Impact of Capacity Building of Healthcare Workers on Management of Post-Traumatic Stress Disorder

Summary

This is a community- and hospital-based interventional study consisting of two interventions:

* Capacity building of healthcare workers (HCWs) in the intervention group (Buea Regional Hospital, selected by simple random sampling-balloting method) on management of post-traumatic stress disorder (PTSD) among road traffic injury (RTI) patients (victims). This intervention will be evaluated using pre/posttest scores via a questionnaire to be administered to HCWs to assess change in knowledge and comfort level in PTSD management and 6 months of follow-up to assess change in practice (number of RTI patients screened for PTSD and number of identified PTSD cases referred for treatment to mental health specialists) after the capacity building.
* Also, a pre/post quasi-experimental study design without a control group where psychotherapy will be used in a 6-month follow-up of RTI patients diagnosed with PTSD. The participants (RTI patients diagnosed with PTSD) that will be used for this pre/post quasi-experimental study using psychotherapy will come from the baseline study where the prevalence of PTSD among RTI victims will be determined.

The goal of this clinical trial is to learn if capacity building of healthcare workers on the management (screening, treatment, and referral) of post-traumatic stress disorder (PTSD) among road traffic injury (RTI) patients in hospitals leads to change in knowledge and comfort level of healthcare workers in screening and timely management of PTSD to improve patients' outcomes. Given that attention to care for RTI victims in hospitals in Cameroon and Fako Division in particular is focused on physical care, this study seeks to ensure the provision of holistic care to RTI victims in hospitals, which is in line with the definition of health (comprising the mental, physical, and social well-being of individuals and not just the mere absence of disease or infirmity) by the World Health Organization (WHO). This study will also, through the pre/post quasi-experiment without a control group, learn about the feasibility of using/integrating psychotherapy alongside timely screening for PTSD in routine RTI patient care in primary health care to improve PTSD status in adult RTI patients diagnosed with PTSD in the Cameroonian context.

This study aims to answer five research questions:

Research Questions

1. What is the epidemiological profile of RTI patients at health facilities in Fako Division from 2019 to 2023?
2. What is the prevalence of PTSD among RTI patients in health facilities in Fako Division?
3. What factors are associated with PTSD among RTI patients in health facilities in Fako Division?
4. What is the standard of PTSD care provided to RTI patients in health facilities in Fako Division?
5. What is the impact of capacity building of healthcare workers on the management of PTSD in RTI patients in health facilities in Fako Division? Researchers will

* Describe the epidemiological profile of RTI patients in hospitals in Fako Division, Cameroon, from January 2019 to December 2023, particularly with regard to PTSD screening recommendation and uptake via an exhaustive chart review of medical records.
* Determine the prevalence of PTSD among RTI patients via survey using PCL-5 and a cut-off score of at least 33/80.
* Assess factors associated with PTSD.
* Assess care given to RTI patients and identify barriers, particularly regarding PTSD management.
* Compare pre/posttest scores (at baseline-T0, post-training-T1, and 30 days post-training-T2) of healthcare workers' knowledge and comfort level in PTSD management following capacity building of HCWs on PTSD management to see if there is change in knowledge and comfort level due to the capacity-building intervention in the randomly selected hospital chosen as the intervention group (Buea Regional Hospital) and also establish if the knowledge was sustained after 30 days.
* Collect data at 1, 3, and 6 months of follow-up on the number of RTI patients screened for PTSD by trained health workers during 6 months of post-training follow-up and the number of timely referrals of PTSD cases identified, and compare these to what was obtained before the training (baseline) and establish if there is a change.
* Collect data on the PTSD status of PTSD patients at 1, 3, and 6 months of follow-up with psychotherapy and conclude on the feasibility of including psychotherapy in the Cameroonian context to improve PTSD status.

Participants (RTI victims) will:

* Be booked for PTSD screening 1 month after RTI, be called up for an appointment to be screened 1 month after RTI, and have diagnosed PTSD cases referred for effective management.
* Diagnosed PTSD cases will be followed up with psychotherapy once every 2 weeks for 6 months (12 sessions in total), and PTSD status will be followed up monthly.
* Keep a record of symptoms, difficulties/challenges faced in managing PTSD, the number of times they experience PTSD symptoms, and improvement over time.

Conditions

• Post-traumatic Stress Disorder (PTSD) Among Road Traffic Injury Victims

Interventions

BEHAVIORAL

Two days, role play, adult interactive capacity building sessions of healthcare workers on PTSD screening and management. Pre/posttest and change in practice in screening will be used for evaluation

Intervention 1\. Capacity Building of Healthcare workers on PTSD Management For training, the three purposefully selected health facilities selected for the study were written on small pieces of paper. The papers were twisted and thrown on a table. Then, a child was asked to pick up any paper. The one picked was the intervention health facility (Buea Regional Hospital). Healthcare workers at the BRH who provide care to RTI survivors at risk of PTSD 1 month after RTI from our health units of interest in the BRH, will be selected for training (mostly unit heads and front-line staff in trauma/injury will be trained) in two role-play, adult training, interactive sessions on the screening of PTSD using the DSM-5 tool and on timely management of RTI patients with regard to PTSD, linkage to care to psychotherapists, and referrals. Pre/post knowledge evaluation on the use of the DSM-5 tool and management of PTSD will be done, and results compared.

Sponsors & Collaborators

• Fogarty International Center of the National Institute of Health

  collaborator NIH

• University of California, Los Angeles

  collaborator OTHER

• University of California, Berkeley

  collaborator OTHER

• University of Buea

  lead OTHER

Principal Investigators

• Claudia Ngeha Ngu, PhD Fellow · University of Buea

Study Design

Allocation

NA

Purpose

SCREENING

Masking

NONE

Model

SINGLE_GROUP

Eligibility

Min Age

18 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2024-07-30

Primary Completion

2025-09-30

Completion

2025-10-30

Countries

• Cameroon

Study Locations