Impact of the WHO's QualityRights Training on Promoting Knowledge of Human Rights for People with Mental Disorders among Brazilian Healthcare Professionals

Impact of the WHO's QualityRights Training on Promoting Knowledge of Human Rights for People with Mental Disorders among Brazilian Healthcare Professionals | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Impact of the WHO's QualityRights Training on Promoting Knowledge of Human Rights for People with Mental Disorders among Brazilian Healthcare Professionals Ana Beatriz Zanardo Mion, Emanuele Seicenti de Brito, Igor de Oliveira Reis, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5844742/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Studies conducted worldwide have employed QualityRights training modules, which have shown promising results in improving the understanding of the human rights of people with mental disorders. This study aims to investigate the impact of QualityRights core training on promoting healthcare professionals' knowledge of the human rights of individuals with mental disorders and to assess whether the training can reduce the stigma associated with mental disorders among these professionals. Methods: A quasiexperimental study was conducted with 26 healthcare professionals from the Family Health Strategy in Brazil, including physicians, nurses, pharmacists, and community health workers. The participants completed questionnaires before and after the training to assess changes in their knowledge and attitudes via a Likert scale. The results were statistically analyzed via paired t tests and multiple linear regression with the Statistical Package for the Social Sciences software. Results: Statistically significant reductions were observed in five items of the QualityRights scale (Pre 2.92 × Post 1.71, p=0.006; Pre 3.21 × Post 2.49, p=0.042; Pre 3.07 × Post 2.28, p=0.016; Pre 2.93 × Post 2.21, p=0.026; Pre 3.50 × Post 2.64, p=0.028). The overall scale score decreased from 27.3 to 21.3 (p=0.022). A longer duration of training (more years of education) was correlated with a greater reduction in the scale score (p=0.015). Conclusions: WHO QualityRights training had a positive effect on the knowledge and practices of Brazilian healthcare professionals, successfully improving their understanding of human rights in mental health and reducing stigma. Further research, including long-term follow-up, is necessary to ensure sustained improvements and expand training to different healthcare contexts. Human rights Mental health People with disability CRPD Training QualityRights Rights-based care World Health Organization Figures Figure 1 Introduction Initially, the understanding of global mental health was shaped by distinct approaches. One of these was advocated by social anthropologists and cultural psychiatrists, who interpreted mental disorders as products of social and cultural forces( 1 ). Despite shifts in these perspectives over time, the lack of equity in the treatment of mental disorders compared with physical illnesses persists globally. People affected by mental disorders, as well as the services designed for them, are often undervalued( 2 ). Treatment rates for these conditions remain remarkably low( 3 ). The challenges faced by mental health services in low- and middle-income countries are multifaceted, encompassing issues such as legislation, policies, financial resources, organization, and planning, in addition to the availability of evidence-based interventions and adequately tailored training. These challenges are intrinsically linked to the worldview and cultural belief systems of each population, which can serve as both advantages and limitations, but both undoubtedly influence service utilization( 3 ). The integration of mental health into primary care has been identified as an effective strategy to ensure early and continuous access to care, promoting positive outcomes and greater social inclusion( 4 ). This approach underscores the essential role of human rights in advancing accessible and quality mental health care, which is fundamental for achieving better outcomes and protecting the most vulnerable members of society( 5 ). Mental disorders are fundamentally linked to human rights issues, including stigma, discrimination, and violations of rights faced by affected individuals and their families. These issues are widespread and severe, making initiatives to combat stigma and promote human rights indispensable in public mental health( 2 ). Despite the shift in attention to the mental health and illness process, reflected in new mental health policies, significant challenges remain. The perspective of professionals toward people with mental disorders should align with the psychosocial care model. However, some professionals still adhere to a biological and medical-centered view, possibly due to a lack of knowledge, ongoing health education, or social stigma( 6 ). Although healthcare providers often have broader biomedical knowledge of mental illnesses, this does not immunize them against stigmatizing attitudes and behaviors. A common narrative is that the social status associated with the healer's role and the self-image of being capable of alleviating suffering are threatened when confronted with a patient with a mental disorder, particularly if they lack psychiatric training or tools to provide effective care( 7 ). Primary care health professionals often report not having a solid theoretical foundation to support the care they provide to people with mental disorders in basic health units. They tend to consider referrals to psychosocial care centers or hospitals as the most appropriate course of action to ensure mental health care in primary settings( 8 ). Furthermore, acknowledging stigma as an influence on the actions of these professionals, education should focus on overcoming this issue. The analysis of stigma signals in concepts and skills appears to converge toward elements related to cultural competence, especially in the attitudinal aspect (feeling and being), suggesting that stigma-combatting strategies should address this competence( 9 ). Given the severity of the challenges faced by people with mental disorders due to stigma, discrimination, and a lack of respect for human rights, concerted and proportional efforts must be made to support methodologically robust research( 10 ). Effective mental health promotion also depends on intersectoral collaboration with areas not directly related to health, such as education, housing, employment, industry, transportation, arts, sports, urban planning, and justice( 2 ). The World Health Organization (WHO) launched the QualityRights Initiative to address the challenges faced by people with mental health conditions. This initiative aims to combat stigma and discrimination, promote recovery, and reform national policies and legislation in line with the Convention on the Rights of Persons with Disabilities (CRPD). To achieve these goals, the WHO developed comprehensive training materials, including in-person modules and an interactive e-training platform that is freely available to individuals and organizations. These resources target healthcare professionals, individuals with lived experiences, policymakers, civil society organizations, and other stakeholders, covering topics such as mental health, human rights, legal capacity, recovery, and the elimination of coercive practices( 11 ). The WHO QualityRights training tools adopt various educational approaches, including skills teaching, myth deconstruction, group work, and case vignettes. These materials are designed to empower a wide range of audiences, including healthcare professionals; people with psychosocial, intellectual, and cognitive disabilities; mental health service users; families; caregivers; nongovernmental organizations; and organizations of persons with disabilities. Their goal is to guide the implementation of a human rights and recovery-based approach in mental health, in line with the United Nations Convention on the Rights of Persons with Disabilities and other international human rights standards. The ultimate aim is to foster sustainable changes in mindset and practice, enabling all stakeholders to advance rights and recovery while improving the quality of life for people with psychosocial, intellectual, or cognitive disabilities worldwide( 11 , 12 ). The WHO QualityRights training tools include a total of eight training modules: five "basic" training modules covering human rights, mental health, disability, capacity, recovery, and the right to freedom from coercion, violence, and abuse; and three specialized training modules addressing recovery practices, strategies to end isolation and restraint, and support decision-making and advance planning (Fig. 1 ). Studies conducted in various parts of the world have employed QualityRights training modules, yielding promising results in improving the understanding of the human rights of people with mental disorders ( 13 ). In this context, the aim of this study is to investigate the impact of QualityRights core training on promoting knowledge among healthcare professionals regarding the human rights of individuals with mental disorders and to assess whether this training can reduce the stigma associated with mental disorders among these professionals. Method Design, setting and participants This is a quasiexperimental, nonrandomized study based on pre- and postintervention data. A quasiexperimental study differs from an experimental study in that it does not include a control group and does not randomize the sample, where a single group serves as its own control before and after the intervention(14,15). Thus, the comparison is made with the same participants, where individuals act as their own control(16). To assess the impact of QualityRights core training on human rights knowledge, as well as its effectiveness as an antistigma intervention, data were collected before and after the intervention. In this study, QualityRights core training was offered as a training course for healthcare professionals from a family health unit. Importantly, these modules had already been translated and validated into Brazilian Portuguese in a previous study(17). To this end, the study was conducted in a Family Health Unit (USF) in the interior of São Paulo state that was willing to participate. In a prior meeting with the USF manager and all professionals, the context and objectives of the present research were explained, and all healthcare professionals in the unit who had direct contact with users were invited to participate. A total of 26 participants initially agreed to take part, but since not all managed to attend at least four of the five preestablished training modules, not all participants completed every stage of the study, as outlined below. Stage 1: Application of the QualityRights PRE-training questionnaire To assess the effectiveness of the training in relation to its objectives, the QualityRights PRE-training questionnaire [1] was applied. Both the pretest and the posttest (administered after the completion of the modules) are part of the