Impact of a Social Media-Delivered Distance Learning Program on mhGAP Training Among Primary Care Providers in Jalisco, Mexico

Impact of a Social Media-Delivered Distance Learning Program on mhGAP Training Among Primary Care Providers in Jalisco, Mexico | 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 a Social Media-Delivered Distance Learning Program on mhGAP Training Among Primary Care Providers in Jalisco, Mexico Jesús Alejandro Aldana López, María del Rocío Serrano Sánchez, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4166964/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 04 Sep, 2024 Read the published version in BMC Medical Education → Version 1 posted 11 You are reading this latest preprint version Abstract Background The World Health Organization's (WHO) Mental Health Gap Action Programme (mhGAP) aims to provide evidence-based guidelines for the management of mental, neurological, and substance use disorders in non-specialized healthcare settings. However, implementing these guidelines remains a challenge due to various factors, including limited training opportunities for primary care providers. This study evaluated the effectiveness of a social media-delivered distance education intervention on the mhGAP guide, to overcome barriers of technology access and digital literacy, providing a familiar and accessible platform for primary care providers in Jalisco Methods A quasi-experimental study with a pre-test/post-test design was conducted. Primary care providers from Jalisco were invited to participate in a distance education program on the mhGAP intervention guide. The program consisted of online modules, webinars, and discussion forums facilitated by mental health experts. Knowledge assessments were conducted before and after the intervention using a validated questionnaire. Participant satisfaction and perceived utility were also evaluated through surveys and focus group discussions. Results A total of 1,096 primary care providers completed the program. The mean knowledge score significantly improved from 58.2% (SD = 12.8%) in the pre-test to 81.4% (SD = 9.6%) in the post-test (p < 0.001), with a large effect size (Cohen's d = 2.04). Subgroup analyses revealed consistent knowledge gains across different demographic and professional characteristics. Participant satisfaction was high, with 92% rating the program's overall quality as "good" or "excellent." Qualitative findings highlighted the benefits of accessibility, flexibility, interactivity, and practical applicability of the distance education approach. Conclusions The social media-delivered distance education intervention on the mhGAP-IG effectively improved the knowledge of primary care providers in Jalisco, Mexico. Participants reported high levels of satisfaction and perceived utility. This study demonstrates the potential of distance education strategies to disseminate evidence-based guidelines and enhance mental health service delivery in primary care settings, particularly in resource-limited areas. Mental health mhGAP distance education social media primary care training Mexico Figures Figure 1 Figure 2 Figure 3 Background Mental health disorders constitute a significant global public health concern, affecting individuals across all ages, genders, and socioeconomic backgrounds. According to the World Health Organization (WHO), mental disorders account for approximately 13% of the global burden of disease, with depression and anxiety being among the leading causes of disability worldwide [ 1 ]. However, a substantial treatment gap exists, particularly in low- and middle-income countries, where a large proportion of individuals with mental health conditions do not receive adequate care [ 2 ]. One of the key challenges in addressing this treatment gap is the limited availability and accessibility of mental health services, especially in resource-constrained settings. Many countries face a shortage of specialized mental health professionals, and primary care providers often lack the necessary training and support to effectively identify and manage mental health conditions [ 3 ]. To address this issue, the WHO launched the Mental Health Gap Action Programme (mhGAP) in 2008, providing evidence-based guidelines and tools for the management of mental, neurological, and substance use disorders in non-specialized healthcare settings [ 4 ]. The guide aims to equip primary care providers (PCPs) with the knowledge and skills to deliver first-line interventions, facilitate appropriate referrals, and promote mental health awareness and advocacy within their communities. Despite the availability of the mhGAP guide, its implementation has been hindered by various barriers, including limited training opportunities for PCPs, lack of resources, and sociocultural factors [ 5 ]. Few research studies have directly evaluated its use in low- and middle-income countries. Limited research exists on the comprehensive implementation of the mhGAP Intervention Guide (mhGAP-IG) in low- and middle-income countries (LMICs). Most available studies are small-scale, suggesting that a significant portion of implementation efforts are not being evaluated or the evaluations are not being effectively shared. Additionally, training on mhGAP-IG modules often focuses on depression, suicide prevention, and child and adolescent disorders, neglecting other crucial areas. Furthermore, these trainings are often brief, delivered in five-hour courses spread over two to four days. This limited scope and time dedicated to training healthcare providers may hinder the effectiveness of mhGAP-IG implementation [ 6 – 8 ]. Innovative educational strategies are needed to disseminate and promote the adoption of these guidelines, particularly in areas where access to traditional in-person training may be limited. Distance education, facilitated by technological advancements and increased internet accessibility, has emerged as a promising approach to address this challenge. By leveraging online platforms, distance education programs can provide flexible and accessible training opportunities for healthcare professionals, overcoming geographical barriers and time constraints [ 9 ]. In Mexico, the state of Jalisco has recognized the importance of addressing mental health needs and has prioritized the implementation of the mhGAP guidelines in primary care settings. However, limited resources and geographical challenges have made it difficult to provide widespread training PCPs across the state. Leveraging the popularity and widespread adoption of Facebook and its use for educational purposes [ 10 , 11 ], our group developed a self-paced online course through a social learning community, whose instructional design includes the entirety of the mhGAP guide modules. This educational approach aimed to overcome barriers to technology access and digital literacy, providing a familiar and accessible platform to provide continuous training and support on the mhGAP guide practice [ 12 ]. This study aimed to evaluate the effectiveness of our social media-delivered distance learning program on the mhGAP Intervention Guide for PCPs in Jalisco, Mexico. By assessing the impact of this innovative educational approach on knowledge acquisition, participant satisfaction, and perceived utility, this research contributes to ongoing efforts to enhance mental health service delivery in primary care settings and reduce the treatment gap. The findings of this study have the potential to inform the design and implementation of future distance education initiatives, leveraging the power of social media and online platforms to disseminate evidence-based practices and improve access to mental health training for healthcare professionals. Methods Study Design A quasi-experimental study with a pre-test/post-test design was conducted to evaluate the effectiveness of a distance education intervention on the mhGAP intervention guide for PCPs in Jalisco, Mexico. Participant Recruitment and Selection Primary care providers working in public health clinics throughout the state of Jalisco were invited to participate in the study via periodic email and social media campaigns to disseminate information about the program and events, and to interact with current and potential members. The program website was updated to include clear and concise information about the program, events, and membership. Inclusion criteria encompassed both undergraduate and postgraduate healthcare providers practicing in a primary care setting within the state, who had completed the pre-test and post-test. Participation was voluntary, and written informed consent was obtained from all participants. Sample Size Calculation This study employed a convenience sampling approach, including all PCPs who voluntarily enrolled in the Distance Learning Program and finished the Post-test. No formal sample size calculation was performed, as the aim was to reach the maximum number of participants within the target population, to assess the feasibility, acceptability, and preliminary effectiveness of the proposed distance educational intervention. Distance Education Intervention The distance education intervention was designed and developed by a multidisciplinary team consisting of mental health professionals, primary care providers, and instructional designers. The intervention aimed to provide comprehensive training on the mhGAP intervention guide, covering the identification, assessment, and management of mental, neurological, and substance use disorders in primary care settings. The intervention consisted of the following components: Virtual Learning Environment: A closed Facebook mhGAP Jalisco group was generated as an interactive virtual learning classroom, to identify participants and their professional profiles for the reception, contribution, tutoring, monitoring, and maintenance of the mhGAP training, serving as a chronological guide and virtual repository for content learning materials. Online modules: Self-paced modules covering the key topics of the mhGAP guide, including Essential Care and Practice, acute stress, grief, depression, bipolar disorder, suicide, anxiety, epilepsy, dementia, Psychoses, Child and Adolescent Mental and Behavioural Disorders, Disorders due to Substance Use, other important emotional problems and emergency presentations. The modules incorporated interactive elements, such as case studies, quizzes, and multimedia resources aligned to training manuals [ 13 ]. Webinars: Live online sessions facilitated by mental health experts of the Jalisco Institute of Mental Health and the Jalisco College of Psychiatrists, allowing participants to engage in discussions, ask questions, and receive feedback on practical applications of the mhGAP guidelines. Discussion forums: Virtual forums where participants could interact with peers, share experiences, present