Characteristics of participants
A total of 605 participants returned completed questionnaires out of 618 questionnaires distributed to the respondents (response rate of 97.9%). The characteristic of participants is given in Table 1. Most of the participants were males (60%); 70.5% were rural residents; 6% of the participants had chronic illnesses and 29% of them had experience of counsellor visits in the last one or two years.
At a cut off 10 points of PHQ-9 score, more than half of the participants had depressive symptoms. Among nine items in the PHQ-9, participants responded that 63%, 59%, 60%, 62% and 57% of them experienced lack of motivation, sad mood, sleep problem, fatigue and lack of attention respectively (supplementary graph). Thirty percent of them endorsed for having suicidal ideation.
Counselling needs of the participants
The assessment score of counselling needs scale indicated that students endorsed higher scores for problems related to their education (mean=15.17) followed by vocational problems (mean=14.34). The mean score of the remaining dimensions of counselling needs was nearly similar (mean difference = 0.0458, p>0.5).
Interviewed participants also confirmed that students commonly presented academic issues such as study techniques during counselling sessions.
“Most of the students come to ask about study skills. ..... One of the students told me that she has no attention and got weak and fades up to study. She tells that she cannot wake up once she sleeps. The other girl tells that she was not allocating fair time for subjects with tendency of reading easier subjects”, counsellor 02.
The solution that counsellors often used during counselling was training or teaching students about some psychological topics such as life skills, study skills and how to prepare for exams. However, counsellors agree that they were not assigned with time schedules to provide such trainings. Counsellors also reported that they are also engaged in supporting students with special needs despite lack of strong support system in the schools. according to counsellors’ reports, support systems to these students with special needs included letting them have front chairs and assisting them have access to educational materials.
Associates of counselling needs
In multivariable linear regression (Table 3), each increment in PHQ-9 score (β=0.266, p<001) and anxiety score (β=0.154, p<0.001) were positively associated with increased score in total counselling needs. Each increment in the PHQ-9 scores was also independently associated with increased scores of each of the dimensions in counselling needs scores: educational (β=01149, p<0.05) vocational (β=0.223, p<0.001), social (β=0.253, p<0.001), emotional (β=0.291, p<0.001) and behavioural (β=0.291, p<0.001). Similarly, each increment in the total anxiety score was also independently associated with increased scores of each of the dimensions in counselling needs scores: social (β=0.043, p<0.001), emotional (β=0.147, p<0.001) and behavioural (β=0.147, p<0.001).
The negative association between chronic illness and total score on overall dimensions of counselling needs (β= -0.128) and with counselling needs in educational areas (β= -0141) indicates that students without chronic illness did endorse lower scores on the counselling needs scale.
Challenges and facilitators of guidance and counselling service
A good opportunity in relation to guidance and counselling in the study area was presence of potential counsellors, unutilized task force. The government motivation to expand the services and the presence of need for the services from potential users are also additional facilitators to improve the service quality and to expand its access to the users. There is also a potential to scale up the service into clinical practice for people with psychological problems. Nevertheless, there is a huge gap in the provision of quality guidance and counselling service and to meet students’ needs for guidance and counselling service:
“...the profession is forgotten at the top level. Now it is very apart, no one who needs counselling and no one who gives it. There is wide gap. No educational opportunity for us and that is also one of the reasons for it [profession] to be hated”, counsellor 02.
“There are students who have become hopeless. Good to provide advice and support for those students so that they will be productive citizens”, students.
The following themes have been identified as challenges related to poor counselling service: (1) administrative challenges (2) counsellor competencies and motivation (3) resource constraints (4) beliefs (staff perceptions, cultural beliefs).
Principals, counsellors and district officer agree that lack of delegation of relevant job description to counsellors, supervision, motivation, and evaluation guidelines and lack of refresher training to counsellors as main administrative challenges.
All groups of participants agreed that counsellors are mainly engaged in disciplining misbehaving students (“They [counsellors] have stick and control students to come to school on time”, student 05) who are: “jumping fence, unpunctual, and having unfamiliar hair style, having conflict within family and substance users”. They are also engaged in reproducing exam papers and manage exams and coordinating during exams and get engaged in other administrative activities:
There is a tendency to provide additional responsibility for the counsellors. They are considered as extra items. This is because, .... there is no job description, principal.
On the other hand, some principals agree that there was problem of assigning specific duties to the counsellors. The evaluation of counsellors was based on subjective personal plans of the counsellors. As a result, the work they do differed from one school to another depending on principal personal and administrative experiences.
Even in our level, we have no evaluation on what the psychology professionals are doing. If we think that there is problem of behaviours among students, we attach responsibility to civics and ethical education teachers and the principals’ and administrative bodies. We tend to forget the psychologists in respect to this responsibility, principal.
Since there is no specified job description, most of the guidance and counselling do not know their roles. There are no distinct guidelines about the roles and responsibilities, principal.
Since there is only one counsellor per school, there is no chance to match counsellors with the client’s personality, though students wanted to consult counsellors of the same gender. Female students reported gender difference as a barrier to seek help from the counsellors.