QualityRights training evaluation tools used to assess the effectiveness of the modules and changes in attitudes. This allows for a comparison of results before and after the intervention. The tests include questions on sociodemographic data and opinions on mental health, such as the hiring of people with psychosocial disabilities. Stage 2: Offering the QualityRights core training modules in a course format (training): Each QualityRights core training module was conducted on specific dates previously agreed upon with the health unit manager. Six sessions were needed, as module 2 had to be divided into two days. The sessions were conducted by a multidisciplinary team per the Initiative’s recommendations. Generally, each session had three facilitators: two nurses, holding master's and doctoral degrees, and one law graduate, with a PhD and postdoctoral experience, all with proven expertise in the topics addressed and prior work with the QualityRights Initiative. Additionally, a support team consisting of nurses, psychologists, lawyers, and nursing students assisted in the preparation and execution of each module. Not all professionals who participated in the first step were able to attend all the training days. Therefore, not all of the initial 26 professionals progressed to the next step (Stage 3) because of the maximum allowance of one absence. This stage will be explained further below. The slides used in each module were provided by the QualityRights Initiative and adapted to the local context, respecting the available time of the health professionals in the unit. Each session lasted between 1.5 and 2 hours, as per the Initiative’s recommendations. The training materials are in the public domain on the WHO website[2], and the research project was authorized to use them. Stage 3: Application of the QualityRights POSTtraining questionnaire After the completion of the five core training modules, healthcare professionals who participated on most of the training days were invited to respond to the QualityRights posttraining questionnaire. A total of 20 healthcare professionals participated in this stage. The posttraining questionnaire includes additional questions to evaluate the modules and the changes in participants' practices(18). Data analysis Each participant was assigned a unique identification code for the study, and the data were analyzed via SPSS 21 software. A descriptive analysis was initially conducted to understand the sample and explore important variables, such as demographic data. The pre- and posttraining results included quantitative data, focusing on item 4 of the questionnaires, which consisted of 17 subitems related to attitudes toward people with mental health issues and psychosocial disabilities. These subitems address topics such as coercion, legal capacity, community inclusion, the service environment, treatment choice, and hope and are evaluated via a 5-point Likert scale, where higher scores indicate more negative attitudes. The total scores ranged from 0 to 68, with lower scores indicating greater alignment with human rights(18). The pre- and posttraining distributions were compared via paired data, with a normal distribution assumed. To investigate factors associated with changes in the QualityRights training evaluation tool (pre- and postquestionnaire) scores, multiple linear regression models were adjusted, including variables with p < 0.20 in the bivariate analysis. Associations were considered significant if p < 0.05. Ethical aspects The research was approved by the Ethics Committee of the University of São Paulo at Ribeirão Preto School of Nursing (Approval No: 6.257.303/2021). The free and informed consent term was read and signed by the participants in two copies, with one kept by them and the other by the research team. The study followed the recommendations of Brazilian Resolution No. 466, of 2012, on research involving human beings. [1] Available at: https://www.who.int/publications/i/item/who-qualityrights-guidance-and-training-tools [2] Available at: https://www.who.int/publications/i/item/who-qualityrights-guidance-and-training-tools Results Among the 26 initial participants in this study, the majority (80.8%) were female. Additionally, most of the participants (57.7%) were classified as community health agents (ACSs). Approximately 30.8% of the participants had some specialization. Notably, the majority of the participants (80%) expressed their willingness to recommend training to others, as shown in Table 1 . Table 1 Profile of study participants by characteristics. Variable n % Gender Identity Female 21 80.8 Male 5 19.2 Profession Pharmacy Assistant 1 3.8 Community Health Agent (ACS) 15 57.7 Nursing Assistant 1 3.8 Nursing Technician 2 7.7 Nurse 5 19.2 Physician 2 7.7 Has a degree in health No 4 15.4 Yes 9 34.6 No response 13 50.0 Postgraduate Level No postgraduate degree 3 11.5 Specialist 8 30.8 Master's 1 3.8 Doctorate 1 3.8 No response 13 50.0 Would you recommend this course to others? Yes 20 80.0 No response 6 20.0 Although 20 healthcare professionals responded to the pre- and posttraining questionnaires and were included in the study, only the responses of 14 professionals on the QualityRights training evaluation tools could be compared and paired because some professionals failed to answer certain questions, which could affect the results if included in the specific analysis. Regarding the effect of the training on the pre- and posttraining questions of the QualityRights training evaluation tools, a statistically significant reduction was observed in the following items: "People with dementia should always live in group homes where staff can care for them" (Pre: 2.92 × Post: 1.71; p = 0.006), "People using mental health services should be empowered to make their own decisions about their treatment" (Pre: 3.21 × Post: 2.49; p = 0.042), "Healthcare professionals' opinions about care and treatment should carry more weight than those of a person with an intellectual disability" (Pre: 3.07 × Post: 2.28; p = 0.016), "People with intellectual disabilities have the right to make their own decisions, even if I disagree with them" (Pre: 2.93 × Post: 2.21; p = 0.026), and "It is necessary to control people using mental health services to maintain order" (Pre: 3.50 × Post: 2.64; p = 0.028), as shown in Table 2 . Table 2 Evaluation of the impact of QualityRights core training on the items of question 4 in the pre- and posttraining evaluation questionnaires. Item Pretest Mean Posttest Mean z p 95% CI a Nothing can be improved in mental health services without additional resources. 1.92 2.14 0.83 0.406 b The service environment has little to do with people's mental health and well-being. 1.85 1.93 0.27 0.788 c People with dementia should always live in group homes where staff can care for them. 2.92 1.71 -2.79 0.006 d People with psychosocial disabilities/mental health issues should not be employed in jobs that require direct contact with the public. 1.71 1.78 0.37 0.712 e Taking medication is the most important factor in helping people with mental health issues. 2.14 2.00 -0.44 0.666 f You can only inspire hope when a person is no longer showing symptoms. 2.35 2.00 -1.00 0.318 g People using mental health services should be empowered to make their own decisions about their treatment. 3.21 2.49 -2.04 0.042 h Following the advice of others who have experienced mental health issues is very... 2.93 2.43 -1.40 0.162 i Healthcare professionals' opinions on care and treatment should carry more weight than those of a person with an intellectual disability. 3.07 2.28 -2.40 0.016 j It is acceptable to pressure people using mental health services to undergo treatments they do not want. 2.71 2.07 -1.87 0.062 k People with mental health issues should not be given important responsibilities. 2.35 1.93 -1.89 0.058 l When people go through a crisis, healthcare professionals or family members should take control. 2.85 2.85 0.00 1.000 m People with intellectual disabilities have the right to make their own decisions, even if I disagree with them. 2.93 2.21 -2.23 0.026 n It is necessary to control people using mental health services to maintain order. 3.50 2.64 -2.20 0.028 o The use of seclusion and restraint is necessary if people using mental health services become a threat. 3.14 3.28 0.37 0.712 p People at risk of harming themselves or others should be isolated in a locked room. 2.00 1.71 -1.26 0.208 q Involuntary admission does more harm than good. 2.85 2.93 0.24 0.810 A statistically significant reduction was observed in the total score of the QualityRights scale, with pre- and posttraining values of 27.3 ± 8.2 and 21.3 ± 10.8, respectively (p = 0.022), as shown in Table 3 . Table 3 Evaluation of the impact of QualityRights core training on the scores of the pre- and posttraining evaluation questionnaires Preintervention Postintervention Mean SD Median Q1 Q3 Mean QualityRights Scale Overall score 27.3 8.2 29 20.5 32.2 More years of schooling is related to a more pronounced reduction in the score for item 4 of the pre- and postquestionnaire of the QualityRights training evaluation tools (β = -0.55; 95% CI = (-0.99; -0.10); p = 0.015), as detailed in Table 4 . Table 4 Factors associated with the change in score for item 4 of the pre- and posttraining questionnaires Bivariate Associations Multiple Regression Variable b 95% CI p b 95% CI Age (years) 0.07 -0.31, 0.45 0.713 Gender identity (male) (Ref: Female) 0.33 -9.49, 10.15 0.947 Time working in current service (years) 0.28 -0.17, 0.73 0.215 Degree in health -6.40 -20.16, 7.36 0.362 Years of school -0.58 -1.01, -0.15 0.008 -0.55 -0.99, -0.10 Participation in a course or training on human rights and/or mental health 8.60 -1.93, 19.13 0.110 2.80 -7.40, 13.00 QualityRights score before training -0.10 -0.61, 0.40 0.691 Discussion The present study investigated the effectiveness of QualityRights core training in increasing healthcare professionals’ knowledge about the human rights of people with mental disorders and reducing associated stigma. The Family Health Strategy is a strategic point for the restructuring of the Unified Health System (SUS), serving as a fundamental gateway to integrate the system's principles. The inclusion of mental health actions in primary care aims to disrupt the traditional care model and advance the field of mental health. To achieve this goal, it is essential to provide training for primary care (PC) teams in psychosocial care. Integrated actions between primary care and mental health services are crucial to building processes that result in changes to healthcare practices, creating a network of attentive and individualized care (Â. C. de Souza et al., 2019). Moreover, disease prevention and health promotion are cost-effective strategies that improve quality of life over time( 19 ). Several studies have conducted mental health education interventions in the context of primary care. Ayano et al.