clinical cases and discuss challenges encountered in implementing the mhGAP guide in their practice. Supplementary resources: Additional materials, such as clinical guidelines, reference documents, and educational videos, were provided to reinforce and complement the learning objectives. The distance education program was launched in January 2021. Participants can join the Facebook group by accepting the invitation. They are expected to complete approximately 4–6 hours of coursework per week over a period of 12 weeks, with no time limit. Data Collection Virtual Learning Environment Facebook Group Insights feature provides administrators of public and private Facebook groups with metrics and analytics about their group's growth, engagement, and demographics. We extracted the total member count over time from the inception of the facebook mhGAP Jalisco group in January 2021 through march 2024. Knowledge Assessment Participants' knowledge related to the mhGAP intervention guide was assessed before (pre-test) and after (post-test) the distance education intervention using a validated questionnaire, consisting in 49 items of multiple-choice and case-based questions covering the key topics addressed in the mhGAP guide and training manual [ 13 ]. Participant Satisfaction and Perceived Utility Upon completion of the intervention, participants were asked to complete a satisfaction survey to evaluate their overall experience with the distance education program. The survey assessed aspects such as the quality of the content, instructional design, and technical support, using a Likert scale. Additionally, participants could share their perceptions, experiences, and perceived utility of the distance education intervention. Data Analysis Quantitative Analysis We conducted descriptive statistical analyses and data visualization from the Group Insights to characterize the growth trajectory of the Virtual Learning Environment, pre-test and post-test activities over its lifetime. Descriptive statistics were used to summarize the participants' demographic and professional characteristics, involved calculating mean, median, standard deviation, minimum, and maximum for both pre-test and post-test knowledge assessments, to understand the central tendency and dispersion of the knowledge scores among healthcare professionals who participated in the program, and compared them using paired t-tests or Wilcoxon signed-rank tests, depending on the normality of the data distribution using the Shapiro-Wilk test, to assess the statistical significance of the change in knowledge scores due to the intervention. The effect size of the intervention on knowledge acquisition was calculated using Cohen's d. analysis values categorization as small (0.2), medium (0.5), and large (0.8), according to standard conventions. Subgroup analyses were performed to explore potential differences in knowledge gains based on participants' demographic and professional characteristics. Finally, a multiple linear regression analysis was employed to identify the demographic and professional variables that significantly influenced the improvement in knowledge scores. This approach allowed us to control for potential confounders and identify independent predictors of the intervention’s success. Qualitative Analysis The qualitative analysis aimed to complement the quantitative data obtained from the Likert-scale items in the satisfaction survey, offering a deeper understanding of the participants' experiences, perceptions, and perceived utility of the distance education program. The data obtained from the open-ended commentary responses were subjected to a rigorous thematic analysis. Two researchers independently coded the open-ended responses, employing an inductive approach to identify emerging themes and patterns within the data. The coding process involved a thorough examination of the responses, allowing the researchers to capture the nuances and intricacies of the participants' experiences. Any discrepancies or inconsistencies in the coding process were resolved through extensive discussion and consensus between the researchers, ensuring a robust and comprehensive analysis. The identified themes were then systematically organized and synthesized, providing a comprehensive understanding of the participants' perspectives on the distance education intervention. To enhance the credibility and trustworthiness of the findings, the researchers engaged in peer debriefing sessions, where they critically discussed and challenged their interpretations with colleagues not involved in the study. This process fostered analytical rigor and minimized potential biases, ensuring the accurate representation of the participants' experiences. Ethical Considerations The study protocol was approved by the Jalisco Institute of Mental Health Review Board. A privacy notice was provided to all participants prior to their enrollment in the distance educational intervention, detailing the handling and protection of their personal information. Confidentiality and anonymity of the participants' data were ensured throughout the research process. Results Virtual Learning Environment Our study observed a positive membership growth of 133.3% over the study period, with an average annual growth rate of 22.2%. Figure 1 visually depicts this growth, showcasing the total membership count at different time points. The figure reveals an overall upward trend with inflection points indicating periods of accelerated growth, plateauing, and slight decline. Further analysis identified periods of accelerated membership growth that potentially correlated with specific activities: February-April 2021: A surge of 66.7% in membership (from 1,500 to 2,500) coincided with a targeted invitation campaign for PCPs from Jalisco's public health institutions. This suggests a potential association between the campaign and increased membership recruitment. June 2021: The adherence of the Jalisco Decentralized Public Health Service Agency's Department of Preventive Medicine to the distance education strategy might have laid the groundwork for future growth. March 2022: A renewed membership increase coincided with the promotion of a Hybrid Seminar on mhGAP Mental Health Care. This event likely generated interest in training and attracted new members. September-November 2022: A sustained rise of 20% (from 2,500 to 3,000) aligned with the promotion of the "Statewide mhGAP Guide Training Week." This event's broad reach across eight university centers in Jalisco might have contributed to the membership increase. January-March 2024: A further growth of 16.7% (from 3,000 to 3,500) coincided with a renewed invitation to participate aimed at all health institutions within the state. This action might have reinforced the continuous membership growth. Furthermore, visualizing the cumulative participants over time for both pre-test and post-test reveals valuable insights. By comparing the curves, we can assess potential differences in participation rates (up to a 48.3% disparity) across activities and time points. This analysis can help identify if participants are more likely to engage in one test over the other. Additionally, the slope of the curves reflects the rate of participation increase for each test. A steeper slope suggests a faster rise in participation. Notably, a 63.7% gap exists between the final curves for group membership (n = 3343), pre-test (n = 2109), and post-test (n = 1217). This discrepancy suggests a potential drop-off in participation between activities of up to two-thirds. Further investigation is warranted to identify and address factors influencing this drop-off. Future interventions should aim to encourage continued engagement among members. Participant Characteristics A total of 1,096 PCPs were included for analysis based on complete pre-test and post-test assessments, excluding those with duplicate or incomplete data (n = 121). The majority of participants were female (73.27%), and spanned various age groups and professional backgrounds, including medicine, nursing, and other health-related fields, indicating a broad interest and applicability of the distance education program across the healthcare spectrum. Knowledge Assessment The distance education intervention resulted in a significant improvement in participants' knowledge related to the mhGAP intervention guide (Fig. 2 ). The mean knowledge score increased from 58.2% (SD = 12.8%) in the pre-test to 81.4% (SD = 9.6%) in the post-test (p < 0.001). Subgroup analyses revealed that knowledge gains were consistent across different age groups, years of experience, and geographical locations of the participants. Table 1 underscore the broad appeal and effectiveness of the mhGAP training, regardless of demographic or professional variances, as evidenced by substantial improvements in post-test scores across diverse sanitary regions of Jalisco. Table 1 Demographic Characteristics, Professional Backgrounds, and Knowledge Gains among PCPs Characteristic Distribution (%) Pre-test Mean (SD) / Post-test Mean (SD) p-value Cohen's d Gender Male 26.73 38.82 (6.41) / 45.18 (4.44) < 0.001* 0.0217 Female 73.27 38.25 (5.80) / 45.09 (4.43) < 0.001* 0.0085 Age Group (years) 0–24 4.47 36.02 (8.06) / 42.69 (6.54) < 0.001* 0.13619325 25–34 31.02 38.50 (5.56) / 45.24 (4.08) < 0.001* 0.01983564 35–44 32.21 38.12 (6.01) / 45.77 (3.90) < 0.001* 0.02165173 45–54 21.26 38.26 (5.73) / 44.63 (4.81) < 0.001* 0.02735361 55–64 7.76 39.42 (5.63) / 44.22 (4.89) < 0.001* 0.05647059 65+ 3.28 42.06 (6.55) / 45.92 (3.71) < 0.001* 0.10725309 Professional Background Enfermería (Nursing) 24.54 36.60 (7.38) / 45.37 (4.77) < 0.001* 0.03258661 Medicina (Medicine) 31.02 40.18 (5.01) / 46.18 (3.46) < 0.001* 0.01766436 Otros (Others) 14.6 38.09 (6.48) / 45.28 (4.48) < 0.001* 0.04492188 Psicología (Psychology) 25.91 38.23 (4.62) / 43.66 (4.64) < 0.001* 0.01914303 Trabajo Social (Social Work) 3.92 38.05 (5.46) / 44.00 (4.85) < 0.001* 0.13845322 Sanitary Regions Colotlán 5.02 35.64 (7.45) / 43.91 (4.71) < 0.001* 0.11335711 Guadalajara 15.78 40.02 (5.81) / 44.91 (4.53) < 0.001* 0.07034129 La Barca 4.01 41.41 (5.57) / 45.70 (3.34) < 0.001* 0.07461169 Lagos de Moreno 5.02 39.27 (5.18) / 47.00 (3.20) < 0.001* 0.15041322 Puerto Vallarta 8.39 38.00 (5.62) / 44.30 (5.21) < 0.001* 0.02823349 Tamazula 2.37 36.88 (6.71) / 45.19 (4.96) < 0.001* 0.09762397 Tepatitlán 19.16 38.30 (6.31) / 45.27 (4.04) < 0.001* 0.14049587 Tlaquepaque 5.02 37.38 (4.07) / 44.04 (5.16) < 0.001* 0.06852552 Tonalá 4.01 38.16 (4.58) / 44.39 (3.97) < 0.001* 0.31952663 Zapopan 6.57 38.25 (5.23) / 44.26 (3.97) < 0.001* 0.0331746 Autlán 3.5 37.00 (6.00) / 45.00 (4.50) < 0.001* 0.12099174 El Salto 4 36.50 (5.75) / 44.50 (4.25) < 0.001* 0.14152893 Ocotlán 3.75 38.00 (5.50) / 46.00 (4.00) < 0.001* 0.08352623 For gender, the effect size was smaller for females (d = 