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Published in: BMC Public Health 1/2018

Open Access 01-12-2018 | Research article

“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

Authors: Jessica Spagnolo, François Champagne, Nicole Leduc, Wahid Melki, Myra Piat, Marc Laporta, Nesrine Bram, Imen Guesmi, Fatma Charfi

Published in: BMC Public Health | Issue 1/2018

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Abstract

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.
Appendix
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Footnotes
1
Numbers in brackets highlight individuals from each governorate who participated in the group interviews.
 
2
A circular exists limiting the prescription of certain psychotropic drugs (ex.: benzodiazepines) at the level of primary care. This regulation preventing the prescription of these psychotropic drugs was not revised after the implementation of training initiatives targeting PCPs’ mental health competencies.
 
3
The first wave of family physicians who participated in this new medical curriculum is scheduled to graduate in 2019.
 
4
In certain healthcare clinics, psychotropic drugs have been subject to theft, as they are often coveted in the Greater Tunis area by people living with substance use disorders. Measures have been taken to limit the availability of psychotropic drugs in healthcare clinics where reports of theft have been made. Consequently, these measures create uneven distribution of such drugs in primary care settings.
 
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Metadata
Title
“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
Authors
Jessica Spagnolo
François Champagne
Nicole Leduc
Wahid Melki
Myra Piat
Marc Laporta
Nesrine Bram
Imen Guesmi
Fatma Charfi
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2018
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-018-6261-4

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