Impact Of Training Health Extension Workers In Relation To Child Mental Health Care In Rural Ethiopia

Back ground: Child mental disorders, including autism, are major contributors to the global burden of disease leading to long lasting burden, disability and cost toward affected children and their families. These problems are aggravated by severe shortage of services. Access to services is further impeded by negative beliefs and stigmatising attitudes towards affected children and their families. Task-shifted care provided by community health extension workers (HEWs) has the potential of increasing access to services, and improving community perceptions. This study was conducted as an initial step for developing interventions to improve task-shifted care provision for children with autism and their families. Objective: This thesis is based on three sub-studies that aimed to evaluate: (i) experiences of stigma, explanatory models and unmet needs of caregivers of children with autism (sub-study 1); (ii) the training needs of HEWs to provide integrated child mental health care (sub-study 2); and (iii) the impact of training HEWs through the Health Education and Training (HEAT) programme in relation to child mental health disorder including autism, and appropriateness to the needs of HEWs and affected families in Ethiopia (sub-study 3). Methods: Study setting: The first sub-study was conducted in Addis Ababa, while the second and third sub-studies were conducted in the Southern region. Study design: The studies were primarily cross-sectional with a mixed-methods approach in sub-study 2. Participants and methods Sub-study 1: Participants were caregivers (n=102) of children with developmental disorders—two third of whom were caring for children with intellectual disability (n=68) and a third for children with autism (n=34). Caregivers‘ perceived experiences of stigma (Family Interview schedule) and explanatory models of illness and unmet needs were assessed. Data were subject to descriptive and multi variate analysis. Sub-study 2: In a mixed study approach, 104 HEWs who had received HEAT training were interviewed using a structured questionnaire designed to assess their experience and service practice, and 11 HEWs were involved in in-depth interviews. The quantitative data were subject to descriptive analysis while the qualitative (in-depth) interviews were subject to framework analysis.rnxiiirnSub-study 3: participants comprised of three groups of HEWs: i) HEWs who completed a basic mental health training module (HEAT group, N=104); ii) HEWs who received enhanced training, comprising basic HEAT as well as video-based training on developmental disorders and a mental health pocket guide (HEAT+ group, N=97); iii) HEWs untrained in mental health (N=108). All participants completed a questionnaire assessing beliefs and social distance towards children with autism. Impact of training was assessed by comparing attitudes, experiences and service practices between the three groups. Results: Sub-study 1: Most caregivers reported experience of stigma: 43.1% worried about being treated differently, 45.1% felt ashamed about their child‘s condition and 26.7% made an effort to keep their child‘s condition secret. Reported stigma was significantly higher in caregivers who had sought traditional help (p

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