Identifying Priorities for Enhancing Village Health Volunteer's Mental Health Recovery Practices in Thai Rural Communities: A Nominal Group Technique Study

Background

World Health Organization (WHO) and Thailand's national policy both advocate for recovery-oriented, community-based mental healthcare. Village Health Volunteers (VHVs) in Thailand have limited involvement in mental health services despite their pivotal role in Thai primary healthcare, especially in rural settings. This study aims to engage stakeholders to identify and prioritise key areas for VHVs' role expansion, stigma reduction, training needs, and common mental health conditions, thereby enhancing VHVs' contributions to recovery-oriented mental healthcare in rural Thai communities.

Methods

The study utilised the Nominal Group Technique (NGT). Eight VHVs, six individuals with mental health challenges and caregivers, and four healthcare professionals (HCPs), from three rural sub-districts in Northern Thailand, were purposively and conveniently recruited. Three NGT groups were formed: in-person for service providers (VHVs and HCPs) and service users/caregivers, and online for HCPs. Through structured stages of idea generation, sharing, discussion and ranking, participants identified their top five priorities. Ranked priorities were synthesised, and transcripts were analysed using content analysis.

Results

Eighteen participants attended one of three NGT groups. Collectively, these groups generated 94 ideas in response to four questions. Four themes were identified: (1) Expansion of VHV's mental health role, including vocational support, family support, emotional support and community reintegration; (2) Stigma reduction, focusing on changing attitudes, implementing a buddy system and enhancing mental health literacy; (3) Training needs including training related to stigma reduction, improving communication skills and providing mental health awareness education; and (4) Common mental health conditions, including psychosis and depression.

Conclusion

The prioritisation among the three groups varies. High priorities include vocational support, family support, community reintegration and counselling skills. Addressing stigma is a starting point and can be achieved through increased awareness and literacy. Future research should focus on tailored stigma interventions and trainings to support VHVs in providing effective, recovery-oriented care in these communities.

Patient or Public Contribution

Six patient and public involvement (PPI) advisors participated in the study, comprising two VHVs, one mental health nurse, one caregiver and one peer support worker, to ensure research relevance and applicability. The PPI reviewed the Thai NGT questions to assess the appropriateness of language, particularly in relation to mental health and stigma, leading to minor modifications in wording. Additionally, two VHVs and one caregiver assisted in piloting the questions to evaluate their validity and appropriateness and offered feedback on the procedure, content and timing. They recommended using probing questions to elicit more detailed responses and ensuring concise content to maintain participant engagement.