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. 2018 Nov 26;18(1):890.
doi: 10.1186/s12913-018-3684-7.

Barriers and facilitators to the integration of mental health services into primary healthcare: a qualitative study among Ugandan primary care providers using the COM-B framework

Edith K Wakida  1 , Celestino Obua  2 , Godfrey Z Rukundo  3 , Samuel Maling  3 , Zohray M Talib  4   5 , Elialilia S Okello  6
Affiliations

Barriers and facilitators to the integration of mental health services into primary healthcare: a qualitative study among Ugandan primary care providers using the COM-B framework

Edith K Wakida et al. BMC Health Serv Res. .

Abstract

Background: Uptake of clinical guideline recommendations into routine practice requires changes in attitudes and behaviors of the health care providers. The World Health Organization (WHO) has heavily invested in public health and health promotion globally by developing policy recommendations to guide clinical practice; however, clinical guidelines are often not applied. The success of the implementation of any guidelines depends on consideration of existing barriers and adequately addressing them. Therefore, exploring the context specific barriers and facilitators affecting the primary care providers (PCPs) in Mbarara district, Uganda may provide a practical way of addressing the identified barriers thus influence the PCPs action towards integration of mental healthcare services into PHC.

Methods: We adopted a theoretical model of behavior change; Capability, Opportunity and Motivation developed to understand behavior (COM-B). This was a cross-sectional study which involved using a semi-structured qualitative interview guide to conduct in-depth interviews with PCP's (clinical officers, nurses and midwives).

Results: Capability - inadequacy in knowledge about mental disorders; more comfortable managing patients with a mental problem diagnosis than making a new one; knowledge about mental health was gained during pre-service training; no senior cadre to consultations in mental health; and burdensome to consult the Uganda Clinical Guidelines (UCG). Opportunity - limited supply of hard copies of the UCG; guidelines not practical for local setting; did not regularly deal with clients having mental illness to foster routine usage of the UCG; no sensitization about the UCG to the intended users; and no cues at the health centers to remind the PCPs to use UCG. Motivation - did not feel self-reliant; not seen the UCG at their health facilities; lack of trained mental health specialists; conflicting priorities; and no regulatory measures to encourage screening for mental health.

Conclusions: Efforts to achieve successful integration of mental health services into PHC need to fit in the context of the implementers; thus the need to adapt the UCG into local context, have cues to enforce implementation, and optimize the available expertize (mental healthcare providers) in the process.

Keywords: Capability; Integration of mental health services; Opportunity and motivation; Primary care providers; Uganda clinical guidelines.

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Conflict of interest statement

Authors’ information

EW is a Research Administrator/Manager and a PhD student in Implementation Science at Mbarara University of Science and Technology.

CO is a senior researcher, a Pharmacologist, and Vice Chancellor of Mbarara University of Science and Technology.

GZR is a Psychiatrist and senior Lecturer in the Department of Psychiatry, Mbarara University of Science and Technology.

SM is an Associate Professor of Psychiatry in the Department of Psychiatry, Mbarara University of Science and Technology.

ZT is an Associate Professor of Medicine and of Health Policy, Department of Medical Education, California University of Science and Medicine.

ESO is a Social Anthropologist and Senior Lecturer at the Makerere University College of Health Sciences, Department of Psychiatry.

Ethics approval and consent to participate

Ethical approval was provided by the Gulu University Research Ethics Committee under application number ‘GUREC 006/09/2017. The study was then registered with the Uganda National Council for Science and Technology under the number ‘HS126ES’. All participants gave voluntary written informed consent to participate in this study.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
COM-B Framework for understanding behavior
Fig. 2
Fig. 2
Emergent barriers and facilitators
See this image and copyright information in PMC

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