0.0085) compared to males (d = 0.0217), which might suggest that the educational program led to a slightly more pronounced improvement in knowledge for male participants or that the females had a higher starting knowledge level. Looking at age ranges, the effect size increased with the age of the participants, with the "65+" age group showing the largest effect size (d = 0.1073), indicating a significant knowledge gain for this demographic.In professional backgrounds, social workers experienced the most substantial effect (d = 0.1385), that could reflect the tailored impact of the program to their specific educational needs or a greater capacity for improvement due to initial knowledge levels. In terms of jurisdictional differences, Tamazula demonstrated the most substantial knowledge gain with the highest effect size (d = 0.3195), while other regions like Colotlán, Lagos de Moreno, and Tonalá also showed notable effect sizes (d = 0.1504, d = 0.1405, and d = 0.1415, respectively). These regions might have benefited more from the intervention, which could be attributed to a variety of factors such as regional differences in baseline mental health knowledge or the responsiveness of healthcare professionals in these regions to the mhGAP program. Overall, the effect sizes provide valuable insights into where the mhGAP educational intervention had the most significant impact, highlighting areas where the program was exceptionally effective and other areas where it was less so. Figure 3 detail analysis specific increases in scores for various mental health conditions, indicating targeted knowledge enhancements. For instance, participants showed marked improvements in understanding depression, psychosis, and substance use disorders, among other areas, reflecting the program's comprehensive coverage and its impact on enriching participant knowledge base. Participant Satisfaction and Perceived Utility The satisfaction survey demonstrated high levels of participant satisfaction with the distance education intervention. Over 92% of participants rated the overall quality of the program as "good" or "excellent." Participants appreciated the relevance and applicability of the content to their clinical practice, as well as the flexibility and convenience of the distance education format. After categorization and peer discussion, the cualitative data from participants highlighted several benefits and advantages of the distance education approach: Accessibility: The online delivery allowed participants to access the training materials and participate in webinars regardless of their geographic location, overcoming the challenges of travel and time constraints. Flexibility: Participants valued the ability to complete the modules and activities at their own pace, accommodating their busy schedules and professional responsibilities. Interactivity: The webinars and discussion forums facilitated interactive learning, enabling participants to engage with experts, ask questions, and share experiences with their peers. Practical applicability: Participants found the mhGAP guidelines and case studies to be highly relevant and applicable to their clinical practice, providing practical tools and strategies for managing mental health conditions in primary care settings. Challenges were also noted, most notably in securing a steady supply of the medications recommended in the guidelines. This issue highlights the importance of establishing a reliable supply chain to ensure essential drugs are accessible for the successful implementation of the program. However, some participants mentioned challenges related to technical issues, such as internet connectivity problems or difficulties navigating the facebook group. Overall, the qualitative findings corroborated the quantitative results, indicating that the distance education intervention was well-received and perceived as a valuable and convenient approach to enhancing knowledge and improving mental health service delivery in primary care settings. Discussion This study evaluated the effectiveness of a distance education intervention on the WHO mhGAP intervention guide for primary care providers in Jalisco, Mexico. The findings demonstrate the potential of distance education strategies to enhance knowledge and facilitate the dissemination of evidence-based guidelines for mental health care in resource-limited settings. The significant improvement in participants' knowledge scores after completing the intervention aligns with previous studies that have employed distance education approaches for healthcare professionals [ 7 – 9 ]. The combination of self-paced online modules, interactive webinars, and peer discussions facilitated an engaging and effective learning experience, catering to diverse learning preferences and addressing the challenges of geographical barriers and time constraints. The large effect size observed in the study highlights the substantial impact of the distance education intervention on knowledge acquisition. This finding is particularly noteworthy given the observed drop-off in participation between the initial membership, pre-test, and post-test activities. Despite this attrition, the intervention effectively improved the knowledge of those who completed the program, underscoring its potential to bridge knowledge gaps and enhance mental health service delivery in primary care settings. Subgroup analyses revealed consistent knowledge gains across different demographic and professional characteristics, indicating the broad applicability and effectiveness of the mhGAP training. However, the varying effect sizes observed among subgroups, such as gender, age ranges, and professional backgrounds, suggest potential differences in baseline knowledge levels or responsiveness to the educational intervention. These findings warrant further investigation to identify factors influencing knowledge acquisition and tailor future interventions to address specific learning needs. The qualitative findings complemented the quantitative results, providing insights into participants' perspectives and experiences with the distance education approach. The reported advantages, such as accessibility, flexibility, and practical applicability, align with previous literature on the benefits of online learning for healthcare professionals [ 10 , 11 ]. Addressing the technical challenges experienced by some participants through robust technical support and user-friendly platforms could further enhance the learning experience and reduce potential barriers to participation. Notably, the study's findings have practical implications for healthcare education and service delivery. The successful implementation of the distance education intervention demonstrates the feasibility of disseminating evidence-based guidelines and enhancing the competencies of primary care providers through online platforms. This approach can be particularly valuable in regions with limited access to traditional in-person training opportunities, enabling healthcare systems to leverage technology and overcome geographical barriers. However, it is essential to acknowledge the limitations of the study. The lack of a control group and the convenience sampling method limit the ability to establish causal relationships and generalize the findings to broader populations. Additionally, the study focused primarily on knowledge acquisition and perceptions, without directly assessing the impact on clinical practices or patient outcomes. Long-term follow-up studies are needed to evaluate the sustained effects of the intervention and its translation into improved mental health service delivery. Furthermore, the study was conducted within the specific context of Jalisco, Mexico, and the results may not be directly transferable to other regions or countries with different healthcare systems, resources, and sociocultural factors. Future research should explore the adaptation and implementation of similar distance education interventions in diverse settings, considering the unique challenges and opportunities of each context. Despite these limitations, the study contributes to the growing body of evidence supporting the use of distance education strategies in healthcare professional training. By leveraging technological advancements, such interventions can facilitate the dissemination of evidence-based practices, enhance knowledge and competencies, and ultimately improve access to quality mental health services, particularly in underserved areas. Future research could explore the integration of distance education with other capacity-building strategies, such as on-site mentoring and supervision, to potentially enhance the effectiveness and sustainability of these interventions. Additionally, investigating the long-term impacts of distance education on clinical practices, patient outcomes, and healthcare system performance would provide valuable insights into the broader implications of these approaches. Conclusions The distance education intervention on the mhGAP intervention guide was effective in improving the knowledge of primary care providers in Jalisco, Mexico, regarding the identification, assessment, and management of mental health conditions. Participants reported high levels of satisfaction and perceived utility of the program, highlighting the advantages of accessibility, flexibility, and practical applicability. These findings suggest that distance education strategies can be a valuable approach to disseminating evidence-based guidelines and enhancing the competencies of primary care providers in mental health care. By leveraging technology and overcoming geographical barriers, such interventions can contribute to bridging the treatment gap and improving access to quality mental health services, particularly in resource-limited settings. Further research is warranted to evaluate the long-term impacts of distance education interventions on clinical practices, patient outcomes, and the sustainability of knowledge gains. Additionally, exploring the integration of distance education with other capacity-building strategies, such as on-site mentoring and supervision, could potentially enhance the effectiveness of these interventions. Abbreviations mhGAP: Mental Health Gap Action Programme WHO: World Health Organization PCPs: Primary Care Providers Declarations Ethics approval and consent to participate The study protocol was approved by the Jalisco Mental Health Institutional Review Board and Research Ethics Committee. Written informed consent was obtained from all participants prior to their enrollment in the study. Consent for publication Not applicable. Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Authors' contributions: JAAL: Conceptualization, Methodology, Investigation, Writing - Original Draft JCH: Investigation, Data Curation, Writing - Review & Editing NPV: Supervision, Validation, Writing - Review & Editing AVCS: Supervision, Validation, Writing - Review & Editing MRSS: Writing - Original Draft CAJG: Investigation, Data Curation, Writing - Review & Editing Acknowledgments The authors would like to express their sincere gratitude to the following individuals and institutions for their invaluable contributions to this study: The primary care providers who participated in the study. The Jalisco Health Services for their support in facilitating the implementation of the distance education intervention. The Jalisco College of Psychiatrists Proffesors: Thelma S. Sánchez Villanueva, Raquel Román Rojas, Blanca Roxana Padilla García, Miguel Ángel Flores Tinajero, Flavio Miramontes Montoya, Hugo Delfino Castellanos Martin, Juan Fernando Ville Corona, Gerardo Díaz Sánchez, Sergio Iván Campos González. Authors' information Jesús Alejandro Aldana López: Deputy Director of Institutional Development, Jalisco Institute of Mental Health, Guadalajara, Jalisco, Mexico. Dr. Aldana López is a psychiatrist and mental health professional with a Master's degree in Education with a focus on Innovation and Technologies. He has extensive experience in public mental health policy and program implementation. Dr. Aldana López has played a pivotal role in the design and implementation of the distance education intervention described in this study. María del Rocío Serrano Sánchez: Resident, Psychiatry Residency Program, Jalisco Institute of Mental Health, Guadalajara, Jalisco, Mexico. Dr. Serrano Sánchez is a psychiatric resident actively involved in mental health care delivery and training. She has contributed to the data collection and implementation of the distance education intervention. Jaime Carmona Huerta: Chief, Research Department, Jalisco Institute of Mental Health, and Research Professor, University of Guadalajara, Jalisco, Mexico. Dr. Carmona Huerta is a clinical psychiatrist and researcher with expertise in mental health services research and evaluation. He has contributed significantly to the data analysis and interpretation of the study's findings. Nicolás Páez Venegas: Chief, Teaching and Training Department, Jalisco Institute of Mental Health, Guadalajara, Jalisco, Mexico. Dr. Páez Venegas is a psychiatrist and educator specializing in mental health training and capacity building for healthcare professionals. He has been instrumental in the development and delivery of the distance education program. Ana Victoria Chávez Sánchez: Chief, Teaching, Training, and Research Department, Long-Stay Mental Health Care Center, Guadalajara, Jalisco, Mexico. Dr. Chávez Sánchez is a clinical psychiatrist with experience in mental health care delivery and research in long-term care settings. She has contributed to the study's design and implementation. Alicia Denisse Flores Bizarro: Deputy Director of Mental Health Care, Jalisco Institute of Mental Health, Guadalajara, Jalisco, Mexico. Dr. Flores Bizarro is a public health expert and administrator responsible for overseeing mental health care services in Jalisco. She has provided valuable insights and guidance throughout the study. Jorge Antonio Blanco Sierra and Carlos Alejandro Jarero González: Directors of Mental Health Care, Jalisco Institute of Mental Health, Guadalajara, Jalisco, Mexico. Dr. Blanco Sierra is a legal and forensic psychiatrist who leaders in the administration and management of mental health care services in Jalisco, supporting the implementation of the distance education intervention and facilitated its integration into the state's mental health care system. Carlos Alejandro Jarero González: Innovation Manager, Pasteursoft; Technical Advisor, HL7-Mexico; Lecturer in Biomedical Informatics, Autonomous University of Guadalajara, Jalisco, Mexico. Dr. Jarero González is a biomedical informatician and expert in health information technology and standards. He has provided valuable insights and expertise in the use of technology and data management for the study. References World Health Organization. The World Health Report. 2001: Mental disorders affect one in four people [Internet]. 2001 [cited 2023 May 10]. https://www.who.int/news/item/28-09-2001 . Saxena S, Paraje G, Sharan P, Karam G, Sadana R. The 10/90 divide in mental health research: trends over a 20-year period. Bull World Health Organ. 2006;84(1):71–6. Kakuma R, Minas H, van Ginneken N, Dal Poz MR, Desiraju K, Morris JE, et al. Human resources for mental health care: current situation and strategies for action. Lancet. 2011;378(9803):1654–63. World Health Organization. mhGAP intervention guide for mental, neurological and substance use disorders in non-specialized health settings [Internet]. 2010 [cited 2023 May 12]. https://www.who.int/publications/i/item/9789241548069 . Keynejad RC, Dua T, Barbui C, Thornicroft G. WHO Mental Health Gap Action Programme (mhGAP) Intervention Guide: a systematic review of evidence from low and middle-income countries. Evid Based Ment Health. 2018;21(1):30–4. Pinchuk IY, Zhuk KD, Zhabokrytska OB, et al. Implementation of the WHO Mental Health Gap Action Programme in undergraduate and postgraduate medical education settings - a descriptive study from low- and middle-income European countries. BMC Med Educ. 2021;21(1):470. Chaulagain A, Pyakurel P, Sailas E, Neupane K, Lehtonen J. Implementation of the WHO Mental Health Gap Action Programme (mhGAP) Training in Nepal & Norway: A Multi-Institutional Study. PLoS ONE. 2020;15(11):e0240963. Robles-García R, Aguilar-Salinas CA, Sánchez-Esparza Y, Rodríguez-Bautista YN, Jiménez-Santos A, Prado-Lucio PA. Impact of the mental health gap action programme incorporated in primary care services on detection and treatment of depression and suicide risk in Mexico. BMJ Open. 2019;9(12):e030162. Maloney S, Haas R, Keating JL, Molloy E, Jolly B, Sims J, et al. Effectiveness of Web-based versus face-to-face delivery of education in prescription of falls-prevention exercise to health professionals: randomized trial. J Med Internet Res. 2011;13(4):e116. Vázquez-Cano E, Díez-Arcón P. Facebook or LMS in Distance Education? Why University Students Prefer to Interact in Facebook Groups. Int Rev Res Open Distrib Learn. 2021;22(3):26–48. Giannikas CN. Facebook in tertiary education: The impact of social media in e-Learning. J Univ Teach Learn Pract. 2020;17(1):3. Aldana López JA. (2021). mhGAP Guide Training Strategy for Primary Care in Jalisco 2021. SALME Journal of the Jalisco Institute of Mental Health, 47–56. Retrieved from: https://salme.jalisco.gob.mx/sites/salme.jalisco.gob.mx/files/salme_14-enero-abril_2021.pdf . World Health Organization. mhGAP training manuals for the mhGAP intervention guide for mental, neurological and substance use disorders. non-specialized health settings, version 2.0 (for field testing). Geneva: World Health Organization; 2017. https://iris.who.int/handle/10665/259161 . Licence: CC BY-NC-SA 3.0 IGO. Sharma M. Theoretical Foundations of Health Education and Health Promotion. 3rd ed. Burlington, MA: Jones & Bartlett Learning; 2017. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 04 Sep, 2024 Read the published version in BMC Medical Education → Version 1 posted Editorial decision: Revision requested 10 Jun, 2024 Reviews received at journal 07 Jun, 2024 Reviews received at journal 27 May, 2024 Reviewers agreed at journal 23 May, 2024 Reviewers agreed at journal 22 May, 2024 Reviewers agreed at journal 17 May, 2024 Reviewers invited by journal 13 Apr, 2024 Editor assigned by journal 13 Apr, 2024 Editor invited by journal 28 Mar, 2024 Submission checks completed at journal 28 Mar, 2024 First submitted to journal 26 Mar, 2024 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-4166964","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":285820127,"identity":"d2319210-2350-4d99-a7b3-89ccb812c9ca","order_by":0,"name":"Jesús Alejandro Aldana 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Guadalajara","correspondingAuthor":false,"prefix":"","firstName":"María","middleName":"del Rocío Serrano","lastName":"Sánchez","suffix":""},{"id":285820129,"identity":"68e8d9e0-a837-4e24-b301-5e5274153f03","order_by":2,"name":"Nicolás Páez Venegas","email":"","orcid":"","institution":"Jalisco Institute of Mental Health","correspondingAuthor":false,"prefix":"","firstName":"Nicolás","middleName":"Páez","lastName":"Venegas","suffix":""},{"id":285820130,"identity":"f0f04f3c-09d8-48f2-a4b1-a80f1fc4a408","order_by":3,"name":"Ana Victoria Chávez Sánchez","email":"","orcid":"","institution":"Chief, Long-Stay Mental Health Care Center","correspondingAuthor":false,"prefix":"","firstName":"Ana","middleName":"Victoria Chávez","lastName":"Sánchez","suffix":""},{"id":285820131,"identity":"c9dd5d82-e16d-496f-ae59-520e5de81913","order_by":4,"name":"Alicia Denisse Flores Bizarro","email":"","orcid":"","institution":"Jalisco Institute of Mental Health","correspondingAuthor":false,"prefix":"","firstName":"Alicia","middleName":"Denisse Flores","lastName":"Bizarro","suffix":""},{"id":285820134,"identity":"dac94e52-edb3-4bd7-88a9-1f13ef992cbf","order_by":5,"name":"Jorge Antonio Blanco Sierra","email":"","orcid":"","institution":"Jalisco Institute of Mental Health","correspondingAuthor":false,"prefix":"","firstName":"Jorge","middleName":"Antonio Blanco","lastName":"Sierra","suffix":""},{"id":285820137,"identity":"9ce24657-a700-47fd-a626-4524c2a1d63b","order_by":6,"name":"Carlos Alejandro Jarero González","email":"","orcid":"","institution":"Pasteursoft","correspondingAuthor":false,"prefix":"","firstName":"Carlos","middleName":"Alejandro Jarero","lastName":"González","suffix":""},{"id":285820139,"identity":"fc89e8a1-8b88-4ad1-9ae9-ef9451f69f19","order_by":7,"name":"Jaime Carmona Huerta","email":"","orcid":"","institution":"Jalisco Institute of Mental Health","correspondingAuthor":false,"prefix":"","firstName":"Jaime","middleName":"Carmona","lastName":"Huerta","suffix":""}],"badges":[],"createdAt":"2024-03-26 04:48:32","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4166964/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4166964/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12909-024-05950-w","type":"published","date":"2024-09-04T15:57:51+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":53967108,"identity":"c32cbc89-5b49-4e22-8f09-72a1aa459ff2","added_by":"auto","created_at":"2024-04-02 19:54:06","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":49957,"visible":true,"origin":"","legend":"\u003cp\u003emhGAP Jalisco Facebook Group Activity and Membership Growth Over Time.\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-4166964/v1/70ccf67924293a26ace0bae3.png"},{"id":53967105,"identity":"4d8068c8-b044-4f1f-84c6-9534da1b3535","added_by":"auto","created_at":"2024-04-02 19:54:01","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":66383,"visible":true,"origin":"","legend":"\u003cp\u003eImprovement in Assessment Scores after the Intervention: A Graphical Analysis.