Content validation of Mental Health Literacy Scale (MHLS) for primary health care workers in South Africa and Zambia ─ a heterogeneous expert panel method

Exploring Mental Health Literacy and Its Associated Factors: A National Cross-Sectional Study in Saudi Arabia, 2023

Objective

The aim of this study is to examine, for the first time, the mental health literacy of the Saudi general population. Additionally, we aim to identify demographic factors associated with elevated mental health literacy scores.

Methods

A cross-sectional study using a phone interview survey with quota sampling was conducted for equal distribution of sexes, age and administrative regions. Mental health literacy was assessed by the previously validated mental health literacy scale (MHLS). The MHLS ranges from 35 to 160, and a higher score indicates greater level of mental health literacy.

Results

In this study, 4,547 (70.2%) agreed to complete the interview. The sample was equally distributed across Saudi Arabia's 13 administrative regions with 50.1% female and mean age 35.9 (SD: ±12.8). In terms of education, 55.1% have a bachelor's degree or above. The nationally weighted score on the original MHLS was 110.75. the MHLS Saudi validation score was influenced by various variables including: marital status, healthcare-related job, sex, education level, and proximity to individuals with mental health issues.

Conclusion

The study offers data for the first time on Saudi Arabian mental health literacy status. The high MHLS score reflects good societal awareness and understanding of mental health related concepts and issues in the Saudi population. The results of this study set the baseline for mental health literacy in Saudi Arabia. Future research may focus on utilizing the validated MHLS and the method used in this study to explore the effect of other social and individual factors on mental health literacy.

Validation and psychometric testing of the Arabic version of the mental health literacy scale among the Saudi Arabian general population

OBJECTIVE

This study aimed to validate the Arabic Version of the Mental Health Literacy Scale (Arabic-MHLS) among the Saudi Arabian general population, assessing its internal consistency, test-retest reliability, and structural validity.

METHODS

A total of 700 Arabic-speaking Saudi adults were randomly selected to complete the electronic questionnaire in May 2023, which generated 544 participants. Data were coded and stored in the ZdataCloud research data collection system database. Test-retest reliability was assessed using a subsample of 48 participants who completed the questionnaire twice, with a one-week interval. Structural validity was examined using confirmatory factor analysis (CFA) and Exploratory Factor Analysis (EFA).

RESULTS

The Arabic-MHLS demonstrated good internal consistency (Cronbach's alpha = 0.87) and test-retest reliability (intraclass correlation coefficient = 0.89). EFA revealed a four-factor model closely resembling the model identified in the Slovenian validation of MHLS, with factor loadings ranging from 0.40 to 0.85. The four factors included knowledge of mental health disorders, knowledge of help-seeking, knowledge of self-help strategies, and knowledge of professional help also showed good internal consistency.

CONCLUSION

The Arabic-MHLS is a valid and reliable tool for assessing mental health literacy in the Saudi Arabian general population. However, further research is needed to refine the measurement tool and understand the complex relationships between mental health literacy and other mental health-related concepts. This will contribute to the development of targeted interventions and policies aimed at improving mental health literacy and promoting mental well-being in the Saudi Arabian population and beyond.

An Assessment of the Training Program on Mental Health for Community Health Workers in Kashmir, India

In recent years mental health has emerged as a major health threat in low income countries like India. In response, mental health care has been integrated into primary health care, in turn creating a rising demand for trained and skillful mental health professionals. This study was conducted in district Budgam (J&K), India with the aim of providing training to community health workers (CHWs) and measuring the change using pre- and post-training evaluations. The pre and post tests were undertaken, assessing changes in mental health literacy at three different points of time: pre-training, post-training, and three month follow-up. Mental health literacy was assessed using the interviewer-administered Mental Health Literacy Survey. The training intervention was a five-day course based on a facilitator's manual developed specifically for community health workers in India. A total of 25 community health workers from rural areas of Budgam District (mostly Integrated Child Development Service supervisors), Health Educators and Anganwadi Workers, were engaged for the study. Findings demonstrate that the training course improved participants' ability to recognize any mental health disorders. There was a clear distinction between the level of awareness pre- and post- training. The results were statistically significant on various domains Ability to recognize disorders (Pre-post P= 0.001), Knowledge of the professional help available (Pre-post p= 0.000), Attitudes that promote the recognition or appropriate help-seeking behavior (Pre-post p= 0.000) (p<0.05). Further follow up after three months was done. The mixed findings from this study, suggesting the training course has potential to improve some aspects of mental health literacy among the CHWs, including their understanding of various mental health problems.

