title: Building system capacity for the integration of mental health at the level of primary care in Tunisia: a study protocol in global mental health.
abstract: In low- and middle-income countries (LMICs), addressing the high prevalence of mental disorders is a challenge given the limited number and unequal distribution of specialists, as well as scarce resources allocated to mental health. The Mental Health Gap Action Programme (mhGAP) and its accompanying Intervention Guide (IG), developed by the World Health Organization (WHO), aim to address this challenge by training non-specialists such as general practitioners (GPs) in mental health care. This trial aims to implement and evaluate an adapted version of the mhGAP-IG (version 1.0) offered to GPs in 2 governorates of Tunisia (i.e., Tunis and Sousse), in order to uncover important information regarding implementation process and study design before country-wide implementation and evaluation.
  
  
  
  First, a systematic review will be conducted to explore types and effectiveness of mental health training programs offered to GPs around the world, with a specific focus on programs implemented and evaluated in LMICs. Second, a cluster randomized controlled trial (RCT) will be conducted to evaluate the effectiveness of the implemented training based on the mhGAP-IG (version 1.0). Third, multiple case study design will be used to explore how contextual factors impact the successful implementation of the training and desired outcomes.
  
  
  
  In Tunisia, an important need exists to further develop proximity health services and to address the growing mental health treatment gap. One solution is to train GPs in the detection, treatment, and management of mental health problems, given their strategic role in the healthcare system. This trial thus aims to implement and evaluate an adapted version of a training based on the mhGAP-IG (version 1.0) in Tunis and Sousse before country-wide implementation and evaluation. Several contributions are envisioned: adding to the growing evidence on the mhGAP and its accompanying guide, especially in French-speaking nations; building research capacity in Tunisia and more generally in LMICs by employing rigorous designs; evaluating an adapted version of the mhGAP-IG (version 1.0) on a sample of GPs; generating important information regarding implementation process and study design before country-wide implementation; and complimenting the trial results with implementation analysis, a priority in global mental health.
authors.affiliation: School of Public Health, Institut de recherche en santé publique de l'Université de Montréal (IRSPUM), University of Montreal, 7101 Parc Avenue, Montreal, Quebec, H3N 1X9, Canada. jessica.maria-violanda.spagnolo@umontreal.ca.|Douglas Mental Health University Institute (CIUSS Ouest-de-l'Île-de-Montréal), 6875 LaSalle boul., Montreal, Québec, H4H 1R3, Canada. jessica.maria-violanda.spagnolo@umontreal.ca.
authors.forename: Jessica
authors.identifier: 0000-0002-1125-3121
authors.initials: J
authors.lastname: Spagnolo
authors.affiliation: School of Public Health, Institut de recherche en santé publique de l'Université de Montréal (IRSPUM), University of Montreal, 7101 Parc Avenue, Montreal, Quebec, H3N 1X9, Canada.
authors.forename: François
authors.initials: F
authors.lastname: Champagne
authors.affiliation: School of Public Health, Institut de recherche en santé publique de l'Université de Montréal (IRSPUM), University of Montreal, 7101 Parc Avenue, Montreal, Quebec, H3N 1X9, Canada.
authors.forename: Nicole
authors.initials: N
authors.lastname: Leduc
authors.affiliation: Douglas Mental Health University Institute (CIUSS Ouest-de-l'Île-de-Montréal), 6875 LaSalle boul., Montreal, Québec, H4H 1R3, Canada.|McGill University, 845 Sherbrooke Street West Montreal, Quebec, H3A 0G4, Canada.
authors.forename: Myra
authors.initials: M
authors.lastname: Piat
authors.affiliation: Razi Hospital, Cité des Orangers, Manouba, Tunisia.|Faculty of Medicine, University Tunis El-Manar, 15 rue Djebel Lakhdhar, Tunis, Tunisia.
authors.forename: Wahid
authors.initials: W
authors.lastname: Melki
authors.affiliation: Faculty of Medicine, University Tunis El-Manar, 15 rue Djebel Lakhdhar, Tunis, Tunisia.|Mongi-Slim Hospital, 2046 Sidi Daoud, La Marsa, Tunisia.
authors.forename: Fatma
authors.initials: F
authors.lastname: Charfi
authors.affiliation: Douglas Mental Health University Institute (CIUSS Ouest-de-l'Île-de-Montréal), 6875 LaSalle boul., Montreal, Québec, H4H 1R3, Canada.|McGill University, 845 Sherbrooke Street West Montreal, Quebec, H3A 0G4, Canada.
authors.forename: Marc
authors.initials: M
authors.lastname: Laporta
mesh_terms: D057191:Capacity Building; D019033:Delivery of Health Care, Integrated; D006801:Humans; D001523:Mental Disorders / Q000628:therapy; D008603:Mental Health; D008605:Mental Health Services / Q000458:organization & administration*; D011203:Poverty; D011320:Primary Health Care; D011613:Psychotherapy; D012107:Research Design; D014416:Tunisia
keywords: Capacity-building; Effectiveness; General practitioners; Integration; Mental health; Primary care; RCT; Treatment gap; Tunisia; mhGAP