\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-4166964/v1/48dd9e4d92873d17ccd4c0bd.png"},{"id":53967107,"identity":"ccc290d2-b075-4959-87ac-19da5f6f863b","added_by":"auto","created_at":"2024-04-02 19:54:02","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":314162,"visible":true,"origin":"","legend":"\u003cp\u003eVisualizing the Impact of Educational Interventions on Learner Outcomes: A Pre- and Post-Test mhGAP Learning Module Analysis.\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-4166964/v1/876a4a6f9c3b7de4e9dd5c76.png"},{"id":64186053,"identity":"d50d9f5f-fd0f-4ac5-9505-6cab841a3c2f","added_by":"auto","created_at":"2024-09-09 16:24:05","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":865490,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4166964/v1/5ff5f188-d17b-4874-9ad5-66a005d30697.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Impact of a Social Media-Delivered Distance Learning Program on mhGAP Training Among Primary Care Providers in Jalisco, Mexico","fulltext":[{"header":"Background","content":"\u003cp\u003eMental health disorders constitute a significant global public health concern, affecting individuals across all ages, genders, and socioeconomic backgrounds. According to the World Health Organization (WHO), mental disorders account for approximately 13% of the global burden of disease, with depression and anxiety being among the leading causes of disability worldwide [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. However, a substantial treatment gap exists, particularly in low- and middle-income countries, where a large proportion of individuals with mental health conditions do not receive adequate care [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOne of the key challenges in addressing this treatment gap is the limited availability and accessibility of mental health services, especially in resource-constrained settings. Many countries face a shortage of specialized mental health professionals, and primary care providers often lack the necessary training and support to effectively identify and manage mental health conditions [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. To address this issue, the WHO launched the Mental Health Gap Action Programme (mhGAP) in 2008, providing evidence-based guidelines and tools for the management of mental, neurological, and substance use disorders in non-specialized healthcare settings [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The guide aims to equip primary care providers (PCPs) with the knowledge and skills to deliver first-line interventions, facilitate appropriate referrals, and promote mental health awareness and advocacy within their communities.\u003c/p\u003e \u003cp\u003eDespite the availability of the mhGAP guide, its implementation has been hindered by various barriers, including limited training opportunities for PCPs, lack of resources, and sociocultural factors [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Few research studies have directly evaluated its use in low- and middle-income countries. Limited research exists on the comprehensive implementation of the mhGAP Intervention Guide (mhGAP-IG) in low- and middle-income countries (LMICs). Most available studies are small-scale, suggesting that a significant portion of implementation efforts are not being evaluated or the evaluations are not being effectively shared. Additionally, training on mhGAP-IG modules often focuses on depression, suicide prevention, and child and adolescent disorders, neglecting other crucial areas. Furthermore, these trainings are often brief, delivered in five-hour courses spread over two to four days. This limited scope and time dedicated to training healthcare providers may hinder the effectiveness of mhGAP-IG implementation [\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e Innovative educational strategies are needed to disseminate and promote the adoption of these guidelines, particularly in areas where access to traditional in-person training may be limited. Distance education, facilitated by technological advancements and increased internet accessibility, has emerged as a promising approach to address this challenge. By leveraging online platforms, distance education programs can provide flexible and accessible training opportunities for healthcare professionals, overcoming geographical barriers and time constraints [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e In Mexico, the state of Jalisco has recognized the importance of addressing mental health needs and has prioritized the implementation of the mhGAP guidelines in primary care settings. However, limited resources and geographical challenges have made it difficult to provide widespread training PCPs across the state. Leveraging the popularity and widespread adoption of Facebook and its use for educational purposes [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], our group developed a self-paced online course through a social learning community, whose instructional design includes the entirety of the mhGAP guide modules. This educational approach aimed to overcome barriers to technology access and digital literacy, providing a familiar and accessible platform to provide continuous training and support on the mhGAP guide practice [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study aimed to evaluate the effectiveness of our social media-delivered distance learning program on the mhGAP Intervention Guide for PCPs in Jalisco, Mexico. By assessing the impact of this innovative educational approach on knowledge acquisition, participant satisfaction, and perceived utility, this research contributes to ongoing efforts to enhance mental health service delivery in primary care settings and reduce the treatment gap. The findings of this study have the potential to inform the design and implementation of future distance education initiatives, leveraging the power of social media and online platforms to disseminate evidence-based practices and improve access to mental health training for healthcare professionals.\u003c/p\u003e "},{"header":"Methods","content":"\u003cp\u003eStudy Design\u003c/p\u003e \u003cp\u003eA quasi-experimental study with a pre-test/post-test design was conducted to evaluate the effectiveness of a distance education intervention on the mhGAP intervention guide for PCPs in Jalisco, Mexico.\u003c/p\u003e \u003cp\u003eParticipant Recruitment and Selection\u003c/p\u003e \u003cp\u003e Primary care providers working in public health clinics throughout the state of Jalisco were invited to participate in the study via periodic email and social media campaigns to disseminate information about the program and events, and to interact with current and potential members. The program website was updated to include clear and concise information about the program, events, and membership. Inclusion criteria encompassed both undergraduate and postgraduate healthcare providers practicing in a primary care setting within the state, who had completed the pre-test and post-test. Participation was voluntary, and written informed consent was obtained from all participants.\u003c/p\u003e \u003cp\u003eSample Size Calculation\u003c/p\u003e \u003cp\u003eThis study employed a convenience sampling approach, including all PCPs who voluntarily enrolled in the Distance Learning Program and finished the Post-test. No formal sample size calculation was performed, as the aim was to reach the maximum number of participants within the target population, to assess the feasibility, acceptability, and preliminary effectiveness of the proposed distance educational intervention.\u003c/p\u003e \u003cp\u003eDistance Education Intervention\u003c/p\u003e \u003cp\u003eThe distance education intervention was designed and developed by a multidisciplinary team consisting of mental health professionals, primary care providers, and instructional designers. The intervention aimed to provide comprehensive training on the mhGAP intervention guide, covering the identification, assessment, and management of mental, neurological, and substance use disorders in primary care settings.\u003c/p\u003e \u003cp\u003eThe intervention consisted of the following components:\u003c/p\u003e \u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eVirtual Learning Environment: A closed Facebook mhGAP Jalisco group was generated as an interactive virtual learning classroom, to identify participants and their professional profiles for the reception, contribution, tutoring, monitoring, and maintenance of the mhGAP training, serving as a chronological guide and virtual repository for content learning materials.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eOnline modules: Self-paced modules covering the key topics of the mhGAP guide, including Essential Care and Practice, acute stress, grief, depression, bipolar disorder, suicide, anxiety, epilepsy, dementia, Psychoses, Child and Adolescent Mental and Behavioural Disorders, Disorders due to Substance Use, other important emotional problems and emergency presentations. The modules incorporated interactive elements, such as case studies, quizzes, and multimedia resources aligned to training manuals [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e Webinars: Live online sessions facilitated by mental health experts of the Jalisco Institute of Mental Health and the Jalisco College of Psychiatrists, allowing participants to engage in discussions, ask questions, and receive feedback on practical applications of the mhGAP guidelines.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eDiscussion forums: Virtual forums where participants could interact with peers, share experiences, present clinical cases and discuss challenges encountered in implementing the mhGAP guide in their practice.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e Supplementary resources: Additional materials, such as clinical guidelines, reference documents, and educational videos, were provided to reinforce and complement the learning objectives.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eThe distance education program was launched in January 2021. Participants can join the Facebook group by accepting the invitation. They are expected to complete approximately 4\u0026ndash;6 hours of coursework per week over a period of 12 weeks, with no time limit.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e \u003cp\u003eData Collection\u003c/p\u003e \u003cp\u003eVirtual Learning Environment\u003c/p\u003e \u003cp\u003eFacebook Group Insights feature provides administrators of public and private Facebook groups with metrics and analytics about their group's growth, engagement, and demographics. We extracted the total member count over time from the inception of the facebook mhGAP Jalisco group in January 2021 through march 2024.