( 20 ) evaluated the knowledge, attitudes, and practices of primary healthcare workers regarding mental, neurological, and substance use disorders. Their findings indicated that these aspects were relatively low before training but improved significantly afterward. These findings suggest that mental health training is essential for successful integration into primary care. Continuous education is critical for enhancing professionals' knowledge, attitudes, and practices, thereby facilitating the effective treatment of disorders within general health services. Another study, conducted by Tilahun et al. ( 21 ), offered mental health training to primary care professionals and demonstrated that, despite being brief, the training had a significant effect on the motivation of community health professionals and the delivery of mental health services. By overcoming major barriers to care and providing adequate policy support, these professionals can substantially contribute to reducing the treatment gap for individuals with mental health needs. Similarly, a study in Malaysia evaluated a short video-based contact intervention as an antistigma measure among healthcare professionals. Ng et al. ( 22 ) reported that stigmatizing attitudes were common among these professionals and that a brief intervention could effectively improve these attitudes in the short term. However, long-term follow-up is recommended to ensure the intervention's sustained effectiveness. Our observations align with the literature, which recommends that anti-stigma interventions include long-term follow-up. Most studies assess the impact of such interventions only over a brief period or immediately after implementation( 23 ). Therefore, we suggest that a reevaluation of participants in this study at a later stage could yield improved outcomes, consolidating the attitude changes promoted by the training. The results of the pre- and postquestionnaires from QualityRights reflect findings that are consistent with those of previous studies. Significant changes were observed in themes such as involuntary treatment and autonomy. These changes align with the literature, highlighting the importance of the right to independence and self-determination for individuals in mental health services. These findings corroborate prior research, such as that of Morrissey( 24 ), who also utilized QualityRights training tools and identified similar changes in attitudes and perceptions following training. Similarly, a study conducted in Tunisia that also used QualityRights training tools and assessed knowledge and attitudes before and after training reported a general improvement in participants' attitudes toward human rights in mental health. While only a few items showed statistically significant differences, such as patients' decision-making power over their treatments, most questions exhibited positive changes( 25 ). These results are comparable to those of the present study, where significant improvements were also observed in items related to patient empowerment and reduced control over mental health service users. Additionally, a study in India implemented the QualityRights program with an intervention group, whereas a control group did not receive the intervention. The program's impact was assessed through attitude scales applied at the beginning and during follow-up. Staff turnover posed a challenge, with only 58% of initially enrolled staff remaining until the study's conclusion—a challenge also observed in our study. The results indicated more favorable attitudes toward reducing coercion among the intervention group staff, with significant changes in areas related to autonomy and the avoidance of coercion, which is consistent with the findings of our study( 26 ). These studies underscore the effectiveness of mental health training interventions in promoting positive changes in healthcare professionals' attitudes, highlighting the importance of supportive policies and continuous training to sustain these changes over the long term. In a study conducted in Ghana, the impact of QualityRights e-training on attitudes toward people with mental health conditions and disabilities was evaluated. The online course covered human rights, recovery, legal capacity, the end of coercion, and community inclusion and was completed by more than 17,000 participants between February 2019 and December 2021. The participants completed pre- and postcourse questionnaires, with the analysis including 417 paired and 4,299 unpaired responses. Significant posttraining improvements were observed, particularly in items related to treatment choice, legal capacity, and coercion, aligning with our findings on the effectiveness of QualityRights in fostering positive changes in attitudes toward human rights( 18 ). Thus, delivering training online can be an effective strategy to increase healthcare professionals' participation, especially among younger professionals and those with fewer years of experience, who may be more inclined to participate in online courses than in-person ones. This aspect is reflected in our results, in which professionals with more years of experience demonstrated more significant attitude changes when comparing pre- and posttest results. Despite these promising results, this study has several limitations. Future research should ensure the full participation of professionals in pre- and posttests, a challenge identified in this study due to incomplete responses. Another limitation is that the modules were delivered exclusively to professionals in the Family Health Strategy, which may limit the generalizability of the results to other population groups. However, this target group was chosen to evaluate the effectiveness of the training modules as an antistigma strategy. Furthermore, if the training had been applied to specialized professionals, the results might have differed, as these professionals have direct contact with individuals with mental disorders, which may result in lower stigma levels toward this population group. Conclusion The results of this study demonstrate that WHO QualityRights training had a positive effect on the knowledge and practices of Brazilian healthcare professionals regarding mental health. Significant changes were observed in key items of the pre- and posttraining questionnaires. The findings suggest that the training successfully improved the understanding of human rights related to mental health, reduced stigma, and fostered more empathetic attitudes among healthcare workers. Demographic characteristics, such as age and gender, did not significantly affect the test scores, but years of schooling were associated with more pronounced reductions in stigma. Therefore, training had a greater impact on professionals with more years of schooling. The study underscores the importance of integrating continuous education in primary care and mental health to foster a compassionate and inclusive care network. This finding also suggests that expanding the implementation of QualityRights training across diverse healthcare settings and audiences, including policymakers and informal caregivers, could further amplify the observed positive outcomes. These findings are consistent with international studies, which highlight the effectiveness of QualityRights training in improving healthcare professionals' attitudes and knowledge. Despite some limitations—such as incomplete participation and a focus on a single healthcare setting—the evidence highlights the significant potential of training programs in mental health to reduce stigma and enhance the quality of care for individuals with mental disorders. Therefore, further research and long-term evaluation of such interventions are recommended to ensure sustained improvements in healthcare practices and the promotion of human rights for people with mental disorders. Declarations Ethics approval and consent to participate The research was approved by the Ethics Committee of the University of São Paulo at Ribeirão Preto School of Nursing (Approval No: 6.257.303/2021). The free and informed consent term was read and signed by the participants in two copies, with one kept by them and the other by the research team. The study followed the recommendations of Brazilian Resolution No. 466, of 2012, on research involving human beings (Brazil, 2012). Consent for publication Not applicable. Availability of data and materials Not applicable. Clinical trial number Not applicable. Competing interests The authors declare that they have no competing interests. Funding This study was funded by the National Council for Scientific and Technological Development (CNPq)-Brazil (process n° 408399/2021-0). Authors' contributions ABZM wrote the main manuscript, with input from ESB, IOR and CAAV. ABZM, ESB and IOR conducted the data collection. 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Available from: https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/who-qualityrights-initiative-building-partnerships-among-psychiatrists-people-with-lived-experience-and-other-key-stakeholders-to-improve-the-quality-of-mental-healthcare/A5287D06B491630DEF4D4686576596DD Mion ABZ, Ventura CAA. The WHO QualityRights Initiative and its use worldwide: A literature review. International Journal of Social Psychiatry [Internet]. 2023 Dec; Available from: http://journals.sagepub.com/doi/10.1177/00207640231207580 Dutra HS, Reis VN dos. Desenhos de estudos experimentais e quase-experimentais: definições e desafios na pesquisa em enfermagem. Revista de Enfermagem UFPE on line [Internet]. 2016 May 6 [cited 2025 Jan 15];10(6):2230–41. Available from: https://periodicos.ufpe.br/revistas/index.php/revistaenfermagem/article/view/11238 Lobiondo-Wood G, Haber J. Desenhos não experimentais. In: Pesquisa em enfermagem: métodos, avaliação crítica e utilização. 4th ed. Guanabara-Koogan; 2001. Polit DF, Beck CT. Fundamentos da pesquisa em enfermagem: avaliação de evidências para a prática de enfermagem. 7th ed. Sao Paulo: Artmed; 2011. Brito ES, Mion ABZ, Reis IO, Silva AM, Ventura CAA. Cultural Adaptation and Validation of the WHO QualityRights Training to Brazilian Portuguese. In Review. 2025; Poynton-Smith E, Orrell M, Osei A, Ohene SA, Ansong J, Gyimah L, et al. A quantitative analysis of human rights-related attitude changes toward people with mental health conditions and psychosocial, intellectual, or cognitive disabilities following completion of the WHO QualityRights e-training in Ghana. Int J Ment Health Syst [Internet]. 2023 Dec;17(1):46. Available from: https://ijmhs.biomedcentral.com/articles/10.1186/s13033-023-00609-3 de Souza ÂC, Amarante PD, Abrahão AL. Inclusion of mental health in primary health care: care strategy in the territory. Rev Bras Enferm [Internet]. 2019 Oct 21 [cited 2025 Jan 15];72(6):1677–82. Available from: https://www.scielo.br/j/reben/a/YpbPFG9gw73C4XdC8yXDrjd/?lang=en Ayano G, Assefa D, Haile K, Chaka A, Haile K, Solomon M, et al. Mental health training for primary health care workers and implication for success of integration of mental health into primary care: Evaluation of effect on knowledge, attitude and practices (KAP). Int J Ment Health Syst [Internet]. 