Date of Award


Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Katie Wang


Background: The Health Action for Psychiatric Problems in Nigeria Including Epilepsy and Substances (HAPPINESS) Project is a mental health capacity building intervention based in Imo State, Nigeria that incorporates the World Health Organization’s Mental Health Gap Action Programme (mhGAP). So far, the HAPPINESS Project has trained 36 primary care workers (doctors, nurses, and community health extension workers) in one initial training (covering 5 local government areas) and one refresher training. The goal of this project is to leverage Imo State’s widespread primary care network, to address gaps in access to mental health care.

Objective: To evaluate the impact of the HAPPINESS Project, both qualitatively and quantitatively, on primary health care workers using a mixed-methods approach.

Methods: Evaluated the quality and effectiveness of the HAPPINESS Project using semistructured interviews with trainees, trainers, and local health officials that have supported the HAPPINESS Project (n=6). The effect of the training on trainee’s perception of mental illness was evaluated using the World Psychiatric Association (WPA)’s questionnaire focused on measuring levels of stigma and discrimination towards people with schizophrenia (n=13). A paired-sample t-test was used to analyze the questionnaire.

Results: The questionnaire showed that respondents significantly improved on three of the subscales used to analyze the WPA questionnaire (socializing, normalizing, and witchcraft). No significant effect was seen on the subscale of “biopsychosocial beliefs regarding mental illness”. The interviews showed a very positive response towards the HAPPINESS Project as a whole and offered ideas on how it should expand moving forward. Notable suggestions include methods of creating awareness with regards to mental illnesses, increasing the length of the training, and potentially doing separate training for different healthcare professions.

Conclusion: This study provides preliminary evidence for the successful contextualization of the mhGAP-IG to local settings. It is unique in highlighting challenges that come with initiating a mhGAP-IG implementation project and quantitatively evaluating levels of stigma among trainees. Future evaluations of the HAPPINESS Project should incorporate the analysis of patient data and patient perspectives.

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