Perception of service users and their caregivers on primary care-based mental health services: a qualitative study in Nepal

Perceptions of primary healthcare providers for screening and management of mental health disorders in India: a qualitative study

Introduction

Individuals experiencing mental health disorders encounter numerous challenges while accessing mental healthcare services. Despite the inclusion of mental health in the primary healthcare system, screening and managing mental health disorders remain significantly overlooked. Therefore, there is a need to understand the perceptions of healthcare providers in primary care settings, identify the challenges faced, and gather suggestions for effective mental healthcare delivery.

Methods

The present qualitative study was conducted in 13 primary healthcare facilities in the Jodhpur district of Rajasthan, India, from 2023 to 2024 among 25 primary healthcare providers. Semi-structured interview guides were developed for each category of primary healthcare provider, including Medical Officers, Community Health Officers, and General Nurse Midwives, Auxiliary Nurse Midwives and in-depth interviews were recorded, transcribed, and thematically analyzed using codes and sub-codes.

Results

Results are summarized under the themes: (i) Navigating Mental Healthcare in Primary Healthcare Facilities, (ii) Challenges and Barriers in Mental Healthcare Delivery, (iii) Recommendation for Enhancing Mental Healthcare Services, and (iv) Approaches for Comprehensive Capacity Building Training and Module and further findings of each theme are presented under various sub-themes.

Conclusion

The findings suggest that despite a perceived competence in providing mental health services, there were substantial levels of negative attitudes towards mental health disorders among participants and provide insights for policymakers and healthcare professionals to develop targeted interventions and improve mental healthcare delivery at primary care facilities.

Attitude of Syrian medical specialty trainees toward providing health care services to patients with mental disorders

BACKGROUND

The stigma associated with mental diseases in the healthcare system and among healthcare professionals has been identified as a significant barrier to treatment and rehabilitation and to the provision of substandard physical care for persons with mental illnesses. The goal of this study is to assess the attitude of physicians in Syria towards individuals with mental health disorders.

METHODS

An online cross-sectional survey was conducted among phyisicians in Syria to evaluate their attitudes toward patients with mental health disorders and their provided treatment in the time period between August 16 and October 1, 2022. The questionnaire for the study was developed based on previous research, and the inclusion criteria for the sample were all medical specialist trainees from all specialties and residents who had direct contact with people suffering from mental health disorders. The questionnaire was divided into two sections; the first included sociodemographic data on the participants and the second assessed physician's attitudes toward mental illness patients. With the IBM SPSS V. 28.0 package tool (IBM Corporation, Armonk, NY, USA), descriptive and multivariate logistic regression analyses were used to analyze the data.

RESULTS

539 medical residents participated in this research; their average age was 26.11 (+- 1.74) years, and 50.27% were males. City residents had the highest stigma score on the third question (2.66 ± 1.06, P value < 0.05) in the 'social distance' domain. The mean stigma scores for these three items in the recovery area were (2.76 ± 1.15, 2.51 ± 0.92, and 3.73 ± 0.83), respectively, for city residents. In the 'social distance' domain, the stigma score of two questions (the first and fourth questions) was associated with the resident's specialty, with dermatology residents having the highest mean score in both questions (mean = 3.6 ± 1.12, 3.43 ± 1.19, respectively). Only the second item in the 'Detection' domain was scored higher (mean = 3.850.81) by surgery residents than other residents. The stigma in the 'Recovery' domain was greatest among dermatology residents (mean = 3.710.94) than among other residents. There was a statistically significant relationship between residency and the Detection stigma scale (p = 0.03, Adj R2 = 0.008). There was a moderate correlation (Adj R2 = 0.048) between the Recovery scale and three of the six predictors (location, marital status, and the number of years living in the current residence). Two demographic factors (country of residence and marital status) were significantly correlated (p0.05) with the Social Responsibility Scale, and the Adjusted R-Squared Value was 0.006.

CONCLUSION

Our findings indicate substantial stigma among resident physicians who treat patients with mental illnesses, which might negatively impact both the efficacy of therapy and the phyisician's mental health. It is important to educate medical residents on mental health issues so that they can treat their patients appropriately. It is suggested that mental health concerns be included in the curriculum of residency programs for physicians so that they have adequate perspectives and attitudes about treating these patients.

