Detecting Depression in Rural Primary Care Clinics in Central Kenya: Impact of a Brief Training Intervention

Abstract

In developing countries, with minimal resources devoted to mental health, detection and treatment of mental illness necessarily falls to primary care providers, yet research has rarely focused on the experiences of private practitioners, especially in rural areas. This mixed-methods study investigated the diagnosis and treatment of depression by rural Kenyan primary care providers and assessed the impact of a brief training intervention on their comfort level and competence in recognizing depression. Participants were 44 providers practicing in private clinics in rural Kenya randomly assigned to intervention and wait-list control groups. Both groups completed pretest questionnaires eliciting diagnostic hypotheses based on live vignettes. The intervention group received brief training about screening for depression. Two months later, 23 participants returned to complete posttest questionnaires. Results demonstrated that brief training about depression and access to diagnostic instruments increased providers' comfort level with diagnosing depression; treatment preferences and barriers to care were also identified.

Reducing mental health-related stigma in primary health care settings in low- and middle-income countries: a systematic review

“…Only six studies compared their intervention to a control condition (Alexander et al , 2013, Hofmann-Broussard et al , 2017, Li et al , 2015, Sadik et al , 2011, Shirazi et al , 2009, Vesel et al , 2015), two of which used random allocation. Four studies applied quasi-experimental designs, e.g.…”

“…No or little effects were found from short training interventions, e.g. a one-hour training on depression screening (Alexander et al , 2013) or a one-session stigma intervention for general practitioners (Ucok et al , 2006). …”

Impact of Contextual Factors on the Effect of Interventions to Improve Health Worker Performance in Sub-Saharan Africa: Review of Randomised Clinical Trials

“…The 42 manuscripts reporting the 41 eligible trials identified are shown in Table 1 [ 16 – 57 ]. Two of the included manuscripts reported the same trial (Pirkle [ 45 ] and Dumont [ 28 ]); however each manuscript reported different aspects of the intervention and different outcomes (one assessing the impact of multi-factorial training on obstetric skills and the other assessing the effect on maternal mortality of focusing training on the lessons learned from maternal death audit).…”

“…There was substantial variation in the effect of these interventions ( Table 2 ); for example, one intervention aimed at improving diagnosis of depression in Kenya was associated with no improvement [ 16 ] while another in Malawi reported a 20-fold improvement in diagnostic sensitivity from 3% to 57% (p<0.001) [ 35 ]. Other interventions with substantial effect sizes were internet-video based training to improve ability to tie surgical knots (61% greater improvement in the intervention group compared to control, p<0.05, though local suture-conserving techniques influenced outcome) [ 17 ] and a management intervention in Kenya to encourage supervisors to improve their effectiveness (increase in proportion directly observing staff performance from 31% to 53%, p<0.01) [ 47 ].…”

The development of the visual screening tool for anxiety disorders and depression: Addressing barriers to screening for depression and anxiety disorders in hypertension and/or diabetes

“…Hermanns et al 24 argue that the translation of concepts across cultures is crucial in order to develop culturally appropriate measurement tools, diagnoses and services for people with depression and anxiety disorders. Language, according to Alexander et al, 25 is a factor that contributes to the non-detection of mental health problems.…”