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Impact of Mental Health Advocacy Training on Mental Health Advocacy Skills among Community Health Workers in Nigeria

Abstract

Mental health remains an important public health concern in Nigeria, while limited awareness, stigma, misconceptions, inadequate access to services, shortages of mental health professionals, and weak referral systems may restrict the availability and utilization of appropriate mental health care. Community health workers occupy an important position within primary healthcare and community settings because of their close contact with individuals, families, and vulnerable populations. Their ability to advocate for mental health can contribute to improved awareness, early identification, appropriate referral, reduction of stigma, and access to available mental health services. However, community health workers may have limited training in mental health advocacy, communication, community mobilization, policy awareness, and referral support. Mental health advocacy training provides an opportunity to equip community health workers with practical skills for promoting mental health awareness, addressing stigma, communicating with community members and stakeholders, mobilizing community support, facilitating access to services, and advocating for improved mental health resources. Against this background, this study investigates the impact of mental health advocacy training on mental health advocacy skills among community health workers in Nigeria. The study will be anchored on Social Cognitive Theory, the Community Organization Model, and the Health Belief Model. Social Cognitive Theory emphasizes the roles of knowledge, self-efficacy, observational learning, behavioural skills, and environmental influences in developing and applying mental health advocacy skills. The Community Organization Model explains how community participation, empowerment, collective action, leadership, and mobilization can support health advocacy and community-level change. The Health Belief Model explains how community health workers' perceptions of mental health problems, perceived benefits of advocacy, perceived barriers, and cues to action may influence their willingness to engage in mental health advocacy activities. Collectively, these theoretical perspectives provide a suitable framework for explaining how mental health advocacy training may influence mental health advocacy skills among community health workers in Nigeria. The study will adopt a quantitative quasi-experimental or analytical cross-sectional research design. The study population will comprise community health workers providing services in selected primary healthcare facilities and communities across Nigeria. A multistage sampling technique will be used to select states, local government areas, communities, primary healthcare centres, and eligible community health workers. Mental health advocacy training will be measured using indicators such as exposure to structured advocacy training, training frequency and duration, mental health awareness education, communication skills, public speaking, stigma-reduction strategies, community mobilization, stakeholder engagement, health education, referral advocacy, resource identification, rights-based advocacy, problem-solving, negotiation, networking, use of advocacy materials, documentation, and monitoring of advocacy activities. Mental health advocacy skills will be assessed using indicators such as ability to communicate accurate mental health information, conduct community awareness activities, address stigma and misconceptions, mobilize community members, engage community leaders and stakeholders, promote mental health services, facilitate appropriate referrals, identify available community resources, communicate with healthcare providers, advocate for vulnerable individuals, organize advocacy activities, and apply appropriate communication and problem-solving strategies. Data will be collected using structured questionnaires, skills assessment tools, practical demonstrations, and appropriately validated mental health advocacy competency instruments administered before and after the training intervention where a quasi-experimental design is used. Descriptive statistics will be used to summarize community health workers' demographic and professional characteristics, previous advocacy experience, exposure to mental health advocacy training, and advocacy skill levels. Inferential statistical techniques, including paired or independent sample tests, chi-square tests, correlation analysis, and multiple regression analysis where appropriate, will be used to determine the impact of mental health advocacy training on mental health advocacy skills. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that mental health advocacy training has a significant positive impact on mental health advocacy skills among community health workers in Nigeria. Community health workers exposed to structured advocacy training are expected to demonstrate improved ability to communicate mental health information, challenge stigma, mobilize community members, engage stakeholders, promote available services, facilitate referrals, and advocate for individuals experiencing mental health difficulties compared with their baseline skills or community health workers without similar training. Practical demonstrations, role-playing, community scenarios, group discussions, and supervised advocacy activities may strengthen participants' confidence and ability to apply advocacy skills in real-world settings. Improved advocacy skills may enable community health workers to contribute more effectively to community mental health promotion, early recognition, referral, and service awareness. However, limited resources, inadequate supervision, heavy workloads, shortages of mental health professionals, weak referral systems, limited advocacy materials, and insufficient opportunities for refresher training may restrict the consistent application of acquired skills. The study therefore expects structured, practical, community-oriented, culturally appropriate, and sustained mental health advocacy training to contribute significantly to improved advocacy skills among community health workers in Nigeria. The study is expected to contribute to the literature on mental health advocacy training, mental health advocacy skills, community health workers, community mental health, primary healthcare, health promotion, stigma reduction, community mobilization, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state ministries of health, primary healthcare facilities, community health worker programmes, mental health institutions, non-governmental organizations, community-based organizations, public health practitioners, development partners, and policymakers regarding strategies for strengthening community-level mental health advocacy. The study will also provide evidence-based recommendations for integrating mental health advocacy training into community health worker education and continuing professional development, strengthening practical advocacy competencies, improving referral networks, providing appropriate advocacy materials, engaging community leaders, strengthening supervision, and establishing sustainable community-based mental health advocacy programmes across Nigeria.

Keywords: Mental health advocacy training, mental health advocacy skills, community health workers, community mental health, primary healthcare, health advocacy, community mobilization, stigma reduction, mental health promotion, health education, Nigeria, public health.