Developing mental health curricula and a service provision model for clinical associates in South Africa: a Delphi survey of family physicians and psychiatrists.

BACKGROUND: Clinical associates are a health professional cadre that could be utilised in mental health task sharing in South Africa but this is training dependent. The objectives of the study were to identify the potential curricula content, training sites, and teaching modalities for undergraduate and potential postgraduate clinical associate mental health training and to identify the tasks that they should perform based on these curricula. METHODS: We utilised the Delphi method to reach consensus on items with the panel comprising psychiatrists and family physicians. The first round questionnaire of the Delphi survey was developed based on a literature review and the results from earlier phases of the overall study. The survey was administered electronically and consisted of three rounds. Following both the first and second rounds, an updated questionnaire was constructed omitting the items on which consensus was reached. The questionnaire consisted primarily of nine-point scales with consensus based on 70% of participants rating 1,2,3 or 7,8,9. RESULTS: There were 26 participants in the first round with this number falling to 23 in later rounds. There was strong consensus on a training attachment to a mental health clinic at a community health centre (CHC) at undergraduate (96.2%) and postgraduate level (100%). Consensus was reached on the importance of training on the management of six categories of disorders at the undergraduate level and nine categories of disorders at the postgraduate level. Clerking patients as a teaching modality reached 100% consensus at both undergraduate and postgraduate levels. PHC clinics, CHCs and district hospitals reached consensus as appropriate settings for clinical associates to provide mental health services. In addition, GP practices and secondary hospitals reached consensus for those with postgraduate training. Consensus was reached on ten of the 21 listed tasks that could be performed based on undergraduate training and 20 of the 21 tasks based on a postgraduate qualification in mental health. CONCLUSIONS: The Delphi panel's recommendations provide a clear roadmap for enhancing mental health curricula for clinical associates, enabling their utilisation in mental health service provision. A future postgraduate mental health qualification for clinical associates would allow for expanded task sharing.

The acceptability of a donor human milk bank and donated human milk among mothers in Limpopo Province, South Africa.

Breastfeeding is a crucial public health approach that reduces infant morbidity and mortality by providing essential nutrients and antibodies, and breast milk is easily digested. Breastfeeding and donated milk serve as a preventative measure against necrotising enterocolitis. Additionally, they protect against viruses and nosocomial sepsis. When a birthing parent's own milk is unavailable, alternative enteral nutrition for preterm or low-birth-weight infants is either donor human milk (DHM) or artificial formula. This study aimed to understand mothers' acceptance of the donor human milk bank (DHMB) and DHM. A qualitative phenomenological study was conducted in Limpopo Province, South Africa. The study used purposive sampling to select 23 mothers in postnatal and neonatal wards. Data collection was via in-depth interviews using a semistructured interview guide. Manual data analysis using an interpretative phenomenological analysis (IPA) framework was used to coding. Concepts were grouped to generate themes. Three themes and nine subthemes were generated: (1) DHMBs (2) cultural perspective of DHMB, and (3) health considerations of DHM. Participants were unaware of the DHMB. Hesitancy in accepting DHM due to fear of contracting HIV was observed. Cultural beliefs are an influencing factor for use, while donation was driven by altruistic reasons, preventing waste, helping others and having previously benefited from DHM. The study found that mothers are willing to donate human milk. Willingness to donate can be increased by raising awareness about DHMB and addressing culture and safety concerns at antenatal clinics.

Using a Nominal Group Technique to Inform a Curriculum of a Short Learning Programme for Peer Mentor Training in a Health Sciences Context.