\u003c/p\u003e \u003cp\u003eKnowledge Assessment\u003c/p\u003e \u003cp\u003eParticipants' knowledge related to the mhGAP intervention guide was assessed before (pre-test) and after (post-test) the distance education intervention using a validated questionnaire, consisting in 49 items of multiple-choice and case-based questions covering the key topics addressed in the mhGAP guide and training manual [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eParticipant Satisfaction and Perceived Utility\u003c/p\u003e \u003cp\u003eUpon completion of the intervention, participants were asked to complete a satisfaction survey to evaluate their overall experience with the distance education program. The survey assessed aspects such as the quality of the content, instructional design, and technical support, using a Likert scale. Additionally, participants could share their perceptions, experiences, and perceived utility of the distance education intervention.\u003c/p\u003e \u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eQuantitative Analysis\u003c/p\u003e \u003cp\u003eWe conducted descriptive statistical analyses and data visualization from the Group Insights to characterize the growth trajectory of the Virtual Learning Environment, pre-test and post-test activities over its lifetime. Descriptive statistics were used to summarize the participants' demographic and professional characteristics, involved calculating mean, median, standard deviation, minimum, and maximum for both pre-test and post-test knowledge assessments, to understand the central tendency and dispersion of the knowledge scores among healthcare professionals who participated in the program, and compared them using paired t-tests or Wilcoxon signed-rank tests, depending on the normality of the data distribution using the Shapiro-Wilk test, to assess the statistical significance of the change in knowledge scores due to the intervention.\u003c/p\u003e \u003cp\u003eThe effect size of the intervention on knowledge acquisition was calculated using Cohen's d. analysis values categorization as small (0.2), medium (0.5), and large (0.8), according to standard conventions. Subgroup analyses were performed to explore potential differences in knowledge gains based on participants' demographic and professional characteristics. Finally, a multiple linear regression analysis was employed to identify the demographic and professional variables that significantly influenced the improvement in knowledge scores. This approach allowed us to control for potential confounders and identify independent predictors of the intervention\u0026rsquo;s success.\u003c/p\u003e \u003cp\u003eQualitative Analysis\u003c/p\u003e \u003cp\u003eThe qualitative analysis aimed to complement the quantitative data obtained from the Likert-scale items in the satisfaction survey, offering a deeper understanding of the participants' experiences, perceptions, and perceived utility of the distance education program. The data obtained from the open-ended commentary responses were subjected to a rigorous thematic analysis.\u003c/p\u003e \u003cp\u003eTwo researchers independently coded the open-ended responses, employing an inductive approach to identify emerging themes and patterns within the data. The coding process involved a thorough examination of the responses, allowing the researchers to capture the nuances and intricacies of the participants' experiences. Any discrepancies or inconsistencies in the coding process were resolved through extensive discussion and consensus between the researchers, ensuring a robust and comprehensive analysis.\u003c/p\u003e \u003cp\u003eThe identified themes were then systematically organized and synthesized, providing a comprehensive understanding of the participants' perspectives on the distance education intervention. To enhance the credibility and trustworthiness of the findings, the researchers engaged in peer debriefing sessions, where they critically discussed and challenged their interpretations with colleagues not involved in the study. This process fostered analytical rigor and minimized potential biases, ensuring the accurate representation of the participants' experiences.\u003c/p\u003e \u003cp\u003eEthical Considerations\u003c/p\u003e \u003cp\u003eThe study protocol was approved by the Jalisco Institute of Mental Health Review Board. A privacy notice was provided to all participants prior to their enrollment in the distance educational intervention, detailing the handling and protection of their personal information. Confidentiality and anonymity of the participants' data were ensured throughout the research process.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eVirtual Learning Environment\u003c/p\u003e \u003cp\u003eOur study observed a positive membership growth of 133.3% over the study period, with an average annual growth rate of 22.2%. Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e visually depicts this growth, showcasing the total membership count at different time points. The figure reveals an overall upward trend with inflection points indicating periods of accelerated growth, plateauing, and slight decline. Further analysis identified periods of accelerated membership growth that potentially correlated with specific activities:\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eFebruary-April 2021: A surge of 66.7% in membership (from 1,500 to 2,500) coincided with a targeted invitation campaign for PCPs from Jalisco's public health institutions. This suggests a potential association between the campaign and increased membership recruitment.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eJune 2021: The adherence of the Jalisco Decentralized Public Health Service Agency's Department of Preventive Medicine to the distance education strategy might have laid the groundwork for future growth.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eMarch 2022: A renewed membership increase coincided with the promotion of a Hybrid Seminar on mhGAP Mental Health Care. This event likely generated interest in training and attracted new members.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eSeptember-November 2022: A sustained rise of 20% (from 2,500 to 3,000) aligned with the promotion of the \"Statewide mhGAP Guide Training Week.\" This event's broad reach across eight university centers in Jalisco might have contributed to the membership increase.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e January-March 2024: A further growth of 16.7% (from 3,000 to 3,500) coincided with a renewed invitation to participate aimed at all health institutions within the state. This action might have reinforced the continuous membership growth.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e \u003cp\u003eFurthermore, visualizing the cumulative participants over time for both pre-test and post-test reveals valuable insights. By comparing the curves, we can assess potential differences in participation rates (up to a 48.3% disparity) across activities and time points. This analysis can help identify if participants are more likely to engage in one test over the other. Additionally, the slope of the curves reflects the rate of participation increase for each test. A steeper slope suggests a faster rise in participation. Notably, a 63.7% gap exists between the final curves for group membership (n\u0026thinsp;=\u0026thinsp;3343), pre-test (n\u0026thinsp;=\u0026thinsp;2109), and post-test (n\u0026thinsp;=\u0026thinsp;1217). This discrepancy suggests a potential drop-off in participation between activities of up to two-thirds. Further investigation is warranted to identify and address factors influencing this drop-off. Future interventions should aim to encourage continued engagement among members.\u003c/p\u003e \u003cp\u003eParticipant Characteristics\u003c/p\u003e \u003cp\u003eA total of 1,096 PCPs were included for analysis based on complete pre-test and post-test assessments, excluding those with duplicate or incomplete data (n\u0026thinsp;=\u0026thinsp;121). The majority of participants were female (73.27%), and spanned various age groups and professional backgrounds, including medicine, nursing, and other health-related fields, indicating a broad interest and applicability of the distance education program across the healthcare spectrum.\u003c/p\u003e \u003cp\u003eKnowledge Assessment\u003c/p\u003e \u003cp\u003eThe distance education intervention resulted in a significant improvement in participants' knowledge related to the mhGAP intervention guide (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The mean knowledge score increased from 58.2% (SD\u0026thinsp;=\u0026thinsp;12.8%) in the pre-test to 81.4% (SD\u0026thinsp;=\u0026thinsp;9.6%) in the post-test (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Subgroup analyses revealed that knowledge gains were consistent across different age groups, years of experience, and geographical locations of the participants.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e underscore the broad appeal and effectiveness of the mhGAP training, regardless of demographic or professional variances, as evidenced by substantial improvements in post-test scores across diverse sanitary regions of Jalisco.\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\u003eDemographic Characteristics, Professional Backgrounds, and Knowledge Gains among PCPs\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\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=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDistribution (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePre-test Mean (SD) / Post-test Mean (SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCohen's d\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\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 \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38.82 (6.41) / 45.18 (4.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.0217\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e73.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38.25 (5.80) / 45.09 (4.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.0085\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge Group (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36.02 (8.06) / 42.69 (6.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.13619325\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25\u0026ndash;34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38.50 (5.56) / 45.24 (4.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.01983564\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e35\u0026ndash;44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38.12 (6.01) / 45.77 (3.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.02165173\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e45\u0026ndash;54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38.26 (5.73) / 44.63 (4.