Dear HIFA and HIFA-Zambia colleagues,
Citation, abstract, questions and a comment from me below.
CITATION: Mental health literacy among primary healthcare workers in South Africa and Zambia
Joonas Korhonen et al. Brain Behav. 2022 Nov 3;e2807. doi: 10.1002/brb3.2807
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.
Below are examples of the questions that were asked. Respondents were directed to answer on a four-point scale:
Q8: To what extent do you think it is likely that the diagnosis of “Substance Abuse Disorder” can include physical and psychological tolerance of the drug (i.e., require more of the drug to get the same effect)?
Q7: To what extent do you think it is likely that the diagnosis of “Bipolar Disorder” includes experiencing periods of extremely elevated (i.e., high) and periods of depressed (i.e., low) mood?
Q5: To what extent do you think it is likely that “Persistent Depressive Disorder (Dysthymia)” is a mental disorder?
Q3: If someone experienced a low mood for two or more weeks, had a loss of pleasure or interest in their normal activities, and experienced changes in their appetite and sleep, then to what extent do you think it is likely they have “Major Depressive Disorder?”
Q14: Mental health professionals are bound by confidentiality; however, there are certain conditions under which this does not apply. To what extent do you think it is likely that the following is a condition that would allow a mental health professional “to break confidentiality”: if a patient is at immediate risk of harm to oneself or others?
Q13: To what extent do you think it is likely that “Cognitive Behavior Therapy (CBT)” is a therapy based on challenging negative thoughts and increasing helpful behaviors?
Q4: To what extent do you think it is likely that “Personality Disorders” are a category of mental illness?
Q2: If someone experienced excessive worry about a number of events or activities where this level of concern was not warranted, had difficulty controlling this worry, and had physical symptoms such as having tense muscles and feeling fatigued, then to what extent do you think it is likely they have “Generalised Anxiety Disorder?”
Q1: If someone became extremely nervous or anxious in one or more situations with other people (e.g., in social gatherings) or performance situations (e.g., presenting at a meeting) in which they were afraid of being evaluated by others and that they would act in a way that was humiliating or feel embarrassed, then to what extent do you think it is likely they have “Social Phobia?”
Q6: To what extent do you think it is likely that the diagnosis of “Agoraphobia” includes anxiety about situations (e.g., open market place) where escape may be difficult or embarrassing? Q11: To what extent do you think it would be helpful for someone to “improve their quality of sleep” if they were having difficulties managing their emotions (e.g., becoming very anxious or depressed)?
Q9: To what extent do you think it is likely that in general, “women are more likely to experience some mental illnesses compared to men?”
Q15: Mental health professionals are bound by confidentiality; however, there are certain conditions under which this does not apply. To what extent do you think it is likely that the following is a condition that would allow a mental health professional to “break confidentiality”: if patient's problem is not life-threatening and professionals want to assist others to better support a patient (Reversed scoring)?
Q10: To what extent do you think it is likely that, in general, “men are more likely to experience an anxiety disorder compared to women” (Reversed scoring)?
Q12: To what extent do you think it would be helpful for someone to “avoid all activities or situations that made them feel anxious” if they were having difficulties managing their emotions (Reversed scoring)?
COMMENT (NPW): To what extent can the above questions measure mental health literacy? What are the limitations of such an approach? What other approaches are possible to measure mental health literacy?
Best wishes, Neil
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HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health movement (Healthcare Information For All - www.hifa.org ), a global community with more than 20,000 members in 180 countries, interacting on six global forums in four languages in collaboration with WHO. HIFA brings stakeholders together to accelerate progress towards universal access to reliable healthcare information. HIFA is administered by Global Healthcare Information Network, a UK based non-profit in official relations with the World Health Organization.
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