Mental health literacy among primary healthcare workers in South Africa and Zambia

BACKGROUND

In developing countries, mental health literacy (MHL) still needs to be improved due to the high prevalence of mental disorders. It is widely recognized that MHL can improve health outcomes for both individuals and populations. Healthcare professionals' development in MHL is crucial to the prevention of mental disorders. The aim of this study was to assess MHL of primary healthcare (PHC) workers in South Africa (SA) and Zambia and determinants thereof. Limited evidence is available on the levels of MHL among PHC workers in the sub-Saharan Africa region, which faces a large burden of mental disorders.

METHODS

The study population for this cross-sectional survey comprised PHC workers (n = 250) in five provinces of SA and Zambia. MHL was measured with the Mental Health Literacy Scale (MHLS). We conducted a multivariate analysis to explore determinants of MHL.

RESULTS

Results showed moderate MHL among PHC professionals, but with a wide range from low to high MHL. Knowledge-related items had a greater dispersion than other attributes of MHL. PHC workers with more education showed a greater ability to recognize mental health-related disorders. Those who had experience in the use of mental health-related assessment scales or screening tools reported a higher total MHL. The results confirmed strong internal consistency for the MHLS.

CONCLUSION

The results highlighted varying mental health perceptions and knowledge in PHC. Implementation of specifically developed formal training programs and interventions to improve MHL in PHC workers to strengthen their competence may help bridge the treatment gap.

Validation of the Mental Health Literacy Scale in French University Students

Background: Mental health literacy is a determinant of mental health, which can facilitate early detection of psychological problems and endorse timely access to care. Instruments to measure mental health literacy exist, but not in French. Assessment of mental health literacy in young adults is essential to tailor appropriate educational interventions promoting psychological wellbeing and preventing mental health problems in this vulnerable population. The aim of this study was to validate the French version of the Mental Health Literacy Scale (MHLS-FR) in university students. Methods: A total of 482 students from the University of Bordeaux, France, completed the translated version of the scale. Collected data were used to validate the MHLS-FR through psychometric analyses: descriptive statistics, item distribution, test-retest reliability, exploratory structural equation model, confirmatory factor analysis, Cronbach’s alpha and McDonald’s omega coefficients, and hypothesis testing. Results: The final scale included 26 items covering 6 dimensions. Cronbach’s alpha and McDonald’s omega coefficients were 0.744 and 0.961, respectively. With test-retest, about 50% of items had intraclass correlation coefficients superior to 0.5. Conclusions: The MHLS-FR can be considered as a valid and reliable instrument for measuring mental health literacy in French students.

Reaching Consensus on Global Health Competencies for Undergraduate Nurses in Indonesia: A Delphi Study

BACKGROUND: Trends in the era of globalization show an increasing need for nurses to have the Global Health Competencies (GHC) so as to enable them to address global health problems particularly in the pandemic Covid-19. However, evidence-based information about relevance and feasibility of these competencies for undergraduate nursing students in Indonesia is very limited. AIM: This study aims to achieve consensus among experts on global health competencies for Indonesian undergraduate nursing students. METHODS: Using the 2-rounds Delphi method in a sequential mixed-method design, a total of 35 nursing experts voluntarily participated in the study. Six experts participated in the first round, and 29 others were in the second round, hence the collection of Quantitative and qualitative data. The Item Content Validation Index (I-CVI) = 0.78 and Scale Content Validation Index (S-CVI) = 0.9 were used to determine the level of agreement among the experts. RESULTS: At the end of round 2, an agreement was reached on the 9 GHC domains. However, from the original 44 competencies there were 5 competencies that was excluded in the first round and 3 competencies in the second round. These results were supported by the most frequent comments from the experts that these competencies were lacking in clarity, suitability and irrelevant to undergraduate nurses’ competencies. CONCLUSION: In conclusion, this study has resulted in an agreement among experts regarding global health competencies for undergraduate nursing students in Indonesia. It is predicted that the findings of this study can contribute to the development of global health competencies in the nursing profession. Having these competencies will enable nurses to participate in overcoming global health problems. Validation of the new GHC by larger groups of nursing educators and graduate users is required. Keywords: Delphi, global health competencies, Indonesia, nurses.

Effectiveness of Mental Health Literacy Programs in Primary and Secondary Schools: A Systematic Review with Meta-Analysis

In recent years, there has been an increase in studies evaluating the effectiveness of mental health literacy programs within the context of education as a universal, preventive intervention. A systematic review and meta-analysis regarding the effectiveness of mental health literacy interventions in schools, from 2013 to the present, on mental health knowledge, stigma, and help-seeking is conducted. Of the 795 identified references, 15 studies met the inclusion criteria. Mental health knowledge increased after the interventions (standardized mean difference: SMD = 0.61; 95% CI (0.05, 0.74)), at two months (SMD = 0.60; 95% CI (0.4, 1.07)) and six months (SMD = 0.39; 95% CI (0.27, 0.51)). No significant differences were observed between stigma and improving help-seeking. Mental health literacy interventions are effective in augmenting mental health knowledge, but not in reducing stigma or improving help-seeking behavior.