2017 Oct 12 [cited 2025 Jan 15];11(1):1–8. Available from: https://ijmhs.biomedcentral.com/articles/10.1186/s13033-017-0169-8 Tilahun D, Hanlon C, Araya M, Davey B, Hoekstra RA, Fekadu A. Training needs and perspectives of community health workers in relation to integrating child mental health care into primary health care in a rural setting in sub-Saharan Africa: a mixed methods study. Int J Ment Health Syst [Internet]. 2017 Dec;11(1):15. Available from: http://ijmhs.biomedcentral.com/articles/10.1186/s13033-017-0121-y Ng YP, Rashid A, O’Brien F. Determining the effectiveness of a video-based contact intervention in improving attitudes of Penang primary care nurses toward people with mental illness. Khan HTA, editor. PLoS One [Internet]. 2017 Nov;12(11):e0187861. Available from: https://dx.plos.org/10.1371/journal.pone.0187861 Carrara BS, Fernandes RHH, Bobbili SJ, Ventura CAA. Health care providers and people with mental illness: An integrative review on anti-stigma interventions. International Journal of Social Psychiatry [Internet]. 2021 Nov;67(7):840–53. Available from: http://journals.sagepub.com/doi/10.1177/0020764020985891 Morrissey FE. An evaluation of attitudinal change toward CRPD rights following delivery of the WHO QualityRights training programme. Ethics Med Public Health. 2020 Apr 1;13:100410. Carta MG, Ghacem R, Milka M, Moula O, Staali N, Uali U, et al. Implementing WHO-Quality Rights Project in Tunisia: Results of an Intervention at Razi Hospital. Clin Pract Epidemiol Ment Health [Internet]. 2020 Aug 2 [cited 2022 Sep 15];16(Suppl-1):125. Available from:/pmc/articles/PMC7431701/ Pathare S, Funk M, Drew Bold N, Chauhan A, Kalha J, Krishnamoorthy S, et al. Systematic evaluation of the QualityRights programme in public mental health facilities in Gujarat, India. The British Journal of Psychiatry [Internet]. 2021 Apr 1 [cited 2024 Nov 26];218(4):196–203. Available from: https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/systematic-evaluation-of-the-qualityrights-programme-in-public-mental-health-facilities-in-gujarat-india/0D467F4768D9D08725AE9F0056A3B929 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5844742","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":414871608,"identity":"d5c591e0-5d4e-442c-ad8e-6f10bf14722a","order_by":0,"name":"Ana Beatriz Zanardo Mion","email":"","orcid":"","institution":"University of São Paulo at Ribeirão Preto College of Nursing, PAHO/WHO Collaborating Centre for Nursing Research Development-Brazil","correspondingAuthor":false,"prefix":"","firstName":"Ana","middleName":"Beatriz Zanardo","lastName":"Mion","suffix":""},{"id":414871609,"identity":"40ec546f-e207-489f-ae38-acbac2b4717e","order_by":1,"name":"Emanuele Seicenti de Brito","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA00lEQVRIiWNgGAWjYPACCwZ+ZsbGByCmAZFaJBgk25sPG5CmxaDnWJoEUVr4xQ4/e8xTISFnIJFjVs3z5w6DufQB/FokZ6eZG/OckTA2B2q5zdv2jMGyLwG/FoPbCWbSvG0SiTtngLQ0HGYwOEPAYfa3079J8/6TqN9wI8esmOcPEVoMpHOAtjRIJBicOZbGzMNGhBaJ2zllknOOSRjOBAay5Ny2ZzyWPQS08M9O3ybxpsZGHhSVH978uSNnzkNACzo4QKoGoBaSdYyCUTAKRsHwBwCAkD+o6U6rVgAAAABJRU5ErkJggg==","orcid":"","institution":"University of São Paulo at Ribeirão Preto College of Nursing, PAHO/WHO Collaborating Centre for Nursing Research Development-Brazil","correspondingAuthor":true,"prefix":"","firstName":"Emanuele","middleName":"Seicenti","lastName":"de Brito","suffix":""},{"id":414871610,"identity":"1626293d-e137-4fff-9d54-c4458af69089","order_by":2,"name":"Igor de Oliveira Reis","email":"","orcid":"","institution":"University of São Paulo at Ribeirão Preto College of Nursing, PAHO/WHO Collaborating Centre for Nursing Research Development-Brazil","correspondingAuthor":false,"prefix":"","firstName":"Igor","middleName":"de Oliveira","lastName":"Reis","suffix":""},{"id":414871611,"identity":"28e4c599-e94e-451a-87a2-adb037593974","order_by":3,"name":"Carla Aparecida Arena Ventura","email":"","orcid":"","institution":"University of São Paulo at Ribeirão Preto College of Nursing, PAHO/WHO Collaborating Centre for Nursing Research Development-Brazil","correspondingAuthor":false,"prefix":"","firstName":"Carla","middleName":"Aparecida Arena","lastName":"Ventura","suffix":""}],"badges":[],"createdAt":"2025-01-16 21:53:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5844742/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5844742/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":76193285,"identity":"dd650691-5bbb-4b4f-ab70-260efbb27ece","added_by":"auto","created_at":"2025-02-13 09:56:32","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":144357,"visible":true,"origin":"","legend":"\u003cp\u003eOverview of WHO QualityRights Training Tools\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5844742/v1/7d8b1e5a8dae3161787df4d2.png"},{"id":76194933,"identity":"d861e691-b1fc-460d-91fe-2601ca8cda7c","added_by":"auto","created_at":"2025-02-13 10:12:33","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1011128,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5844742/v1/712b505b-fdd0-4ed2-a31b-e374794a7322.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Impact of the WHO's QualityRights Training on Promoting Knowledge of Human Rights for People with Mental Disorders among Brazilian Healthcare Professionals","fulltext":[{"header":"Introduction","content":"\u003cp\u003eInitially, the understanding of global mental health was shaped by distinct approaches. One of these was advocated by social anthropologists and cultural psychiatrists, who interpreted mental disorders as products of social and cultural forces(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Despite shifts in these perspectives over time, the lack of equity in the treatment of mental disorders compared with physical illnesses persists globally. People affected by mental disorders, as well as the services designed for them, are often undervalued(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Treatment rates for these conditions remain remarkably low(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe challenges faced by mental health services in low- and middle-income countries are multifaceted, encompassing issues such as legislation, policies, financial resources, organization, and planning, in addition to the availability of evidence-based interventions and adequately tailored training. These challenges are intrinsically linked to the worldview and cultural belief systems of each population, which can serve as both advantages and limitations, but both undoubtedly influence service utilization(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe integration of mental health into primary care has been identified as an effective strategy to ensure early and continuous access to care, promoting positive outcomes and greater social inclusion(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). This approach underscores the essential role of human rights in advancing accessible and quality mental health care, which is fundamental for achieving better outcomes and protecting the most vulnerable members of society(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMental disorders are fundamentally linked to human rights issues, including stigma, discrimination, and violations of rights faced by affected individuals and their families. These issues are widespread and severe, making initiatives to combat stigma and promote human rights indispensable in public mental health(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Despite the shift in attention to the mental health and illness process, reflected in new mental health policies, significant challenges remain. The perspective of professionals toward people with mental disorders should align with the psychosocial care model. However, some professionals still adhere to a biological and medical-centered view, possibly due to a lack of knowledge, ongoing health education, or social stigma(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAlthough healthcare providers often have broader biomedical knowledge of mental illnesses, this does not immunize them against stigmatizing attitudes and behaviors. A common narrative is that the social status associated with the healer's role and the self-image of being capable of alleviating suffering are threatened when confronted with a patient with a mental disorder, particularly if they lack psychiatric training or tools to provide effective care(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePrimary care health professionals often report not having a solid theoretical foundation to support the care they provide to people with mental disorders in basic health units. They tend to consider referrals to psychosocial care centers or hospitals as the most appropriate course of action to ensure mental health care in primary settings(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Furthermore, acknowledging stigma as an influence on the actions of these professionals, education should focus on overcoming this issue. The analysis of stigma signals in concepts and skills appears to converge toward elements related to cultural competence, especially in the attitudinal aspect (feeling and being), suggesting that stigma-combatting strategies should address this competence(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eGiven the severity of the challenges faced by people with mental disorders due to stigma, discrimination, and a lack of respect for human rights, concerted and proportional efforts must be made to support methodologically robust research(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Effective mental health promotion also depends on intersectoral collaboration with areas not directly related to health, such as education, housing, employment, industry, transportation, arts, sports, urban planning, and justice(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe World Health Organization (WHO) launched the \u003cem\u003eQualityRights\u003c/em\u003e Initiative to address the challenges faced by people with mental health conditions. This initiative aims to combat stigma and discrimination, promote recovery, and reform national policies and legislation in line with the Convention on the Rights of Persons with Disabilities (CRPD). To achieve these goals, the WHO developed comprehensive training materials, including in-person modules and an interactive e-training platform that is freely available to individuals and organizations. These resources target healthcare professionals, individuals with lived experiences, policymakers, civil society organizations, and other stakeholders, covering topics such as mental health, human rights, legal capacity, recovery, and the elimination of coercive practices(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe WHO \u003cem\u003eQualityRights\u003c/em\u003e training tools adopt various educational approaches, including skills teaching, myth deconstruction, group work, and case vignettes. These materials are designed to empower a wide range of audiences, including healthcare professionals; people with psychosocial, intellectual, and cognitive disabilities; mental health service users; families; caregivers; nongovernmental organizations; and organizations of persons with disabilities. Their goal is to guide the implementation of a human rights and recovery-based approach in mental health, in line with the United Nations Convention on the Rights of Persons with Disabilities and other international human rights standards. The ultimate aim is to foster sustainable changes in mindset and practice, enabling all stakeholders to advance rights and recovery while improving the quality of life for people with psychosocial, intellectual, or cognitive disabilities worldwide(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe WHO \u003cem\u003eQualityRights\u003c/em\u003e training tools include a total of eight training modules: five \"basic\" training modules covering human rights, mental health, disability, capacity, recovery, and the right to freedom from coercion, violence, and abuse; and three specialized training modules addressing recovery practices, strategies to end isolation and restraint, and support decision-making and advance planning (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eStudies conducted in various parts of the world have employed \u003cem\u003eQualityRights\u003c/em\u003e training modules, yielding promising results in improving the understanding of the human rights of people with mental disorders (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). In this context, the aim of this study is to investigate the impact of \u003cem\u003eQualityRights\u003c/em\u003e core training on promoting knowledge among healthcare professionals regarding the human rights of individuals with mental disorders and to assess whether this training can reduce the stigma associated with mental disorders among these professionals.