Barriers and Facilitators for Translating Skills into Clinical Practice in Primary Psychiatry Care: Primary Care Doctors' Survey Through the Lens of Implementation Research.

Abstract

Background: Though integrating psychiatric care into primary care is thought to be a pivotal step, a huge gap remains in translating this training into clinical practice at primary health centers (PHCs) in India. To address this, we aim to explore the perspectives of the primary care doctors (PCDs) from an implementation research angle.

Methods: An anonymous online survey with a semi-structured questionnaire gathered PCDs' perspectives on integrating primary care psychiatry training into India's healthcare system, focusing on Acceptability, Adoption, Appropriateness, and Feasibility subsets based on the conceptual framework for implementation outcomes. The survey reached 7,200 PCDs via a pan-India mental health capacity-building program, with 124 PCDs from 5 states participating. A 134 PCDs completed the Fidelity questionnaire. PCDs were grouped by mental health training status for comparative analysis. A mixed-method analysis was conducted on the data.

Results: Overall, PCDs reported high ratings across the subsets of Acceptability (91.1%-91.9%), Feasibility (75.8%-91.9%), Adoption (87.9%-93.5%), and Appropriateness (89.5%-92.7%). Clinical practice outcomes in terms of Fidelity (33.6%-52.2%) remained limited. Mental health training was significantly linked to increased comfort in managing mental health issues at PHCs (Acceptability subset, χ² = 4.79, p = .02), a greater readiness to start screening for mental health disorders (Adoption subset, χ² = 4.73 p = .03) and increased prescription practice at PHC for mental health disorders (Fidelity subset, χ² = 4.01, p = .04). Qualitative data analysis identified barriers such as stigma, time constraints, limited access to medications, staff shortages, and inadequate follow-up systems that hindered effective integration of mental health care at PHCs.

Conclusions: Though psychiatry training of PCDs improves resource availability, addressing systemic challenges is essential for ensuring effective mental health service delivery at the primary care level.