BACKGROUND: The purpose of this study was to explore the use of a modified nominal group technique (mNGT) to inform the curriculum of a Short Learning Programme for peer mentors in the Bachelor of Clinical Medical Practice (BCMP) program. METHODS: An mNGT was used to achieve group consensus. Research participants included academic staff and students of the BCMP program called clinical associate (ClinA) students. Two sessions of the nominal group techniques (NGTs) were conducted. Two questions were presented: (1) what should be the learning outcomes of a Short Learning Programme for peer mentors for ClinA students? and (2) what learning activities should be included to achieve the intended learning outcomes? RESULTS: mNGT groups were both concluded in < 2 h and the costs involved were minimal. The priority outcomes of academic staff were to promote and encourage a positive, inclusive environment to enhance student morale; and to provide insight into the roles that peer mentors should fulfill. The primary objectives of academic staff were to foster and support a welcoming, inclusive atmosphere to boost student morale, as well as to offer guidance on the responsibilities that peer mentors should undertake. The top priorities of students were to provide insight into the role of a ClinA and the personal development of peer mentors. Learning activities suggested included time management and personal growth of peer mentors, "how to be an effective mentor," and leadership skills. The outcomes formulated by research participants reflected the graduate attributes listed by the University of Pretoria as well as generic attributes described by international scholars. DISCUSSION: A common NGT was an inexpensive and time-saving way to obtain rank-ordered data from research participants. This modified method ensured an equitable and inclusive approach, ensuring buy-in from all stakeholders, and is useful in the development of a curriculum for Short Learning Programmes. Both staff and students converged on common outcomes related to academic, psychosocial, and ClinA role support MeSH Terms: Consensus; Curriculum; Humans; Leadership; Mentors; Students.

Mental illness attitudes, service provision interest and further training preferences of clinical associates.

BACKGROUND:  Non-specialist health professionals are required to provide mental health services given the burden of disease due to mental illness. The study aimed to explore the attitudes of clinical associates towards those with mental illness as well as their interest in mental health work and additional mental health training. METHODS:  A cross-sectional study design was utilised. The study population consisted of clinical associates based in South Africa. An electronic questionnaire was developed that incorporated the 16-item Mental Illness Clinicians' Attitudes version 4 scale (MICA-4), which is scored out of 96 with higher scores indicating more stigmatising attitudes. Multivariate linear regression was used to determine factors associated with the MICA-4 score. RESULTS:  The mean MICA-4 score for the 166 participants who completed all 16 questions was 37.55 (standard deviation 7.33). In multivariate analysis, the factors associated with significantly lower MICA-4 scores were falling in the 25- to 29-year-old age category and indicating that a mental health rotation formed part of the undergraduate degree. More than 80% of the participants (140/167, 83.8%) indicated an interest in mental health work. Two-thirds of the participants (111/167, 66.5%) indicated an interest in a specialisation in mental health. CONCLUSION:  The mean MICA-4 score recorded for clinical associates indicates low stigma levels towards those with mental illness. Additionally, there is significant interest in working and training in mental health.Contribution: Training programmes should take note of the contribution of a mental health rotation to a positive attitude to mental health patients. Clinical associates' attitudes towards mental illness together with their interest in working and training in mental health suggest that they could be more widely utilised in mental health service provision.

Undergraduate research- a tale of three African institutions.

Background: The inclusion of research in undergraduate medical curricula benefits students as well as the scientific community. Multiple studies report the presence of one or more barriers to research training in these curricula. Objectives: This paper presents and compares three studies done regarding the teaching of research in undergraduate medical curricula in South Africa, Sudan and Uganda. Methods: Two cross-sectional study designs (South Africa and Sudan) and one interventional study design (Uganda) were conducted. Both cross-sectional studies used mixed methods while the Ugandan study used a quantitative method. A total of 41 faculty members and 554 students participated. The studies used a combination of surveys, focus group discussions, key informant interviews and document analysis. Results: Participants from all three studies valued research and considered it useful and relevant to their studies. The findings from the South African and Sudanese studies align with the 'Four I's' framework that summarise the barriers to research training as lack of initiative, impulse, incentive and idols. The Ugandan study demonstrated improved self-reported knowledge and attitude (specifically anxiety) among participants after completion of a short course on research.