\u003c/p\u003e"},{"header":"Method","content":"\u003cp\u003e\u003cem\u003eDesign, setting and participants\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis is a quasiexperimental, nonrandomized study based on pre- and postintervention data. A quasiexperimental study differs from an experimental study in that it does not include a control group and does not randomize the sample, where a single group serves as its own control before and after the intervention(14,15). Thus, the comparison is made with the same participants, where individuals act as their own control(16). To assess the impact of \u003cem\u003eQualityRights\u003c/em\u003e core training on human rights knowledge, as well as its effectiveness as an antistigma intervention, data were collected before and after the intervention. In this study, \u003cem\u003eQualityRights\u003c/em\u003e core training was offered as a training course for healthcare professionals from a family health unit. Importantly, these modules had already been translated and validated into Brazilian Portuguese in a previous study(17). To this end, the study was conducted in a Family Health Unit (USF) in the interior of São Paulo state that was willing to participate.\u003c/p\u003e\n\u003cp\u003eIn a prior meeting with the USF manager and all professionals, the context and objectives of the present research were explained, and all healthcare professionals in the unit who had direct contact with users were invited to participate. A total of 26 participants initially agreed to take part, but since not all managed to attend at least four of the five preestablished training modules, not all participants completed every stage of the study, as outlined below.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eStage 1: Application of the QualityRights PRE-training questionnaire\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTo assess the effectiveness of the training in relation to its objectives, the \u003cem\u003eQualityRights PRE-training questionnaire\u003cstrong\u003e[1]\u003c/strong\u003e\u003c/em\u003e was applied. Both the pretest and the posttest (administered after the completion of the modules) are part of the \u003cem\u003eQualityRights\u003c/em\u003e training evaluation tools used to assess the effectiveness of the modules and changes in attitudes. This allows for a comparison of results before and after the intervention. The tests include questions on sociodemographic data and opinions on mental health, such as the hiring of people with psychosocial disabilities.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eStage 2: Offering the QualityRights core training modules in a course format (training):\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eEach \u003cem\u003eQualityRights \u003c/em\u003ecore training module was conducted on specific dates previously agreed upon with the health unit manager. Six sessions were needed, as module 2 had to be divided into two days.\u003c/p\u003e\n\u003cp\u003eThe sessions were conducted by a multidisciplinary team per the Initiative’s recommendations. Generally, each session had three facilitators: two nurses, holding master's and doctoral degrees, and one law graduate, with a PhD and postdoctoral experience, all with proven expertise in the topics addressed and prior work with the \u003cem\u003eQualityRights\u003c/em\u003e Initiative. Additionally, a support team consisting of nurses, psychologists, lawyers, and nursing students assisted in the preparation and execution of each module.\u003c/p\u003e\n\u003cp\u003eNot all professionals who participated in the first step were able to attend all the training days. Therefore, not all of the initial 26 professionals progressed to the next step (Stage 3) because of the maximum allowance of one absence. This stage will be explained further below.\u003c/p\u003e\n\u003cp\u003eThe slides used in each module were provided by the \u003cem\u003eQualityRights\u003c/em\u003e Initiative and adapted to the local context, respecting the available time of the health professionals in the unit. Each session lasted between 1.5 and 2 hours, as per the Initiative’s recommendations. The training materials are in the public domain on the WHO website[2], and the research project was authorized to use them.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eStage 3: Application of the QualityRights POSTtraining questionnaire\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAfter the completion of the five core training modules, healthcare professionals who participated on most of the training days were invited to respond to the \u003cem\u003eQualityRights\u003c/em\u003e posttraining questionnaire. A total of 20 healthcare professionals participated in this stage.\u003c/p\u003e\n\u003cp\u003eThe posttraining questionnaire includes additional questions to evaluate the modules and the changes in participants' practices(18).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eData analysis\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eEach participant was assigned a unique identification code for the study, and the data were analyzed via SPSS 21 software. A descriptive analysis was initially conducted to understand the sample and explore important variables, such as demographic data.\u003c/p\u003e\n\u003cp\u003eThe pre- and posttraining results included quantitative data, focusing on item 4 of the questionnaires, which consisted of 17 subitems related to attitudes toward people with mental health issues and psychosocial disabilities. These subitems address topics such as coercion, legal capacity, community inclusion, the service environment, treatment choice, and hope and are evaluated via a 5-point Likert scale, where higher scores indicate more negative attitudes. The total scores ranged from 0 to 68, with lower scores indicating greater alignment with human rights(18).\u003c/p\u003e\n\u003cp\u003eThe pre- and posttraining distributions were compared via paired data, with a normal distribution assumed. To investigate factors associated with changes in the \u003cem\u003eQualityRights \u003c/em\u003etraining evaluation tool (pre- and postquestionnaire) scores, multiple linear regression models were adjusted, including variables with p \u0026lt; 0.20 in the bivariate analysis. Associations were considered significant if p \u0026lt; 0.05.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eEthical aspects\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe research was approved by the Ethics Committee of the University of São Paulo at Ribeirão Preto School of Nursing (Approval No: 6.257.303/2021). The free and informed consent term was read and signed by the participants in two copies, with one kept by them and the other by the research team. The study followed the recommendations of Brazilian Resolution No. 466, of 2012, on research involving human beings.\u003c/p\u003e\n\u003cp\u003e[1] Available at: https://www.who.int/publications/i/item/who-qualityrights-guidance-and-training-tools\u003c/p\u003e\n\u003cp\u003e[2] Available at: https://www.who.int/publications/i/item/who-qualityrights-guidance-and-training-tools\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eAmong the 26 initial participants in this study, the majority (80.8%) were female. Additionally, most of the participants (57.7%) were classified as community health agents (ACSs). Approximately 30.8% of the participants had some specialization. Notably, the majority of the participants (80%) expressed their willingness to recommend training to others, as shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eProfile of study participants by characteristics.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender Identity\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e80.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eProfession\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePharmacy Assistant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCommunity Health Agent (ACS)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e57.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNursing Assistant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNursing Technician\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysician\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHas a degree in health\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo response\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePostgraduate Level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo postgraduate degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpecialist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaster's\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDoctorate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo response\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWould you recommend this course to others?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e80.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo response\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAlthough 20 healthcare professionals responded to the pre- and posttraining questionnaires and were included in the study, only the responses of 14 professionals on the \u003cem\u003eQualityRights\u003c/em\u003e training evaluation tools could be compared and paired because some professionals failed to answer certain questions, which could affect the results if included in the specific analysis.