title: Exploring the perspectives and experiences of health workers at primary health facilities in Kenya following training.
abstract: BACKGROUND
  A cluster randomised controlled trial (RCT) of a national Kenyan mental health primary care training programme demonstrated a significant impact for health workers on the health, disability and quality of life of their clients, despite a severe shortage of medicines in the clinics. In order to better understand the potential reasons for the improved outcomes in the intervention group, the experiences of the participating health workers were explored through qualitative focus group discussions, as focus group methodology has been found to be a useful method of obtaining a detailed understanding of client and health worker perspectives within health systems.
  
  
  METHODS
  Two ninety minute focus groups were conducted in Nyanza province, a poor agricultural region of Kenya, with 10 health workers from the intervention group clinics where staff had received the training programme, and 10 health workers from the control group where staff had not received the training during the earlier randomised controlled trial.
  
  
  RESULTS
  These focus group discussions suggest that the health workers in the intervention group perceived an increase in their communication, diagnostic and counselling skills, and that the clients in the intervention group noticed and appreciated these enhanced skills, while health workers and clients in the control group were both aware of the lack of these skills.
  
  
  CONCLUSIONS
  Enhanced health worker skills conferred by the mental health training programme may be responsible for the significant improvement in outcome of patients in the intervention clinics found in the randomised controlled trial, despite the general shortage of medicines and other health system weaknesses. These findings suggest that strengthening mental health training for primary care staff is worthwhile even where health systems are not strong and where the medicine supply cannot be guaranteed.
  
  
  BACKGROUND
  ISRCTN 53515024.
authors: Epidemiology and Mental Health Policy, and WHO Collaborating Centre (Mental Health), Institute of Psychiatry, King's College London, PO35, David Goldberg Centre, De Crespigny Park, London, SE5 8AF, UK. rachel.jenkins@kcl.ac.uk.
authors: Rachel
authors: R
authors: Jenkins
authors: Caleb
authors: C
authors: Othieno
authors: Stephen
authors: S
authors: Okeyo
authors: Julyan
authors: J
authors: Aruwa
authors: Jan
authors: J
authors: Wallcraft
authors: Ben
authors: B
authors: Jenkins
references: Ment Health Fam Med. 2011 Mar;8(1):39-49
references: 22479291
references: World Psychiatry. 2010 Jun;9(2):118-20
references: 20671901
references: Int J Ment Health Syst. 2013 Jan 23;7(1):5
references: 23343127
references: Health Transit Rev. 1994 Apr;4(1):81-5
references: 10147316
references: Ment Health Fam Med. 2010 Mar;7(1):37-47
references: 22477921