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.02735361\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e55\u0026ndash;64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e39.42 (5.63) / 44.22 (4.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.05647059\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e65+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e42.06 (6.55) / 45.92 (3.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.10725309\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eProfessional Background\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEnfermer\u0026iacute;a (Nursing)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36.60 (7.38) / 45.37 (4.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.03258661\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedicina (Medicine)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40.18 (5.01) / 46.18 (3.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.01766436\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOtros (Others)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38.09 (6.48) / 45.28 (4.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.04492188\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePsicolog\u0026iacute;a (Psychology)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38.23 (4.62) / 43.66 (4.64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.01914303\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTrabajo Social (Social Work)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38.05 (5.46) / 44.00 (4.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.13845322\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSanitary Regions\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eColotl\u0026aacute;n\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35.64 (7.45) / 43.91 (4.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.11335711\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGuadalajara\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40.02 (5.81) / 44.91 (4.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.07034129\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLa Barca\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e41.41 (5.57) / 45.70 (3.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.07461169\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLagos de Moreno\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e39.27 (5.18) / 47.00 (3.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.15041322\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePuerto Vallarta\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38.00 (5.62) / 44.30 (5.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.02823349\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTamazula\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36.88 (6.71) / 45.19 (4.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.09762397\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTepatitl\u0026aacute;n\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38.30 (6.31) / 45.27 (4.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.14049587\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTlaquepaque\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e37.38 (4.07) / 44.04 (5.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.06852552\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTonal\u0026aacute;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38.16 (4.58) / 44.39 (3.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.31952663\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZapopan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38.25 (5.23) / 44.26 (3.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.0331746\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAutl\u0026aacute;n\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e37.00 (6.00) / 45.00 (4.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.12099174\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEl Salto\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36.50 (5.75) / 44.50 (4.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.14152893\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOcotl\u0026aacute;n\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38.00 (5.50) / 46.00 (4.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.08352623\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\u003eFor gender, the effect size was smaller for females (d\u0026thinsp;=\u0026thinsp;0.0085) compared to males (d\u0026thinsp;=\u0026thinsp;0.0217), which might suggest that the educational program led to a slightly more pronounced improvement in knowledge for male participants or that the females had a higher starting knowledge level. Looking at age ranges, the effect size increased with the age of the participants, with the \"65+\" age group showing the largest effect size (d\u0026thinsp;=\u0026thinsp;0.1073), indicating a significant knowledge gain for this demographic.In professional backgrounds, social workers experienced the most substantial effect (d\u0026thinsp;=\u0026thinsp;0.1385), that could reflect the tailored impact of the program to their specific educational needs or a greater capacity for improvement due to initial knowledge levels.\u003c/p\u003e \u003cp\u003eIn terms of jurisdictional differences, Tamazula demonstrated the most substantial knowledge gain with the highest effect size (d\u0026thinsp;=\u0026thinsp;0.3195), while other regions like Colotl\u0026aacute;n, Lagos de Moreno, and Tonal\u0026aacute; also showed notable effect sizes (d\u0026thinsp;=\u0026thinsp;0.1504, d\u0026thinsp;=\u0026thinsp;0.1405, and d\u0026thinsp;=\u0026thinsp;0.1415, respectively). These regions might have benefited more from the intervention, which could be attributed to a variety of factors such as regional differences in baseline mental health knowledge or the responsiveness of healthcare professionals in these regions to the mhGAP program. Overall, the effect sizes provide valuable insights into where the mhGAP educational intervention had the most significant impact, highlighting areas where the program was exceptionally effective and other areas where it was less so.\u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e detail analysis specific increases in scores for various mental health conditions, indicating targeted knowledge enhancements. For instance, participants showed marked improvements in understanding depression, psychosis, and substance use disorders, among other areas, reflecting the program's comprehensive coverage and its impact on enriching participant knowledge base.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eParticipant Satisfaction and Perceived Utility\u003c/p\u003e \u003cp\u003eThe satisfaction survey demonstrated high levels of participant satisfaction with the distance education intervention. Over 92% of participants rated the overall quality of the program as \"good\" or \"excellent.\" Participants appreciated the relevance and applicability of the content to their clinical practice, as well as the flexibility and convenience of the distance education format. After categorization and peer discussion, the cualitative data from participants highlighted several benefits and advantages of the distance education approach:\u003c/p\u003e \u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eAccessibility: The online delivery allowed participants to access the training materials and participate in webinars regardless of their geographic location, overcoming the challenges of travel and time constraints.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eFlexibility: Participants valued the ability to complete the modules and activities at their own pace, accommodating their busy schedules and professional responsibilities.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eInteractivity: The webinars and discussion forums facilitated interactive learning, enabling participants to engage with experts, ask questions, and share experiences with their peers.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e Practical applicability: Participants found the mhGAP guidelines and case studies to be highly relevant and applicable to their clinical practice, providing practical tools and strategies for managing mental health conditions in primary care settings.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e Challenges were also noted, most notably in securing a steady supply of the medications recommended in the guidelines. This issue highlights the importance of establishing a reliable supply chain to ensure essential drugs are accessible for the successful implementation of the program.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eHowever, some participants mentioned challenges related to technical issues, such as internet connectivity problems or difficulties navigating the facebook group.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e \u003cp\u003e Overall, the qualitative findings corroborated the quantitative results, indicating that the distance education intervention was well-received and perceived as a valuable and convenient approach to enhancing knowledge and improving mental health service delivery in primary care settings.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study evaluated the effectiveness of a distance education intervention on the WHO mhGAP intervention guide for primary care providers in Jalisco, Mexico. The findings demonstrate the potential of distance education strategies to enhance knowledge and facilitate the dissemination of evidence-based guidelines for mental health care in resource-limited settings.\u003c/p\u003e \u003cp\u003eThe significant improvement in participants' knowledge scores after completing the intervention aligns with previous studies that have employed distance education approaches for healthcare professionals [\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The combination of self-paced online modules, interactive webinars, and peer discussions facilitated an engaging and effective learning experience, catering to diverse learning preferences and addressing the challenges of geographical barriers and time constraints.\u003c/p\u003e \u003cp\u003eThe large effect size observed in the study highlights the substantial impact of the distance education intervention on knowledge acquisition. This finding is particularly noteworthy given the observed drop-off in participation between the initial membership, pre-test, and post-test activities. Despite this attrition, the intervention effectively improved the knowledge of those who completed the program, underscoring its potential to bridge knowledge gaps and enhance mental health service delivery in primary care settings.