\u003c/p\u003e \u003cp\u003eRegarding the effect of the training on the pre- and posttraining questions of the \u003cem\u003eQualityRights\u003c/em\u003e training evaluation tools, a statistically significant reduction was observed in the following items: \"People with dementia should always live in group homes where staff can care for them\" (Pre: 2.92 \u0026times; Post: 1.71; p\u0026thinsp;=\u0026thinsp;0.006), \"People using mental health services should be empowered to make their own decisions about their treatment\" (Pre: 3.21 \u0026times; Post: 2.49; p\u0026thinsp;=\u0026thinsp;0.042), \"Healthcare professionals' opinions about care and treatment should carry more weight than those of a person with an intellectual disability\" (Pre: 3.07 \u0026times; Post: 2.28; p\u0026thinsp;=\u0026thinsp;0.016), \"People with intellectual disabilities have the right to make their own decisions, even if I disagree with them\" (Pre: 2.93 \u0026times; Post: 2.21; p\u0026thinsp;=\u0026thinsp;0.026), and \"It is necessary to control people using mental health services to maintain order\" (Pre: 3.50 \u0026times; Post: 2.64; p\u0026thinsp;=\u0026thinsp;0.028), as shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eEvaluation of the impact of \u003cem\u003eQualityRights\u003c/em\u003e core training on the items of question 4 in the pre- and posttraining evaluation questionnaires.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePretest Mean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePosttest Mean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ez\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ea\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNothing can be improved in mental health services without additional resources.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.406\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eb\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe service environment has little to do with people's mental health and well-being.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.788\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ec\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePeople with dementia should always live in group homes where staff can care for them.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-2.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ed\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePeople with psychosocial disabilities/mental health issues should not be employed in jobs that require direct contact with the public.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.712\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ee\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTaking medication is the most important factor in helping people with mental health issues.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.666\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ef\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYou can only inspire hope when a person is no longer showing symptoms.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.318\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eg\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePeople using mental health services should be empowered to make their own decisions about their treatment.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-2.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.042\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eh\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFollowing the advice of others who have experienced mental health issues is very...\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-1.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.162\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ei\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHealthcare professionals' opinions on care and treatment should carry more weight than those of a person with an intellectual disability.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-2.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.016\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ej\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIt is acceptable to pressure people using mental health services to undergo treatments they do not want.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-1.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.062\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ek\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePeople with mental health issues should not be given important responsibilities.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-1.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.058\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003el\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWhen people go through a crisis, healthcare professionals or family members should take control.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003em\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePeople with intellectual disabilities have the right to make their own decisions, even if I disagree with them.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-2.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.026\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003en\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIt is necessary to control people using mental health services to maintain order.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-2.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.028\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eo\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe use of seclusion and restraint is necessary if people using mental health services become a threat.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.712\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ep\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePeople at risk of harming themselves or others should be isolated in a locked room.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-1.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.208\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eq\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInvoluntary admission does more harm than good.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.810\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eA statistically significant reduction was observed in the total score of the \u003cem\u003eQualityRights\u003c/em\u003e scale, with pre- and posttraining values of 27.3\u0026thinsp;\u0026plusmn;\u0026thinsp;8.2 and 21.3\u0026thinsp;\u0026plusmn;\u0026thinsp;10.8, respectively (p\u0026thinsp;=\u0026thinsp;0.022), as shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eEvaluation of the impact of \u003cem\u003eQualityRights\u003c/em\u003e core training on the scores of the pre- and posttraining evaluation questionnaires\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePreintervention\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePostintervention\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMedian\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eQ1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eQ3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQualityRights Scale\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOverall score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e20.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e32.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eMore years of schooling is related to a more pronounced reduction in the score for item 4 of the pre- and postquestionnaire of the \u003cem\u003eQualityRights\u003c/em\u003e training evaluation tools (β = -0.55; 95% CI = (-0.99; -0.10); p\u0026thinsp;=\u0026thinsp;0.015), as detailed in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFactors associated with the change in score for item 4 of the pre- and posttraining questionnaires\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026minus;\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBivariate Associations\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMultiple Regression\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eb\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eb\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.31, 0.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.713\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender identity (male) (Ref: Female)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-9.49, 10.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.947\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTime working in current service (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.17, 0.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.215\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDegree in health\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-6.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-20.16, 7.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.362\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eYears of school\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-1.01, -0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026minus;\" colname=\"c6\"\u003e \u003cp\u003e-0.99, -0.10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eParticipation in a course or training on human rights and/or mental health\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-1.93, 19.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-7.40, 13.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQualityRights score before training\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.61, 0.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.691\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present study investigated the effectiveness of \u003cspan type=\"ItalicUnderline\" class=\"ItalicUnderline\" name=\"Emphasis\"\u003eQualityRights\u003c/span\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ecore\u003c/span\u003e training in increasing healthcare professionals\u0026rsquo; knowledge about the human rights of people with mental disorders and reducing associated stigma. The Family Health Strategy is a strategic point for the restructuring of the Unified Health System (SUS), serving as a fundamental gateway to integrate the system's principles. The inclusion of mental health actions in primary care aims to disrupt the traditional care model and advance the field of mental health. To achieve this goal, it is essential to provide training for primary care (PC) teams in psychosocial care. Integrated actions between primary care and mental health services are crucial to building processes that result in changes to healthcare practices, creating a network of attentive and individualized care (\u0026Acirc;. C. de Souza et al., 2019). Moreover, disease prevention and health promotion are cost-effective strategies that improve quality of life over time(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSeveral studies have conducted mental health education interventions in the context of primary care. Ayano et al.