Assessing mhGAP-IG training on primary healthcare workers’ knowledge, attitudes, and practices: a mixed-methods study in Kenya

The Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) aims to build the capacity of non-specialist healthcare workers (NSHWs) to deliver mental healthcare, including care for Child and Adolescent Mental and Behavioral Disorders (CAMBD). However, few studies have evaluated the mhGAP-IG CAMBD module. This study examined changes in NSHWs’ knowledge, attitudes, and self-reported practices following a contextualized mhGAP-IG CAMBD training in Kenya. A mixed-methods, pre-post implementation evaluation was conducted across 58 primary healthcare facilities. Knowledge and attitudes data were collected at baseline, immediately post-training, and three months post-training. Interviews with six supervisors and five focus group discussions with 60 NSHWs explored perceived changes in competencies and clinical practice. A six-month follow-up survey further explored NSHWs’ experiences. Quantitative data were analyzed using descriptive statistics and pooled mixed-effects models, and qualitative data analyzed thematically. Knowledge scores increased from baseline (M = 23.07, SD = 3.68) to post-training (M = 25.57, SD = 3.35; p<.001) and remained stable at three-month follow-up (M = 25.53, SD = 3.38). Attitude scores decreased from pre-training (M = 34.40, SD = 8.87) to post-training (M = 28.00, SD = 9.70; p<.001), with no changes between post-training and follow-up (p=.67). NSHWs reported improved confidence in identifying and managing CAMBD and increased integration of mental health into routine care. At six months, among the 37 (39.8% response rate), 94.5% reported continued routine CAMBD screening; about half (51.4%) reported frequent use of the CAMBD module; however, limited supervision and health system constraints persisted. The CAMBD training increased knowledge, reduced stigma, and improved self-reported practices, preliminarily suggesting that a contextualized CAMBD module may help strengthen care, inform policy, and scale up.