Barriers to mental health treatment in primary care practice in low- and middle-income countries in a post-covid era: A systematic review

General primary care workers and family physicians are a crucial work force in managing the mental health of people in any given region. However, the barriers they face in low- and middle-income countries (LMICs) may be worsened by the pandemic. This review aims to bring together evidence about mental health treatment challenges experienced by people in LMICs in primary care settings. The review focuses on the shortage of essential mental healthcare services, stigma and lack of competent primary care professionals in establishing these services and their importance in the COVID-19 pandemic context. The systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and the search strategy included keyword search terms (MeSH) to perform a search across three electronic databases - Critical Appraisal Skills Program assessed PubMed, SpringerLink, and Cochrane and quality of the articles. The articles selected were analyzed through thematic analysis to identify the main themes and conclude our findings. Findings indicate that out of 1792 publications found, 14 studies matched the desired criteria for the studies. Endnotes, database search filters, and Covidence data extraction tools were used to generate the relevant articles in this study. This study shows that primary care institutions have financial and management issues in providing mental health services and a shortage of competent mental health experts in primary care, especially mental health-trained family physicians. The study also identifies community stigma as the most prevalent barrier to seeking mental health therapy, reflecting the lack of community health education in LMICs.

Perspectives of healthcare providers, service users, and family members about mental illness stigma in primary care settings: A multi-site qualitative study of seven countries in Africa, Asia, and Europe

BACKGROUND

Stigma among healthcare providers is a barrier to the effective delivery of mental health services in primary care. Few studies have been conducted in primary care settings comparing the attitudes of healthcare providers and experiences of people with mental illness who are service users in those facilities. Such research is necessary across diverse global settings to characterize stigma and inform effective stigma reduction.

METHODS

Qualitative research was conducted on mental illness stigma in primary care settings in one low-income country (Nepal), two lower-middle income countries (India, Tunisia), one upper-middle-income country (Lebanon), and three high-income countries (Czech Republic, Hungary, Italy). Qualitative interviews were conducted with 248 participants: 64 primary care providers, 11 primary care facility managers, 111 people with mental illness, and 60 family members of people with mental illness. Data were analyzed using framework analysis.

RESULTS

Primary care providers endorsed some willingness to help persons with mental illness but reported not having appropriate training and supervision to deliver mental healthcare. They expressed that people with mental illness are aggressive and unpredictable. Some reported that mental illness is incurable, and mental healthcare is burdensome and leads to burnout. They preferred mental healthcare to be delivered by specialists. Service users did not report high levels of discrimination from primary care providers; however, they had limited expectations of support from primary care providers. Service users reported internalized stigma and discrimination from family and community members. Providers and service users reported unreliable psychiatric medication supply and lack of facilities for confidential consultations. Limitations of the study include conducting qualitative interviews in clinical settings and reliance on clinician-researchers in some sites to conduct interviews, which potentially biases respondents to present attitudes and experiences about primary care services in a positive manner.

CONCLUSIONS

Primary care providers' willingness to interact with people with mental illness and receive more training presents an opportunity to address stigmatizing beliefs and stereotypes. This study also raises important methodological questions about the most appropriate strategies to accurately understand attitudes and experiences of people with mental illness. Recommendations are provided for future qualitative research about stigma, such as qualitative interviewing by non-clinical personnel, involving non-clinical staff for recruitment of participants, conducting interviews in non-clinical settings, and partnering with people with mental illness to facilitate qualitative data collection and analysis.

"We improved our life because I cut my drinking": Qualitative analysis of a brief intervention for people with alcohol use disorder in Ethiopian primary health care

BACKGROUND

Despite global recommendations that brief, task-shared interventions are effective for addressing problematic alcohol use in primary health care (PHC), low-income countries have made few attempts to implement and scale-up these interventions.

AIM

To explore perspectives and experiences of service users and providers on a brief intervention (BI) for alcohol use disorders (AUDs) delivered by nonspecialist health workers who are health officers and clinical nurses in PHC in a rural Ethiopian district.

METHODS

The study team conducted a qualitative study, comprising in-depth interviews with 26 purposively selected participants. The participants were 14 people who had been screened for probable AUD and were receiving the brief intervention; four caregivers without any intervention; and eight nonspecialist health workers who provided a single session brief intervention at four primary care health centers in Sodo district, south Ethiopia. The study used framework analysis. We grouped findings into five themes: acceptability, engagement in and barriers to care, implementation of the service, perceived impact of the BI, and unmet needs and expectations.

RESULTS

Participants perceived the intervention to be useful, and it was well-accepted by most service users and relatives. Participants reported reductions in alcohol consumption and benefits in terms of their capacity to work, increased earnings, less money wasted, and ability to provide for their families. However, most did not attend follow-up visits, often influenced by the belief that they did not have a serious problem and could handle it alone. Some did not believe AUDs to be treatable; others did not attend because of lack of money for transportation and stigma from peers. Providing BI did not affect PHC workers' routine work. However, they noticed a reluctance from people with probable AUD to speak openly about their drinking, and they were constrained by a shortage of space. They recommended training and involvement from community members, leaders, and health extension workers to raise awareness, increase acceptability, refer cases, and reduce stigma.

CONCLUSION

The brief intervention that nonspecialist health workers in PHC delivered was acceptable, feasible, and perceived to have positive benefits. To extend the impact of the intervention, the community needs to be involved to address low awareness and to tackle stigma.