(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) evaluated the knowledge, attitudes, and practices of primary healthcare workers regarding mental, neurological, and substance use disorders. Their findings indicated that these aspects were relatively low before training but improved significantly afterward. These findings suggest that mental health training is essential for successful integration into primary care. Continuous education is critical for enhancing professionals' knowledge, attitudes, and practices, thereby facilitating the effective treatment of disorders within general health services.\u003c/p\u003e \u003cp\u003eAnother study, conducted by Tilahun et al. (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e), offered mental health training to primary care professionals and demonstrated that, despite being brief, the training had a significant effect on the motivation of community health professionals and the delivery of mental health services. By overcoming major barriers to care and providing adequate policy support, these professionals can substantially contribute to reducing the treatment gap for individuals with mental health needs.\u003c/p\u003e \u003cp\u003eSimilarly, a study in Malaysia evaluated a short video-based contact intervention as an antistigma measure among healthcare professionals. Ng et al. (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e) reported that stigmatizing attitudes were common among these professionals and that a brief intervention could effectively improve these attitudes in the short term. However, long-term follow-up is recommended to ensure the intervention's sustained effectiveness.\u003c/p\u003e \u003cp\u003eOur observations align with the literature, which recommends that anti-stigma interventions include long-term follow-up. Most studies assess the impact of such interventions only over a brief period or immediately after implementation(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Therefore, we suggest that a reevaluation of participants in this study at a later stage could yield improved outcomes, consolidating the attitude changes promoted by the training.\u003c/p\u003e \u003cp\u003eThe results of the pre- and postquestionnaires from \u003cem\u003eQualityRights\u003c/em\u003e reflect findings that are consistent with those of previous studies. Significant changes were observed in themes such as involuntary treatment and autonomy. These changes align with the literature, highlighting the importance of the right to independence and self-determination for individuals in mental health services. These findings corroborate prior research, such as that of Morrissey(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e), who also utilized \u003cem\u003eQualityRights\u003c/em\u003e training tools and identified similar changes in attitudes and perceptions following training.\u003c/p\u003e \u003cp\u003eSimilarly, a study conducted in Tunisia that also used \u003cem\u003eQualityRights\u003c/em\u003e training tools and assessed knowledge and attitudes before and after training reported a general improvement in participants' attitudes toward human rights in mental health. While only a few items showed statistically significant differences, such as patients' decision-making power over their treatments, most questions exhibited positive changes(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). These results are comparable to those of the present study, where significant improvements were also observed in items related to patient empowerment and reduced control over mental health service users.\u003c/p\u003e \u003cp\u003eAdditionally, a study in India implemented the \u003cem\u003eQualityRights\u003c/em\u003e program with an intervention group, whereas a control group did not receive the intervention. The program's impact was assessed through attitude scales applied at the beginning and during follow-up. Staff turnover posed a challenge, with only 58% of initially enrolled staff remaining until the study's conclusion\u0026mdash;a challenge also observed in our study. The results indicated more favorable attitudes toward reducing coercion among the intervention group staff, with significant changes in areas related to autonomy and the avoidance of coercion, which is consistent with the findings of our study(\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThese studies underscore the effectiveness of mental health training interventions in promoting positive changes in healthcare professionals' attitudes, highlighting the importance of supportive policies and continuous training to sustain these changes over the long term. In a study conducted in Ghana, the impact of \u003cem\u003eQualityRights\u003c/em\u003e e-training on attitudes toward people with mental health conditions and disabilities was evaluated. The online course covered human rights, recovery, legal capacity, the end of coercion, and community inclusion and was completed by more than 17,000 participants between February 2019 and December 2021. The participants completed pre- and postcourse questionnaires, with the analysis including 417 paired and 4,299 unpaired responses. Significant posttraining improvements were observed, particularly in items related to treatment choice, legal capacity, and coercion, aligning with our findings on the effectiveness of \u003cem\u003eQualityRights\u003c/em\u003e in fostering positive changes in attitudes toward human rights(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThus, delivering training online can be an effective strategy to increase healthcare professionals' participation, especially among younger professionals and those with fewer years of experience, who may be more inclined to participate in online courses than in-person ones. This aspect is reflected in our results, in which professionals with more years of experience demonstrated more significant attitude changes when comparing pre- and posttest results.\u003c/p\u003e \u003cp\u003eDespite these promising results, this study has several limitations. Future research should ensure the full participation of professionals in pre- and posttests, a challenge identified in this study due to incomplete responses. Another limitation is that the modules were delivered exclusively to professionals in the Family Health Strategy, which may limit the generalizability of the results to other population groups. However, this target group was chosen to evaluate the effectiveness of the training modules as an antistigma strategy. Furthermore, if the training had been applied to specialized professionals, the results might have differed, as these professionals have direct contact with individuals with mental disorders, which may result in lower stigma levels toward this population group.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe results of this study demonstrate that WHO QualityRights training had a positive effect on the knowledge and practices of Brazilian healthcare professionals regarding mental health. Significant changes were observed in key items of the pre- and posttraining questionnaires. The findings suggest that the training successfully improved the understanding of human rights related to mental health, reduced stigma, and fostered more empathetic attitudes among healthcare workers.\u003c/p\u003e \u003cp\u003eDemographic characteristics, such as age and gender, did not significantly affect the test scores, but years of schooling were associated with more pronounced reductions in stigma. Therefore, training had a greater impact on professionals with more years of schooling.\u003c/p\u003e \u003cp\u003eThe study underscores the importance of integrating continuous education in primary care and mental health to foster a compassionate and inclusive care network. This finding also suggests that expanding the implementation of \u003cem\u003eQualityRights\u003c/em\u003e training across diverse healthcare settings and audiences, including policymakers and informal caregivers, could further amplify the observed positive outcomes. These findings are consistent with international studies, which highlight the effectiveness of \u003cem\u003eQualityRights\u003c/em\u003e training in improving healthcare professionals' attitudes and knowledge. Despite some limitations\u0026mdash;such as incomplete participation and a focus on a single healthcare setting\u0026mdash;the evidence highlights the significant potential of training programs in mental health to reduce stigma and enhance the quality of care for individuals with mental disorders. Therefore, further research and long-term evaluation of such interventions are recommended to ensure sustained improvements in healthcare practices and the promotion of human rights for people with mental disorders.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthics approval and consent to participate\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research was\u0026nbsp;approved by the Ethics Committee of the University of São Paulo at Ribeirão Preto School of Nursing\u0026nbsp;(Approval No: 6.257.303/2021). The free and informed consent term was read and signed by the participants in two copies, with one kept by them and the other by the research team. The study followed the recommendations of Brazilian Resolution No. 466, of 2012, on research involving human beings (Brazil, 2012).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAvailability of data and materials\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eClinical trial number\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was funded by the National Council for Scientific and Technological Development (CNPq)-Brazil (process n° 408399/2021-0).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthors' contributions\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eABZM wrote the main manuscript, with input from ESB, IOR and CAAV. ABZM, ESB and IOR conducted the data collection. ABZM conducted the analysis. ESB obtained ethical consent for the study. ESB and IOR contributed to data interpretation. ESB, IOR and CAAV revised the manuscript. All the authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAcknowledgments\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003ePatel V, Saxena S, Lund C, Thornicroft G, Baingana F, Bolton P, et al. The Lancet Commission on global mental health and sustainable development. Lancet [Internet]. 2018 Oct 27 [cited 2024 Nov 26];392(10157):1553\u0026ndash;98. Available from: https://pubmed.ncbi.nlm.nih.gov/30314863/\u003c/li\u003e\n \u003cli\u003eWahlbeck K. Public mental health: the time is ripe for translation of evidence into practice. World Psychiatry [Internet]. 2015 Feb 1 [cited 2025 Jan 15];14(1):36\u0026ndash;42. Available from: https://onlinelibrary.wiley.com/doi/full/10.1002/wps.20178\u003c/li\u003e\n \u003cli\u003eRathod S, Pinninti N, Irfan M, Gorczynski P, Rathod P, Gega L, et al. Mental Health Service Provision in Low- and Middle-Income Countries. https://doi.org/101177/1178632917694350 [Internet]. 2017 Mar 28 [cited 2025 Jan 15];10. Available from: https://journals.sagepub.com/doi/10.1177/1178632917694350\u003c/li\u003e\n \u003cli\u003eFunk M, Saraceno B, Drew N, Faydi E. Integrating mental health into primary healthcare. Ment Health Fam Med [Internet]. 