This experience showed the potential value of training nurses of different departments and operating at both primary and secondary health level. The statistically significant improvement in acquisition of knowledge and positive attitudes towards mental disorders is a fundamental finding of this study. Such a combination (knowledge and attitudes) is indeed is critical for quality and efficient service delivery.
Similar results were indicated by previous reports that examined changes in knowledge and attitude of primary healthcare workers and primary care physicians after short-term trainings.11-14
A WHO collaborative study also showed an equal magnitude increase in knowledge and behavior of general health workers in six different low- and middle-income countries despite approaches to training varied between study areas.15 The same study emphasized the persistence of knowledge and attitude for 18 months post training, which is in line with our study in spite of a slight decline.
As correctly inferred by Ignacio et al., some cultural ingrained beliefs are reflected in specific negative attitudes and may require longer term interventions to reverse them.15 In the case of our experience in Port Said, this is particularly true for the questions “Psychiatric nurses are always subject to verbal or physical aggression during care for psychiatric patient”, whose correct answer is No, and “Psychiatric patient need special care that is not available in general hospital”, whose correct answer is again No.
While a general improvement in knowledge was registered, is also important to remark how no significant changes were detected for some items, which remained similar to the baseline scores. This was showed also by Chinnayya et al.,10 and reinforces the theory of culturally ingrained beliefs and attitudes, which might require alternative and longer strategies of training.
It is essential to embed mental health knowledge and skills within primary and secondary care and the integration of mental health into the basic training of staff would be fundamental in association with post basic training and continuing professional development and for building independent mental health researchers.16.
As very well-emphasized by Makanjuola et al.,2 there is “no health without mental health” and overall service delivery would drastically benefit from the inclusion of mental health knowledge and positive attitudes. In fact, essential universal health would be an unattainable goal if the complex relationship between physical and mental health is not addressed at the healthcare service delivery portal level.17-19
While the protocol for our study was substantiated by literature review and each step was carefully implemented, few limitations are present.
First of all, this study did not explore whether the skills acquired would impact the clinical practice. However, some studies have reported significant improved skill changes in workplaces after intensive training with similar approaches.13 Secondly, although questionnaires were anonymous and completely confidential, changes were obtained by self-report and may have been influenced by a need to please trainers rather than being a “true conviction”.
To conclude, intensive short-term training on mental illness could be instrumental in improving knowledge and attitudes in a country like Egypt with extensive needs in terms of quality of comprehensive healthcare at primary and secondary level. However, retention of information seems to decline overtime; this requires additional evidence tailored to local contexts and how such programs translate in clinical practice.