Cargando…

Integrating mental health into primary care: evaluation of the Health Action for Psychiatric Problems In Nigeria including Epilepsy and SubstanceS (HAPPINESS) pilot project

BACKGROUND: The Health Action for Psychiatric Problems In Nigeria including Epilepsy and SubstanceS (HAPPINESS) project trains non-specialist and primary health care workers in Imo State, Nigeria. This project adapted the World Health Organization’s Mental Health Gap Action Programme-Intervention Gu...

Descripción completa

Detalles Bibliográficos
Autores principales: Chu, Casey, Roxas, Nichole, Aguocha, Chinyere M., Nwefoh, Emeka, Wang, Katie, Dike, Charles, Iheanacho, Theddeus
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8917687/
https://www.ncbi.nlm.nih.gov/pubmed/35279154
http://dx.doi.org/10.1186/s12913-022-07703-1
_version_ 1784668602206519296
author Chu, Casey
Roxas, Nichole
Aguocha, Chinyere M.
Nwefoh, Emeka
Wang, Katie
Dike, Charles
Iheanacho, Theddeus
author_facet Chu, Casey
Roxas, Nichole
Aguocha, Chinyere M.
Nwefoh, Emeka
Wang, Katie
Dike, Charles
Iheanacho, Theddeus
author_sort Chu, Casey
collection PubMed
description BACKGROUND: The Health Action for Psychiatric Problems In Nigeria including Epilepsy and SubstanceS (HAPPINESS) project trains non-specialist and primary health care workers in Imo State, Nigeria. This project adapted the World Health Organization’s Mental Health Gap Action Programme-Intervention Guide (mhGAP-IG), emphasizing stigma reduction among trainees. This convergent mixed-methods proof-of-concept study evaluates the HAPPINESS pilot project mhGAP-IG training’s impact on mental illness stigma among trainees and barriers, facilitators, and opportunities to consider for project improvement. METHODS: Trainees (n = 13) completed a 43-item questionnaire before and after their 5-day training to assess perceptions of mental disorders and attitudes towards people with mental illness. These responses were analyzed using paired-sample t-tests for four subscales of the questionnaire: acceptance of socializing with people with mental illness, normalizing activities and relationships with people with mental illness, supernatural causation of mental illness, and endorsement of a biopsychosocial approach to mental illness. Semi-structured key informant interviews (n = 11) with trainees, trainers, and local health officials who participated in or supported the HAPPINESS project were thematically analyzed to understand their experiences and perspectives of the project’s barriers, facilitators, and opportunities. RESULTS: Trainees showed significant improvements on socializing, normalizing, and supernatural causation subscales of the stigma questionnaire (p < 0.05). No significant effect was seen on the biopsychosocial subscale; however, evidence of biopsychosocial beliefs was found in interview responses. Key informant interviews revealed that the HAPPINESS project enhanced trainees’ diagnostic and treatment abilities, mental health awareness, and empathy towards patients. Misinformation, stigma, inadequate funding, and lack of road access to clinics were identified as barriers to mental health care integration into general care in Imo State. Respondents also suggested ways that the HAPPINESS project could be improved and expanded in the future. CONCLUSIONS: This study adds to the limited evidence on the implementation of mhGAP-IG in Nigeria. Using mixed methods, it evaluates how mhGAP-IG can impact perceptions and knowledge of stigma among primary care trainees. It also highlights barriers, facilitators, and opportunities to consider for project growth. Future efforts should focus on clinical support, supervision, health outcomes, as well as scaling up and assessing the cost-effectiveness of the HAPPINESS project intervention. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-022-07703-1.
format Online
Article
Text
id pubmed-8917687
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-89176872022-03-21 Integrating mental health into primary care: evaluation of the Health Action for Psychiatric Problems In Nigeria including Epilepsy and SubstanceS (HAPPINESS) pilot project Chu, Casey Roxas, Nichole Aguocha, Chinyere M. Nwefoh, Emeka Wang, Katie Dike, Charles Iheanacho, Theddeus BMC Health Serv Res Research Article BACKGROUND: The Health Action for Psychiatric Problems In Nigeria including Epilepsy and SubstanceS (HAPPINESS) project trains non-specialist and primary health care workers in Imo State, Nigeria. This project adapted the World Health Organization’s Mental Health Gap Action Programme-Intervention Guide (mhGAP-IG), emphasizing stigma reduction among trainees. This convergent mixed-methods proof-of-concept study evaluates the HAPPINESS pilot project mhGAP-IG training’s impact on mental illness stigma among trainees and barriers, facilitators, and opportunities to consider for project improvement. METHODS: Trainees (n = 13) completed a 43-item