Using Quality Improvement To Implement Substance Use Disorders Services In Primary Health Care In Kenya: Impact And Experiences Of A Blended Course Among Health Workers Using The NextGenU Online Model

Background: Worldwide, mental and substance use disorders (SUD) account for over 183.9 million disability adjusted life years. While interventions do exist they are not readily implemented, especially in low- and middle-income countries, due to a lack of available human resources, monetary resources, stigma, and difficulties in changing practice patterns. Quality Improvement (QI) has been reported in literature to successfully improve health services and systems through small-scale, iterative change cycles. Objectives: This study assessed the impact of the NextGenU.org online blended course in terms of integrating, improving and sustaining mental health services using quality improvement methods in primary health care in Kenya. It also analyzed the experience of participants who completed the NextGenU.org online blended course. Method: A mixed-methods study was conducted, incorporating both qualitative focus groups (FGD) and key informant interviews (KII), and quantitative statistical measures. Data came from the Computer-Based and Alcohol Training Assessment in Kenya (eDATA K), which was implemented in collaboration with the University of British Columbia (UBC) and African Mental Health Foundation (AMHF). FGDs and KIIs were analyzed using NVivo through a constant-comparison method, to identify themes emerging from the data. A second coder analyzed the data to ensure reliability and validity. Quantitative analysis was conducted to analyze the course completion rates. Additionally, the researcher incorporated their own notes from observations made during fieldwork over the course of a 12-week practicum with AMHF to triangulate the results. Results: Overall, 27 screeners and clinicians completed the NextGenU.org online blended course. There were two FGDS and two KIIs conducted in Makueni county during July - September 2015. In terms of the staff’s experience in completing the online course many participants noted strong facilitators such as: the certificates, desire for knowledge, personal motivations, relevant material, and case studies. The limited amount of space, computers, and restrictions on Internet access acted as barriers. Participants perceived their knowledge of QI methods, leadership, and time management to have increased from completing the course. Perceived self-efficacy also increased, as staff believed their ability to be a leader, manage time and deal with errors and mistakes within the workplace improved. There was also a positive shift in stigma associated with SUD. Most importantly, the integration and improvement in mental health services was maintained even though staff discussed common challenges, such as heavy workload and limited time. Some participants reported that some people in management roles should have been more supportive, as their limited involvement acts as a barrier to greater integration of services, while other where thankful of the management support. Conclusion: This is one of the first studies of using QI methods to integrate, improve and sustain mental health services in the primary health care system in Kenya. Based upon the experiences described in the FGDs and KIIs, the blended online course was perceived to be acceptable, feasible and successful. The results indicate that quality improvement continues to be integrated in Makueni overall improving mental health services.