abstract: 'BackgroundPrimary care physicians (PCPs) working in mental health care

  in Tunisia often lack knowledge and skills needed to adequately address

  mental health-related issues. To address these lacunas, a training based

  on the Mental Health Gap Action Programme (mhGAP) Intervention Guide

  (IG) was offered to PCPs working in the Greater Tunis area between

  February and April 2016. While the mhGAP-IG has been used extensively in

  low- and middle-income countries (LMICs) to help build non-specialists''

  mental health capacity, little research has focused on how contextual

  factors interact with the implemented training program to influence its

  expected outcomes. This paper''s objective is to fill that lack.MethodsWe

  conducted a case study with a purposeful sample of 18 trained PCPs. Data

  was collected by semi-structured interviews between March and April

  2016. Qualitative data was analyzed using thematic

  analysis.ResultsParticipants identified more barriers than facilitators

  when describing contextual factors influencing the mhGAP-based

  training''s expected outcomes. Barriers were regrouped into five

  categories: structural factors (e.g., policies, social context, local

  workforce development, and physical aspects of the environment),

  organizational factors (e.g., logistical issues for the provision of

  care and collaboration within and across healthcare organizations),

  provider factors (e.g., previous mental health experience and personal

  characteristics), patient factors (e.g., beliefs about the health system

  and healthcare professionals, and motivation to seek care), and

  innovation factors (e.g., training characteristics). These contextual

  factors interacted with the implemented training to influence knowledge

  about pharmacological treatments and symptoms of mental illness,

  confidence in providing treatment, negative beliefs about certain mental

  health conditions, and the understanding of the role of PCPs in mental

  health care delivery. In addition, post-training, participants still

  felt uncomfortable with certain aspects of treatment and the management

  of some mental health conditions.ConclusionsFindings highlight the

  complexity of implementing a mhGAP-based training given its interaction

  with contextual factors to influence the attainment of expected

  outcomes. Results may be used to tailor structural, organizational,

  provider, patient, and innovation factors prior to future

  implementations of the mhGAP-based training in Tunisia. Findings may

  also be used by decision-makers interested in implementing the mhGAP-IG

  training in other LMICs.'
affiliation: 'Spagnolo, J (Corresponding Author), Univ Montreal, IRSPUM, Sch Publ
  Hlth, Montreal, PQ H3N 1X9, Canada.

  Spagnolo, Jessica; Champagne, Francois, Univ Montreal, IRSPUM, Sch Publ Hlth, Montreal,
  PQ H3N 1X9, Canada.

  Leduc, Nicole, Univ Montreal, Sch Publ Hlth, Montreal, PQ, Canada.

  Melki, Wahid; Bram, Nesrine, Univ Tunis El Manar, Razi Hosp, Tunis, Tunisia.

  Piat, Myra, McGill Univ, Douglas Mental Hlth Univ Inst, Montreal, PQ, Canada.

  Laporta, Marc, McGill Univ, Montreal WHO PAHO Collaborating Ctr Res \& Trainin,
  Montreal, PQ, Canada.

  Guesmi, Imen, Ctr Sch \& Univ Med Manouba, Manouba, Tunisia.

  Charfi, Fatma, Univ Tunis El Manar, Mongi Slim Hosp, Tunis, Tunisia.'
article-number: '1398'
author: Spagnolo, Jessica and Champagne, Francois and Leduc, Nicole and Melki, Wahid
  and Piat, Myra and Laporta, Marc and Bram, Nesrine and Guesmi, Imen and Charfi,
  Fatma
author-email: jessica.maria-violanda.spagnolo@umontreal.ca
author_list:
- family: Spagnolo
  given: Jessica
- family: Champagne
  given: Francois
- family: Leduc
  given: Nicole
- family: Melki
  given: Wahid
- family: Piat
  given: Myra
- family: Laporta
  given: Marc
- family: Bram
  given: Nesrine
- family: Guesmi
  given: Imen
- family: Charfi
  given: Fatma
da: '2023-09-28'
doi: 10.1186/s12889-018-6261-4
eissn: 1471-2458
files: []
journal: BMC PUBLIC HEALTH
keywords: 'Implementation; mhGAP; Training; Mental health; Primary care;

  Physicians; Case study; Tunisia'
keywords-plus: MIDDLE-INCOME COUNTRIES; DISORDERS; GAP
language: English
month: DEC 20
number-of-cited-references: '71'
orcid-numbers: 'Spagnolo, Jessica/0000-0002-1125-3121

  Charfi, Fatma/0000-0002-5171-2767'
papis_id: ade6f79cd987993f3a7cfad6a4cf0abc
ref: Spagnolo2018wefind
researcherid-numbers: 'Charfi, Fatma/AAZ-8912-2020

  '
times-cited: '12'
title: '``We find what we look for, and we look for what we know″: factors interacting
  with a mental health training program to influence its expected outcomes in Tunisia'
type: Article
unique-id: WOS:000454103900006
usage-count-last-180-days: '1'
usage-count-since-2013: '5'
volume: '18'
web-of-science-categories: Public, Environmental \& Occupational Health
year: '2018'