questionnaire before and after their 5-day training to assess perceptions of mental disorders and attitudes towards people with mental illness. These responses were analyzed using paired-sample t-tests for four subscales of the questionnaire: acceptance of socializing with people with mental illness, normalizing activities and relationships with people with mental illness, supernatural causation of mental illness, and endorsement of a biopsychosocial approach to mental illness. Semi-structured key informant interviews (n = 11) with trainees, trainers, and local health officials who participated in or supported the HAPPINESS project were thematically analyzed to understand their experiences and perspectives of the project’s barriers, facilitators, and opportunities. RESULTS: Trainees showed significant improvements on socializing, normalizing, and supernatural causation subscales of the stigma questionnaire (p < 0.05). No significant effect was seen on the biopsychosocial subscale; however, evidence of biopsychosocial beliefs was found in interview responses. Key informant interviews revealed that the HAPPINESS project enhanced trainees’ diagnostic and treatment abilities, mental health awareness, and empathy towards patients. Misinformation, stigma, inadequate funding, and lack of road access to clinics were identified as barriers to mental health care integration into general care in Imo State. Respondents also suggested ways that the HAPPINESS project could be improved and expanded in the future. CONCLUSIONS: This study adds to the limited evidence on the implementation of mhGAP-IG in Nigeria. Using mixed methods, it evaluates how mhGAP-IG can impact perceptions and knowledge of stigma among primary care trainees. It also highlights barriers, facilitators, and opportunities to consider for project growth. Future efforts should focus on clinical support, supervision, health outcomes, as well as scaling up and assessing the cost-effectiveness of the HAPPINESS project intervention. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-022-07703-1. BioMed Central 2022-03-12 /pmc/articles/PMC8917687/ /pubmed/35279154 http://dx.doi.org/10.1186/s12913-022-07703-1 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Chu, Casey
Roxas, Nichole
Aguocha, Chinyere M.
Nwefoh, Emeka
Wang, Katie
Dike, Charles
Iheanacho, Theddeus
Integrating mental health into primary care: evaluation of the Health Action for Psychiatric Problems In Nigeria including Epilepsy and SubstanceS (HAPPINESS) pilot project
title Integrating mental health into primary care: evaluation of the Health Action for Psychiatric Problems In Nigeria including Epilepsy and SubstanceS (HAPPINESS) pilot project
title_full Integrating mental health into primary care: evaluation of the Health Action for Psychiatric Problems In Nigeria including Epilepsy and SubstanceS (HAPPINESS) pilot project
title_fullStr Integrating mental health into primary care: evaluation of the Health Action for Psychiatric Problems In Nigeria including Epilepsy and SubstanceS (HAPPINESS) pilot project
title_full_unstemmed Integrating mental health into primary care: evaluation of the Health Action for Psychiatric Problems In Nigeria including Epilepsy and SubstanceS (HAPPINESS) pilot project
title_short Integrating mental health into primary care: evaluation of the Health Action for Psychiatric Problems In Nigeria including Epilepsy and SubstanceS (HAPPINESS) pilot project
title_sort integrating mental health into primary care: evaluation of the health action for psychiatric problems in nigeria including epilepsy and substances (happiness) pilot project
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8917687/
https://www.ncbi.nlm.nih.gov/pubmed/35279154
http://dx.doi.org/10.1186/s12913-022-07703-1
work_keys_str_mv AT chucasey integratingmentalhealthintoprimarycareevaluationofthehealthactionforpsychiatricproblemsinnigeriaincludingepilepsyandsubstanceshappinesspilotproject
AT roxasnichole integratingmentalhealthintoprimarycareevaluationofthehealthactionforpsychiatricproblemsinnigeriaincludingepilepsyandsubstanceshappinesspilotproject
AT aguochachinyerem integratingmentalhealthintoprimarycareevaluationofthehealthactionforpsychiatricproblemsinnigeriaincludingepilepsyandsubstanceshappinesspilotproject
AT nwefohemeka integratingmentalhealthintoprimarycareevaluationofthehealthactionforpsychiatricproblemsinnigeriaincludingepilepsyandsubstanceshappinesspilotproject
AT wangkatie integratingmentalhealthintoprimarycareevaluationofthehealthactionforpsychiatricproblemsinnigeriaincludingepilepsyandsubstanceshappinesspilotproject
AT dikecharles integratingmentalhealthintoprimarycareevaluationofthehealthactionforpsychiatricproblemsinnigeriaincludingepilepsyandsubstanceshappinesspilotproject
AT iheanachotheddeus integratingmentalhealthintoprimarycareevaluationofthehealthactionforpsychiatricproblemsinnigeriaincludingepilepsyandsubstanceshappinesspilotproject