Implementing the mhGAP-HIG: the process and evaluation of training primary healthcare workers in Khyber Pakhtunkhwa, Pakistan

Background To address the treatment gap for common mental disorders in low- and middle-income countries facing humanitarian challenges, it is crucial to build the capacity of primary healthcare workers (PHCWs) and integrate mental healthcare into primary care settings. Aims To investigate the effectiveness of a Mental Health Gap Action Programme Humanitarian Intervention Guide (mhGAP-HIG) adapted for use in Pakistan to build the capacity of PHCWs in Khyber Pakhtunkhwa. Method Six mhGAP-HIG training workshops were conducted, each lasting for 5 days, across six districts of Khyber Pakhtunkhwa. A total of 105 PHCWs (74 primary care physicians and 31 clinical psychologists) were trained through these workshops. We used multiple triangulations for data collection and analyses. Paired-sample t -tests were applied to compare scores on knowledge questionnaires pre- and post-training and after 8 months. We also conducted thematic analysis to examine participants’ feedback regarding the training, and performed content analysis on the participants’ reflections on the adapted guide. Results Our findings demonstrated significant improvements in PHCWs’ knowledge related to the mental health conditions in the mhGAP-HIG. Their scores improved by 12.08%, increasing from 73.86% pre-training to 85.94% post-training. Noticeable improvements in knowledge were recorded for the modules ‘Harmful use of alcohol and drugs’ (22.56%), ‘General principles of care’ and ‘Other significant mental health complaints’ (15.15%), ‘Acute stress’ (13.80%) and ‘Suicide’ and ‘Epilepsy’ (13.13%). The thematic analysis of the feedback of the PHCWs and trainers recommended the use of the guide to strengthen pre-service training and broaden the scope of the initiative to train PHCWs across the province. Conclusions This study underscores the feasibility of implementing an adapted mhGAP-HIG for training primary care physicians and clinical psychologists within the existing healthcare resources of Khyber Pakhtunkhwa. The preliminary findings endorse the scalability across other districts in the province.