Epidemiology and Mental Health Policy, and WHO Collaborating Centre (Mental Health), Institute of Psychiatry, King's College London, PO35, David Goldberg Centre, De Crespigny Park, London, SE5 8AF, UK.
Int J Ment Health Syst. 2013 Feb 4;7(1):6. doi: 10.1186/1752-4458-7-6.
A cluster randomised controlled trial (RCT) of a national Kenyan mental health primary care training programme demonstrated a significant impact for health workers on the health, disability and quality of life of their clients, despite a severe shortage of medicines in the clinics. In order to better understand the potential reasons for the improved outcomes in the intervention group, the experiences of the participating health workers were explored through qualitative focus group discussions, as focus group methodology has been found to be a useful method of obtaining a detailed understanding of client and health worker perspectives within health systems.
Two ninety minute focus groups were conducted in Nyanza province, a poor agricultural region of Kenya, with 10 health workers from the intervention group clinics where staff had received the training programme, and 10 health workers from the control group where staff had not received the training during the earlier randomised controlled trial.
These focus group discussions suggest that the health workers in the intervention group perceived an increase in their communication, diagnostic and counselling skills, and that the clients in the intervention group noticed and appreciated these enhanced skills, while health workers and clients in the control group were both aware of the lack of these skills.
Enhanced health worker skills conferred by the mental health training programme may be responsible for the significant improvement in outcome of patients in the intervention clinics found in the randomised controlled trial, despite the general shortage of medicines and other health system weaknesses. These findings suggest that strengthening mental health training for primary care staff is worthwhile even where health systems are not strong and where the medicine supply cannot be guaranteed.
ISRCTN 53515024.
一项针对肯尼亚国家精神卫生初级保健培训计划的整群随机对照试验（RCT）表明，尽管诊所的药物严重短缺，但卫生工作者对其客户的健康、残疾和生活质量产生了重大影响。为了更好地理解干预组结果改善的潜在原因，通过定性焦点小组讨论探索了参与卫生工作者的经验，因为焦点小组方法已被发现是一种获取客户和卫生工作者在卫生系统内观点的详细理解的有用方法。
在肯尼亚贫困农业地区的 Nyanza 省进行了两次 90 分钟的焦点小组讨论，参与者包括来自干预组诊所的 10 名卫生工作者，这些诊所的工作人员接受了培训计划，以及来自对照组诊所的 10 名卫生工作者，这些诊所的工作人员在早期的随机对照试验中没有接受培训。
这些焦点小组讨论表明，干预组的卫生工作者认为他们的沟通、诊断和咨询技能有所提高，而干预组的客户注意到并欣赏到了这些增强的技能，而对照组的卫生工作者和客户都意识到缺乏这些技能。
尽管普遍存在药物短缺和其他卫生系统弱点，但精神卫生培训计划赋予卫生工作者的增强技能可能是干预诊所患者在随机对照试验中结果显著改善的原因。这些发现表明，即使在卫生系统不强且无法保证药物供应的情况下，加强初级保健人员的精神卫生培训也是值得的。
ISRCTN53515024。
