Examining pre-training interpersonal skills as a predictor of post-training competence in mental health care among lay health workers in South Africa

Abstract

A worldwide shortage of mental health specialists contributes to a substantial global mental health treatment gap. Despite evidence that lay health workers (LHWs), or health workers with little formal training, can effectively deliver mental health care, LHWs vary widely in their abilities to competently deliver mental health care, which undermines the quality of care and patient safety. Prior research from both high-income and low- and middle-income countries suggests this variability may be predicted by LHW interpersonal skills, yet this relationship is little explored to date. The first aim of the current study, which uses an exploratory sequential mixed methods design, was to explore qualitative perspectives through semi-structured individual interviews (n=20, researchers, policymakers, NGO staff, LHWs) in Cape Town, South Africa on interpersonal skills relevant to delivery of mental health interventions by LHWs. The second aim was to quantitatively examine the preliminary effectiveness of pre-training interpersonal skills in predicting post-training competence following a mental health training among LHWs in Cape Town (n=26). Using a standardized LHW assessment measure adapted to the setting, two raters rated ten-minute standardized role plays conducted before and after the training for pre-training interpersonal skills and post-training competence. Qualitative findings highlight the perceived importance of and challenges with assessing interpersonal skills among LHWs being trained in psychological intervention. Quantitative analyses did not identify any interpersonal skills as significant predictors of post-training competence. However, interpersonal skills improved during the training itself, specifically verbal communication, suggesting the potential promise of further research in this area. Recruitment of larger samples with more variable training outcomes would be important in future studies examining predictors of LHW competence. Further research may ultimately help identify areas of intervention to support more LHWs in attaining competence and can help play an important role in increasing access to psychological services globally.