Validation and Psychometric Testing of the Chinese Version of the Mental Health Literacy Scale Among Nurses

The Mental Health Literacy Scale (MHLS) is the most widely used and strong theory-based measurement tool to gain an understanding of mental health knowledge and ability. This study aimed to test the psychometric properties of the Chinese version of the Mental Health Literacy Scale (MHLS-C) and to document the norm and its influential factors of mental health literacy among nurses. The MHLS was translated following Brislin's translation model and tested with a sample of 872 clinical registered nurses. The Jefferson Scale of Empathy-Health Professionals (JSE-HP), Patient Health Questionnaire-2 (PHQ-2), and Generalized Anxiety Disorder-2 (GAD-2) were administered to assess convergent validity. The minimum average partial test, parallel analysis and confirmatory factor analysis supported 4 first-order 2 second-order structure. The 4 factors were named "knowledge of mental disorder," "ability to seek information and help," "recognition of mental disorder," and "acceptance of patients with mental illness," with factor 1-3 were summarized into MHLS-Core (Core literacy subscale) and factor 4 as MHLS-SA (Social acceptance subscale). The MHLS-C was moderately negatively correlated with the PHQ-2 and GAD-2 (-0.111, -0.081) and highly positively correlated with JSE-HP (0.492). The Cronbach's α was 0.85 for the overall scale and 0.89 and 0.93 for two subscales. The test-retest reliability was good, with intraclass correlation coefficients (ICCs) of 0.80 for the whole scale, and 0.79 and 0.94 for two subscales. As an approximately normal distribution, the 50 th percentile for the MHLS-C was 99, with 50 th percentiles of 74 and 20 for MHLS-Core and MHLS-SA. Higher position, higher professional credentials, higher hospital hierarchy, other specialist hospital, psychiatric hospital and unmarried status were positive predictors. The 29-item MHLS-C, with two subscales of MHLS-Core and MHLE-SA, is a stable and validated tool to measure mental health literacy. MHLS-Core could be used independently to measure the core content of mental health literacy. It may be applicable for Chinese health professionals, but need further validation among the general public. MHL curriculum and a targeted culturally appropriate program for acceptance for health professionals, especially for those in general hospitals and with less working tenure, may be recommended.

Slovenian Validation of the Mental Health Literacy Scale (S-MHLS) on the General Population: A Four-Factor Model

The aim of the present validation study is to determine the psychometric properties of the Slovenian version of the Mental Health Literacy Scale. For this purpose, the factorial structure, internal consistency, cross-cultural, convergent and discriminant validity were assessed. The measure was translated and adapted to Slovenian context through a blind back-translation process. It was applied to a representative sample of the Slovenian adult population via an online research panel. A total of 1189 participants (598 women), aged between 18 and 95 years (M = 46.7, SD = 16.2) completed the survey. Confirmatory and exploratory factor analyses, reliability analyses, hypothesis testing, and correlational analyses were conducted. The analyses rejected a hypothesised unidimensional model and demonstrated that a four-factor model with 27 items was the most theoretically and psychometrically adequate. The Slovenian version of Mental Health Literacy Scale (S-MHLS) consists of the following factors: (1) Attitudes Towards People With Mental Health Problems, (2) General Attitudes Towards Mental Health Problems and Help-Seeking, (3) Recognition of Mental Health Disorders and (4) Knowledge About Seeking Mental Health Information. The factors have adequate construct validity and internal consistency, which is also adequate for the entire S-MHLS. However, a decreased scope of the content might result in an inadequate representation of the construct of mental health literacy. In addition, the psychometric interpretation of the MHLS varies widely in validation studies across different linguistic contexts. Therefore, we propose a further improvement of the instrument with a psychometrically and theoretically sound multifactorial structure that demonstrates strong cross-cultural validity.

Construct validity and internal consistency of the revised Mental Health Literacy Scale in South African and Zambian contexts

AIM

The aim of this study was to evaluate the construct validity and internal consistency of the revised Mental Health Literacy Scale (MHLS) in South Africa (SA) and Zambia.

DESIGN

This cross-sectional study was conducted between October 2018 and December 2019.

METHODS

The study population comprised PHC workers (n = 454) in five districts in SA and Zambia. Principal component analysis (PCA) was used to explore the construct validity, and Cronbach's alpha was applied to measure the internal consistency of the MHLS.

RESULTS

Cronbach's alpha values for three attributes were below the appropriate level, but the value was strong (0.804) for the whole scale. The study found nine components explaining ~59% of the total variance of variables. All MHLS items loaded to main attributes based on the theory of MHL. The results stated that the revised version of the MHLS is a construct valid instrument with strong internal consistency.