# Strengthening Nonspecialist Health Care Providers’ Capacity to Address Mental Health in the Context of Domestic Violence in Nepal: Pre–Post Mixed Methods Training Evaluation

## TL;DR

A training program improved mental health knowledge and confidence among nonspecialist health workers in Nepal, especially those dealing with domestic violence.

## Contribution

A mixed-methods evaluation of a mental health training program tailored for nonspecialist providers in a domestic violence context in Nepal.

## Key findings

- Both training groups showed improved mental health knowledge, with the 10-day group showing greater gains.
- Participants reported increased confidence and improved attitudes toward mental health issues.
- Thematic analysis revealed enhanced psychosocial support skills for managing mental health in domestic violence cases.

## Abstract

Health care providers (HCPs) in public health facilities in low- and middle-income countries, including Nepal, often lack adequate training to manage mental health problems effectively.

This study evaluated the impact of structured mental health training on the knowledge, attitudes, confidence, and psychosocial support skills of nonspecialist HCPs in Madhesh Province, Nepal.

This study is a nested substudy within a larger domestic violence (DV) intervention trial and used a mixed method, pre–post intervention design with a comparison group. A total of 46 nonspecialist HCPs were randomized into 2 groups: group 1 (n=24) received a 10-day comprehensive mental health and violence prevention training; group 2 (n=22) received a 3-day training focused on ethical considerations, the link between intimate partner violence (IPV) or DV and mental health, and available referral services. The training was based on the World Health Organization’s Problem Management Plus model, with augmented modules on safety planning and psychosocial support. Changes in knowledge and attitude scores were assessed at baseline, immediately post-training, and at 3-month follow-up. In-depth interviews with participants from group 1 were thematically analyzed.

At baseline, nearly 90% of nonspecialist HCPs had not received any prior formal mental health training. Both groups demonstrated significant improvements in mental health knowledge, with a greater increase observed in group 1 (mean score 41.33-48.41) compared to group 2 (41.18-44.27). Attitudes toward individuals with mental health problems also improved in both groups, reflected in reductions in social distance and perceived dangerousness scores. Thematic analysis of interviews indicated enhanced confidence and psychosocial support skills, particularly in managing mental health concerns among women experiencing IPV or DV.

Structured mental health training significantly improved both knowledge and attitudes among nonspecialist HCPs in public health facilities in Madhesh Province. Participants also reported increased confidence in addressing common mental health concerns. This training model has potential for scale-up in other resource-limited settings to build frontline capacity in managing mental health problems and supporting women experiencing IPV or DV.