“why there is no female counsellor for females, it is female counsellor who can solve and understand female's problems”. “If the counsellor is male, it is difficult to get counselling and vice versa”, students.
Counsellor competency and motivation
All participants (students, counsellors and principals) agree that guidance and counsellors in the study area are not providing satisfactory services suggesting further training for them. Students have uncertainty on the professional skills (“counsellor fears to discuss”, “Counsellors talk their guess”, “The skill of the counsellors is very poor”, “... they should not talk much, it is boring”, students’ comments). All types of participants linked this poor counsellors’ competency to lack of further educational opportunity. For example, counsellors, principals and district officer asserted that bachelor degree as the maximum educational requirement for the guidance and counselling position as stipulated by the ministry of education. Accordingly, the maximum educational level attained by all the counsellors in the study area was Bachelor Degree.
“... the standard is [bachelor] degree in both preparatory and secondary schools. Because, the standard is degree in the policy”, Zonal education department expert.
Besides, counsellors and schools administrators agree that counsellors had limited access to short skill trainings after employment and for further education. They are either general psychologists or civics and ethical education teachers without practical training of counselling skills in work settings.
“There are short trainings [given] by the district educational bureau for other subjects like laboratory work, for English teachers, etc. But, there was nothing for them [counsellors]”, principal 03.
“... they have no option to compete for further education just as other subject teachers. For example, there is quota for every field for masters degree but, there is no option for them at all”, principal 02.
Besides, students complain that they could not access counsellors because, there is no office or the counsellor or both (“First I cannot easily access the counsellors, second there is no school counsellor”, student 04).
“We only have theoretical background [of guidance and counselling] in the university, we need training. We have no materials”, counsellor 03.
Students’ complain that there is much punishment for their misbehaviours than providing counselling services. For example, when the students were asked to suggest solutions, they even joked by recommending “having more sticks”. Besides, both counsellors and principals agree about lack of motivational schemes for the counsellors and resultant work related stigma at work.
“I expect that he would be psychological hurt for not having something to do. I don’t know since am not psychology professional”, principal 04.
“... people say where did you [counsellors] learn such profession which is all about sitting?” counsellor04 .
“They [counsellors] are now thinking to learn another area like accounting or management or else want to be engaged in other private businesses”, principal 03.
All types of qualitative participants agree that the second reason for poor guidance and counselling service was material resource constraints such as availability and appropriateness of offices, furniture, equipment and stationery and assessment tools. Some school counsellors have no office at all while for others; the office location was not private and not equipped with necessary materials such as audio recorders, file cabinets and assessment tools. There was no counselling manual to guide them what to do and how to provide counselling services.
“There is also problem of office which is comfortable to the counselling service, zonal educ department”.
“There is no clear and separate guidance counselling office for the counsellor and no information is given about it”, students
“I don’t think the office is appropriate. It is open to everybody” [office seen with many other teachers which looks staff office], counsellor 01
Beliefs and Expectation
Several students in their responses to open ended questions reported that they are not aware of about the availability of counselling service in their respective schools. Several students and counsellors agreed that the role given to school counsellors is to discipline student misbehaviours through punishment (“Sometimes students were considered as ignorant and that is embracing…No freedom in the school”, student). Participants assumed that this role was reason for students’ unrealistic beliefs and expectations such as students’ fear of being stigmatized and beliefs about the nature of service seekers (“psychological problem means a problem that an individual has since her/his birth”, student). Besides, additional belief related barriers of counselling service were students’ perceived inability to express inner emotions (“I cannot explain things clearly; do not expect that I can get the solution there”, student), fear of gender based violence from the professionals and lack of information about the nature of service.
“I don't know what the counsellor does when you consult him/her. I also fear to talk from the very beginning, I am the one who is weaker in academics, so I fear to consult and discuss with them”, student.
“there is fear to disclose their problems to counsellors...... There is fear among most of the students. There is problem of disclosing self. The area where they are from disables them to disclose their identity and hiding their problems, making the problem unknown to others”, principal 02
Fear of confidentiality was especially linked to the open location of offices. It was also linked to the familiarity of the counsellors and the teachers with the parents of the students since teachers and the parents are not strangers in the rural schools. Thus, students fear whether their secrets would be disclosed to parents since teachers also usually call parents in some cases of misbehaviours.
“There are many customers and people around the counsellor’s office. When we go to the counsellor’s office they perceive as if we are consulting about love and nothing else. Thus, I fear about my fate of being stigmatized”, student
Teachers are theoretically supposed to cooperate with the counsellors for effective school counselling services. Nevertheless, counsellors reported about their poor cooperation with the teachers:
Everybody tend to say that the counsellor is the sole authority to resolve student problems. There is no collaboration among the teachers. There is problem of perception, counsellor 01.
Even our perception has problem and the teachers’ support on them and helping their work has problems. The tradition of refereeing students to counsellors among teachers in their respective subject areas is problematic, Zonal Educ dept