JMIR Publications

ABSTRACT

Background:

Mental health problems are a growing public health concern, particularly in low- and middle-income countries (LMICs), where access to care remains limited due to a shortage of trained professionals and stigma surrounding mental illness. In Nepal, mental health services are concentrated in tertiary facilities, and healthcare providers (HCPs) at primary and secondary care levels often lack formal training to identify and manage mental health conditions. Evidence suggests that structured mental health training can improve HCPs’ knowledge and attitudes, contributing to better patient outcomes. However, the effectiveness of such training programs, particularly in resource-limited settings, remains underexplored.

Objective:

This study aimed to evaluate the impact of a structured mental health training program on HCPs’ knowledge, attitudes, and confidence in providing mental health support in Madhesh Province, Nepal. The study also assessed the sustainability of these improvements three months post-training.

Methods:

A mixed-methods, pre-post controlled study was conducted among 46 HCPs, randomly assigned to either the intervention group (n=24), which received a 10-day comprehensive mental health training, or the control group (n=22), which received a 3-day abbreviated training. The training curriculum, based on the World Health Organization’s Problem Management Plus (PM+), covered mental health literacy, safety planning, stress management techniques, and counseling skills. Assessments were conducted at three time points: baseline, immediately post-training, and three months post-training. Changes in mental health knowledge and attitudes were measured using the Mental Health Knowledge Schedule (MAKS), Perceived Dangerousness Scale, and Social Distance Scale. Quantitative data were analyzed using repeated measures ANOVA and one-way ANOVA, while qualitative data from in-depth interviews with intervention group participants were analyzed thematically.

Results:

At baseline, 87% of HCPs reported no prior mental health training. Both groups demonstrated significant improvements in knowledge scores post-training, with a greater increase in the intervention group (mean increase: 7.41 points, 95% CI: 4.85–9.98) compared to the control group (3.82 points, 95% CI: 0.01–7.63). Attitude scores also improved across both groups, with reductions in perceived dangerousness and social distance scores, but the intervention group exhibited a more sustained positive shift at follow-up. Thematic analysis of qualitative data highlighted increased confidence among HCPs in identifying, counseling, and referring patients with mental health concerns, particularly among women experiencing violence.

Conclusions:

Comprehensive mental health training significantly enhanced HCPs’ knowledge and attitudes, with greater and more sustained improvements in the intervention group. The findings suggest that integrating structured mental health training into routine capacity-building initiatives can empower non-specialist HCPs to provide early intervention and referral services, especially in resource-limited settings. Scaling up this training model could improve mental health service delivery and reduce stigma in primary healthcare systems.