The influence of primary care physicians’ mental health knowledge, attitudes and self-efficacy on referrals to specialised services: findings from a longitudinal pilot trial
School of Public Health, University of Montreal; Department of Community Health Sciences, University of Sherbrooke; and Charles-Le-Moyne - Saguenay-Lac-St-Jean Research Centre on Health Innovations, University of Sherbrooke - Longueuil Campus, Quebec, Canada
Helen-Maria Vasiliadis
Department of Community Health Sciences, University of Sherbrooke; and Charles-Le-Moyne - Saguenay-Lac-St-Jean Research Centre on Health Innovations, University of Sherbrooke - Longueuil Campus, Quebec, Canada
Djamal Berbiche
Department of Community Health Sciences, University of Sherbrooke; and Charles-Le-Moyne - Saguenay-Lac-St-Jean Research Centre on Health Innovations, University of Sherbrooke - Longueuil Campus, Quebec, Canada
François Champagne
School of Public Health, University of Montreal, Quebec, Canada
Nicole Leduc
School of Public Health, University of Montreal, Quebec, Canada
Wahid Melki
Department of Psychiatry D, Razi Hospital; Faculty of Medicine of Tunis, University of Tunis El-Manar, Tunisia; and Technical Committee for Mental Health Promotion in Ministry of Health, Tunis, Tunisia
Khalid Saeed
Mental Health and Substance Abuse Unit, Department of Non-Communicable Diseases and Mental Health, World Health Organization Regional Office for the Eastern Mediterranean, Egypt
Fatma Charfi
Department of Child Psychiatry, Mongi Slim Hospital; and Faculty of Medicine of Tunis, University of Tunis El-Manar, Tunisia
Background Training based on the Mental Health Gap Action Programme (mhGAP) is being increasingly adopted by countries to enhance non-specialists’ mental health capacities. However, the influence of these enhanced capacities on referral rates to specialised mental health services remains unknown. Aims We rely on findings from a longitudinal pilot trial to assess the influence of mental health knowledge, attitudes and self-efficacy on self-reported referrals from primary to specialised mental health services before, immediately after and 18 months after primary care physicians (PCPs) participated in an mhGAP-based training in the Greater Tunis area of Tunisia. Method Participants included PCPs who completed questionnaires before (n = 112), immediately after (n = 88) and 18 months after (n = 59) training. Multivariable analyses with linear mixed models accounting for the correlation among participants were performed with the SAS version 9.4 PROC MIXED procedure. The significance level was α < 0.05. Results Data show a significant interaction between time and mental health attitudes on referrals to specialised mental health services per week. Higher scores on the attitude scale were associated with more referrals to specialised services before and 18 months after training, compared with immediately after training. Conclusion Findings indicate that, in parallel to mental health training, considering structural/organisational supports to bring about a sustainable change in the influence of PCPs’ mental health attitudes on referrals is important. Our results will inform the scale-up of an initiative to further integrate mental health into primary care settings across Tunisia, and potentially other countries with similar profiles interested in further developing task-sharing initiatives.
