Implementing the mhGAP-HIG: The process and evaluation of training primary health care workers in KP, Pakistan

BackgroundBuilding the capacity of primary care staff is crucial for integrating mental health care into primary healthcare to reduce the significant treatment gap for psychiatric disorders prevalent in low- and middle-income countries. This research investigates the effectiveness of adapted mhGAP-HIG guidelines in Khyber Pakhtunkhwa (KP). MethodsA team of seven trained experts conducted six five-day training workshops in six districts of KP. A total of 105 primary care physicians and clinical psychologists were trained. Mix method analysis was performed. Paired sample t-tests were used to compare knowledge scores pre- and post-training and after 8 months. Thematic analysis was conducted to examine feedback of the participants regarding the training, whereas content analysis was performed on the reflections of the trainers on the adapted guide. ResultsFindings demonstrated significant improvements in knowledge of the participants to identify and manage common mental health conditions. The percentage of correctly answered questions in the pre-test was 73.86%, which increased to 85.94% in the post-test, indicating a 12.08% increase in knowledge. Most noticeable improvements in knowledge were observed in harmful use of substances (22.56), General principles of care and other significant mental health complaints (15.15%), stress (13.80%), suicide, and epilepsy (13.13%). The thematic analyses highlighted the strengths and gaps of training and made recommendations to strengthen preservice training and provide regular refresher courses. ConclusionThe study underscores the feasibility of implementing an adapted mhGAP-HIG for training primary care physicians and clinical psychologists within existing healthcare resources of KP. The preliminary findings endorse the scalability across other provinces in the country.