2008 [cited 2025 Jan 15];5(1):5. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC2777555/\u003c/li\u003e\n \u003cli\u003eFunk M, Drew N, Knapp M. Mental health, poverty and development. J Public Ment Health. 2012;11(4):166\u0026ndash;85.\u003c/li\u003e\n \u003cli\u003eBarros S, N\u0026oacute;brega M do PS de S, dos Santos JC, da Fonseca LM, Floriano LSM. Mental health in primary health care: health-disease according to health professionals. Rev Bras Enferm [Internet]. 2019 Dec;72(6):1609\u0026ndash;17. Available from: http://www.scielo.br/scielo.php?script=sci_arttext\u0026amp;pid=S0034-71672019000601609\u0026amp;tlng=en\u003c/li\u003e\n \u003cli\u003eKohrt BA, Turner EL, Rai S, Bhardwaj A, Sikkema KJ, Adelekun A, et al. Reducing mental illness stigma in healthcare settings: Proof of concept for a social contact intervention to address what matters most for primary care providers. Soc Sci Med [Internet]. 2020 Apr;250:112852. Available from: https://linkinghub.elsevier.com/retrieve/pii/S027795362030071X\u003c/li\u003e\n \u003cli\u003eRotoli A, Santos da Silva MR, Marques dos Santos A, Netto de Oliveira AM, Calcagno Gomes G. Mental health in Primary Care: challenges for the resoluteness of actions. Anna Nery School Journal of Nursing/Escola Anna Nery Revista de Enfermagem [Internet]. 2019 Apr;23(2):1\u0026ndash;8. Available from: http://search.ebscohost.com/login.aspx?direct=true\u0026amp;db=c8h\u0026amp;AN=137508489\u0026amp;lang=pt-br\u0026amp;site=ehost-live\u003c/li\u003e\n \u003cli\u003eVieira VB, Delgado PGG. Estigma e sa\u0026uacute;de mental na aten\u0026ccedil;\u0026atilde;o b\u0026aacute;sica: lacunas na forma\u0026ccedil;\u0026atilde;o m\u0026eacute;dica podem interferir no acesso \u0026agrave; sa\u0026uacute;de? Physis: Revista de Sa\u0026uacute;de Coletiva [Internet]. 2021;31(4). Available from: http://www.scielo.br/scielo.php?script=sci_arttext\u0026amp;pid=S0103-73312021000400619\u0026amp;tlng=pt\u003c/li\u003e\n \u003cli\u003eThornicroft G, Mehta N, Clement S, Evans-Lacko S, Doherty M, Rose D, et al. Evidence for effective interventions to reduce mental-health-related stigma and discrimination. The Lancet [Internet]. 2016 Mar 12 [cited 2025 Jan 15];387(10023):1123\u0026ndash;32. Available from: http://www.thelancet.com/article/S0140673615002986/fulltext\u003c/li\u003e\n \u003cli\u003eWHO WHO. QualityRights materials for training, guidance and transformation [Internet]. World Health Organization. 2019. Available from: https://www.who.int/publications/i/item/who-qualityrights-guidance-and-training-tools\u003c/li\u003e\n \u003cli\u003eMoro MF, Pathare S, Zinkler M, Osei A, Puras D, Paccial RC, et al. The WHO QualityRights initiative: building partnerships among psychiatrists, people with lived experience and other key stakeholders to improve the quality of mental healthcare. The British Journal of Psychiatry [Internet]. 2022 Feb 21 [cited 2024 Nov 26];220(2):49\u0026ndash;51. Available from: https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/who-qualityrights-initiative-building-partnerships-among-psychiatrists-people-with-lived-experience-and-other-key-stakeholders-to-improve-the-quality-of-mental-healthcare/A5287D06B491630DEF4D4686576596DD\u003c/li\u003e\n \u003cli\u003eMion ABZ, Ventura CAA. The WHO QualityRights Initiative and its use worldwide: A literature review. International Journal of Social Psychiatry [Internet]. 2023 Dec; Available from: http://journals.sagepub.com/doi/10.1177/00207640231207580\u003c/li\u003e\n \u003cli\u003eDutra HS, Reis VN dos. Desenhos de estudos experimentais e quase-experimentais: defini\u0026ccedil;\u0026otilde;es e desafios na pesquisa em enfermagem. Revista de Enfermagem UFPE on line [Internet]. 2016 May 6 [cited 2025 Jan 15];10(6):2230\u0026ndash;41. Available from: https://periodicos.ufpe.br/revistas/index.php/revistaenfermagem/article/view/11238\u003c/li\u003e\n \u003cli\u003eLobiondo-Wood G, Haber J. Desenhos n\u0026atilde;o experimentais. In: Pesquisa em enfermagem: m\u0026eacute;todos, avalia\u0026ccedil;\u0026atilde;o cr\u0026iacute;tica e utiliza\u0026ccedil;\u0026atilde;o. 4th ed. Guanabara-Koogan; 2001.\u003c/li\u003e\n \u003cli\u003ePolit DF, Beck CT. Fundamentos da pesquisa em enfermagem: avalia\u0026ccedil;\u0026atilde;o de evid\u0026ecirc;ncias para a pr\u0026aacute;tica de enfermagem. 7th ed. Sao Paulo: Artmed; 2011.\u003c/li\u003e\n \u003cli\u003eBrito ES, Mion ABZ, Reis IO, Silva AM, Ventura CAA. Cultural Adaptation and Validation of the WHO QualityRights Training to Brazilian Portuguese. In Review. 2025;\u003c/li\u003e\n \u003cli\u003ePoynton-Smith E, Orrell M, Osei A, Ohene SA, Ansong J, Gyimah L, et al. A quantitative analysis of human rights-related attitude changes toward people with mental health conditions and psychosocial, intellectual, or cognitive disabilities following completion of the WHO QualityRights e-training in Ghana. Int J Ment Health Syst [Internet]. 2023 Dec;17(1):46. Available from: https://ijmhs.biomedcentral.com/articles/10.1186/s13033-023-00609-3\u003c/li\u003e\n \u003cli\u003ede Souza \u0026Acirc;C, Amarante PD, Abrah\u0026atilde;o AL. Inclusion of mental health in primary health care: care strategy in the territory. Rev Bras Enferm [Internet]. 2019 Oct 21 [cited 2025 Jan 15];72(6):1677\u0026ndash;82. Available from: https://www.scielo.br/j/reben/a/YpbPFG9gw73C4XdC8yXDrjd/?lang=en\u003c/li\u003e\n \u003cli\u003eAyano G, Assefa D, Haile K, Chaka A, Haile K, Solomon M, et al. Mental health training for primary health care workers and implication for success of integration of mental health into primary care: Evaluation of effect on knowledge, attitude and practices (KAP). Int J Ment Health Syst [Internet]. 2017 Oct 12 [cited 2025 Jan 15];11(1):1\u0026ndash;8. Available from: https://ijmhs.biomedcentral.com/articles/10.1186/s13033-017-0169-8\u003c/li\u003e\n \u003cli\u003eTilahun D, Hanlon C, Araya M, Davey B, Hoekstra RA, Fekadu A. Training needs and perspectives of community health workers in relation to integrating child mental health care into primary health care in a rural setting in sub-Saharan Africa: a mixed methods study. Int J Ment Health Syst [Internet]. 2017 Dec;11(1):15. Available from: http://ijmhs.biomedcentral.com/articles/10.1186/s13033-017-0121-y\u003c/li\u003e\n \u003cli\u003eNg YP, Rashid A, O\u0026rsquo;Brien F. Determining the effectiveness of a video-based contact intervention in improving attitudes of Penang primary care nurses toward people with mental illness. Khan HTA, editor. PLoS One [Internet]. 2017 Nov;12(11):e0187861. Available from: https://dx.plos.org/10.1371/journal.pone.0187861\u003c/li\u003e\n \u003cli\u003eCarrara BS, Fernandes RHH, Bobbili SJ, Ventura CAA. Health care providers and people with mental illness: An integrative review on anti-stigma interventions. International Journal of Social Psychiatry [Internet]. 2021 Nov;67(7):840\u0026ndash;53. Available from: http://journals.sagepub.com/doi/10.1177/0020764020985891\u003c/li\u003e\n \u003cli\u003eMorrissey FE. An evaluation of attitudinal change toward CRPD rights following delivery of the WHO QualityRights training programme. Ethics Med Public Health. 2020 Apr 1;13:100410.\u003c/li\u003e\n \u003cli\u003eCarta MG, Ghacem R, Milka M, Moula O, Staali N, Uali U, et al. Implementing WHO-Quality Rights Project in Tunisia: Results of an Intervention at Razi Hospital. Clin Pract Epidemiol Ment Health [Internet]. 2020 Aug 2 [cited 2022 Sep 15];16(Suppl-1):125. Available from:/pmc/articles/PMC7431701/\u003c/li\u003e\n \u003cli\u003ePathare S, Funk M, Drew Bold N, Chauhan A, Kalha J, Krishnamoorthy S, et al. Systematic evaluation of the QualityRights programme in public mental health facilities in Gujarat, India. The British Journal of Psychiatry [Internet]. 2021 Apr 1 [cited 2024 Nov 26];218(4):196\u0026ndash;203. Available from: https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/systematic-evaluation-of-the-qualityrights-programme-in-public-mental-health-facilities-in-gujarat-india/0D467F4768D9D08725AE9F0056A3B929\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Human rights, Mental health, People with disability, CRPD, Training, QualityRights, Rights-based care, World Health Organization","lastPublishedDoi":"10.21203/rs.3.rs-5844742/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5844742/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eStudies conducted worldwide have employed QualityRights training modules, which have shown promising results in improving the understanding of the human rights of people with mental disorders. This study aims to investigate the impact of QualityRights core training on promoting healthcare professionals' knowledge of the human rights of individuals with mental disorders and to assess whether the training can reduce the stigma associated with mental disorders among these professionals.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A quasiexperimental study was conducted with 26 healthcare professionals from the Family Health Strategy in Brazil, including physicians, nurses, pharmacists, and community health workers. The participants completed questionnaires before and after the training to assess changes in their knowledge and attitudes via a Likert scale. The results were statistically analyzed via paired t tests and multiple linear regression with the Statistical Package for the Social Sciences software.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eStatistically significant reductions were observed in five items of the QualityRights scale (Pre 2.92 × Post 1.71, p=0.006; Pre 3.21 × Post 2.49, p=0.042; Pre 3.07 × Post 2.28, p=0.016; Pre 2.93 × Post 2.21, p=0.026; Pre 3.50 × Post 2.64, p=0.028). The overall scale score decreased from 27.3 to 21.3 (p=0.022). A longer duration of training (more years of education) was correlated with a greater reduction in the scale score (p=0.015).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eWHO QualityRights training had a positive effect on the knowledge and practices of Brazilian healthcare professionals, successfully improving their understanding of human rights in mental health and reducing stigma. Further research, including long-term follow-up, is necessary to ensure sustained improvements and expand training to different healthcare contexts.\u003c/p\u003e","manuscriptTitle":"Impact of the WHO's QualityRights Training on Promoting Knowledge of Human Rights for People with Mental Disorders among Brazilian Healthcare Professionals","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-02-13 09:56:28","doi":"10.21203/rs.3.rs-5844742/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e629846b-d4c9-4873-81ea-4f429c0fd941","owner":[],"postedDate":"February 13th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-02-13T09:56:28+00:00","versionOfRecord":[],"versionCreatedAt":"2025-02-13 09:56:28","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5844742","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5844742","identity":"rs-5844742","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}