current societal and public health needs in China. To achieve its potential impact, significant contextual adaptation is required, particularly in terms of course content, delivery formats, and financing models. Overcoming low levels of engagement in community-based mental health interventions and combating stigma will also be critical for its scale-up.
Highlights
Mental, neurological, and substance use disorders affect a significant portion of the global population with a high burden, in low- and middle-income countries (LMICs) [1]
Higher mental health literacy has been found to be a predictor of mental health service use [8]
This paper reports on a qualitative study that was undertaken to understand the implementation issues and contextual factors among key stakeholders in order to promote future scale-up of Mental Health First Aid (MHFA) in China in a culturally appropriate way
Summary
Neurological, and substance use disorders affect a significant portion of the global population with a high burden, in low- and middle-income countries (LMICs) [1]. The latest epidemiological data show increases in the prevalence of these disorders in China, with an estimated 12-month prevalence of any of the above disorders of 9.3% in 2013 compared with 1.1% in 1982 [2], and a projected increase of 10% in the disease burden between 2013 and 2025 [3] In both developed and less-developed countries, the number of people with untreated mental disorders far outweighs those that receive treatment. In China, this unmet need constitutes an ongoing challenge to the mental health system [4] Many factors, both individual and structural, interact to influence people’s mental health service use [5].
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