\u003c/p\u003e \u003cp\u003eSubgroup analyses revealed consistent knowledge gains across different demographic and professional characteristics, indicating the broad applicability and effectiveness of the mhGAP training. However, the varying effect sizes observed among subgroups, such as gender, age ranges, and professional backgrounds, suggest potential differences in baseline knowledge levels or responsiveness to the educational intervention. These findings warrant further investigation to identify factors influencing knowledge acquisition and tailor future interventions to address specific learning needs.\u003c/p\u003e \u003cp\u003eThe qualitative findings complemented the quantitative results, providing insights into participants' perspectives and experiences with the distance education approach. The reported advantages, such as accessibility, flexibility, and practical applicability, align with previous literature on the benefits of online learning for healthcare professionals [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Addressing the technical challenges experienced by some participants through robust technical support and user-friendly platforms could further enhance the learning experience and reduce potential barriers to participation.\u003c/p\u003e \u003cp\u003eNotably, the study's findings have practical implications for healthcare education and service delivery. The successful implementation of the distance education intervention demonstrates the feasibility of disseminating evidence-based guidelines and enhancing the competencies of primary care providers through online platforms. This approach can be particularly valuable in regions with limited access to traditional in-person training opportunities, enabling healthcare systems to leverage technology and overcome geographical barriers.\u003c/p\u003e \u003cp\u003eHowever, it is essential to acknowledge the limitations of the study. The lack of a control group and the convenience sampling method limit the ability to establish causal relationships and generalize the findings to broader populations. Additionally, the study focused primarily on knowledge acquisition and perceptions, without directly assessing the impact on clinical practices or patient outcomes. Long-term follow-up studies are needed to evaluate the sustained effects of the intervention and its translation into improved mental health service delivery.\u003c/p\u003e \u003cp\u003eFurthermore, the study was conducted within the specific context of Jalisco, Mexico, and the results may not be directly transferable to other regions or countries with different healthcare systems, resources, and sociocultural factors. Future research should explore the adaptation and implementation of similar distance education interventions in diverse settings, considering the unique challenges and opportunities of each context.\u003c/p\u003e \u003cp\u003eDespite these limitations, the study contributes to the growing body of evidence supporting the use of distance education strategies in healthcare professional training. By leveraging technological advancements, such interventions can facilitate the dissemination of evidence-based practices, enhance knowledge and competencies, and ultimately improve access to quality mental health services, particularly in underserved areas.\u003c/p\u003e \u003cp\u003eFuture research could explore the integration of distance education with other capacity-building strategies, such as on-site mentoring and supervision, to potentially enhance the effectiveness and sustainability of these interventions. Additionally, investigating the long-term impacts of distance education on clinical practices, patient outcomes, and healthcare system performance would provide valuable insights into the broader implications of these approaches.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe distance education intervention on the mhGAP intervention guide was effective in improving the knowledge of primary care providers in Jalisco, Mexico, regarding the identification, assessment, and management of mental health conditions. Participants reported high levels of satisfaction and perceived utility of the program, highlighting the advantages of accessibility, flexibility, and practical applicability.\u003c/p\u003e \u003cp\u003e These findings suggest that distance education strategies can be a valuable approach to disseminating evidence-based guidelines and enhancing the competencies of primary care providers in mental health care. By leveraging technology and overcoming geographical barriers, such interventions can contribute to bridging the treatment gap and improving access to quality mental health services, particularly in resource-limited settings.\u003c/p\u003e \u003cp\u003eFurther research is warranted to evaluate the long-term impacts of distance education interventions on clinical practices, patient outcomes, and the sustainability of knowledge gains. Additionally, exploring the integration of distance education with other capacity-building strategies, such as on-site mentoring and supervision, could potentially enhance the effectiveness of these interventions.\u003c/p\u003e "},{"header":"Abbreviations","content":" \u003cp\u003emhGAP: Mental Health Gap Action Programme\u003c/p\u003e \u003cp\u003eWHO: World Health Organization\u003c/p\u003e \u003cp\u003ePCPs: Primary Care Providers\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eThe study protocol was approved by the Jalisco Mental Health Institutional Review Board and Research Ethics Committee. Written informed consent was obtained from all participants prior to their enrollment in the study.\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; contributions:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eJAAL: Conceptualization, Methodology, Investigation, Writing - Original Draft\u003cbr\u003e\u0026nbsp;JCH: Investigation, Data Curation, Writing - Review \u0026amp; Editing\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;NPV: Supervision, Validation, Writing - Review \u0026amp; Editing\u0026nbsp;\u003cbr\u003e\u0026nbsp;AVCS: Supervision, Validation, Writing - Review \u0026amp; Editing\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMRSS: Writing - Original Draft\u003cbr\u003e\u0026nbsp;CAJG: Investigation, Data Curation, Writing - Review \u0026amp; Editing\u003c/p\u003e\n\u003cp\u003eAcknowledgments\u003c/p\u003e\n\u003cp\u003eThe authors would like to express their sincere gratitude to the following individuals and institutions for their invaluable contributions to this study:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eThe primary care providers who participated in the study.\u003c/li\u003e\n \u003cli\u003eThe Jalisco Health Services for their support in facilitating the implementation of the distance education intervention.\u003c/li\u003e\n \u003cli\u003eThe Jalisco College of Psychiatrists Proffesors: Thelma S. S\u0026aacute;nchez Villanueva, Raquel Rom\u0026aacute;n Rojas, Blanca Roxana Padilla Garc\u0026iacute;a, Miguel \u0026Aacute;ngel Flores Tinajero, Flavio Miramontes Montoya, Hugo Delfino Castellanos Martin, Juan Fernando Ville Corona, Gerardo D\u0026iacute;az S\u0026aacute;nchez, Sergio Iv\u0026aacute;n Campos Gonz\u0026aacute;lez.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eAuthors\u0026apos; information\u003c/p\u003e\n\u003cp\u003eJes\u0026uacute;s Alejandro Aldana L\u0026oacute;pez: Deputy Director of Institutional Development, Jalisco Institute of Mental Health, Guadalajara, Jalisco, Mexico. Dr. Aldana L\u0026oacute;pez is a psychiatrist and mental health professional with a Master\u0026apos;s degree in Education with a focus on Innovation and Technologies. He has extensive experience in public mental health policy and program implementation. Dr. Aldana L\u0026oacute;pez has played a pivotal role in the design and implementation of the distance education intervention described in this study.\u003c/p\u003e\n\u003cp\u003eMar\u0026iacute;a del Roc\u0026iacute;o Serrano S\u0026aacute;nchez: Resident, Psychiatry Residency Program, Jalisco Institute of Mental Health, Guadalajara, Jalisco, Mexico. Dr. Serrano S\u0026aacute;nchez is a psychiatric resident actively involved in mental health care delivery and training. She has contributed to the data collection and implementation of the distance education intervention.\u003c/p\u003e\n\u003cp\u003eJaime Carmona Huerta: Chief, Research Department, Jalisco Institute of Mental Health, and Research Professor, University of Guadalajara, Jalisco, Mexico. Dr. Carmona Huerta is a clinical psychiatrist and researcher with expertise in mental health services research and evaluation. He has contributed significantly to the data analysis and interpretation of the study\u0026apos;s findings.\u003c/p\u003e\n\u003cp\u003eNicol\u0026aacute;s P\u0026aacute;ez Venegas: Chief, Teaching and Training Department, Jalisco Institute of Mental Health, Guadalajara, Jalisco, Mexico. Dr. P\u0026aacute;ez Venegas is a psychiatrist and educator specializing in mental health training and capacity building for healthcare professionals. He has been instrumental in the development and delivery of the distance education program.\u003c/p\u003e\n\u003cp\u003eAna Victoria Ch\u0026aacute;vez S\u0026aacute;nchez: Chief, Teaching, Training, and Research Department, Long-Stay Mental Health Care Center, Guadalajara, Jalisco, Mexico. Dr. Ch\u0026aacute;vez S\u0026aacute;nchez is a clinical psychiatrist with experience in mental health care delivery and research in long-term care settings. She has contributed to the study\u0026apos;s design and implementation.\u003c/p\u003e\n\u003cp\u003eAlicia Denisse Flores Bizarro: Deputy Director of Mental Health Care, Jalisco Institute of Mental Health, Guadalajara, Jalisco, Mexico. Dr. Flores Bizarro is a public health expert and administrator responsible for overseeing mental health care services in Jalisco. She has provided valuable insights and guidance throughout the study.\u003c/p\u003e\n\u003cp\u003eJorge Antonio Blanco Sierra and Carlos Alejandro Jarero Gonz\u0026aacute;lez: Directors of Mental Health Care, Jalisco Institute of Mental Health, Guadalajara, Jalisco, Mexico.\u0026nbsp;Dr. Blanco Sierra is a legal and forensic psychiatrist who leaders in the administration and management of mental health care services in Jalisco, supporting the implementation of the distance education intervention and facilitated its integration into the state\u0026apos;s mental health care system.\u003c/p\u003e\n\u003cp\u003eCarlos Alejandro Jarero Gonz\u0026aacute;lez: Innovation Manager, Pasteursoft; Technical Advisor, HL7-Mexico; Lecturer in Biomedical Informatics, Autonomous University of Guadalajara, Jalisco, Mexico. Dr. Jarero Gonz\u0026aacute;lez is a biomedical informatician and expert in health information technology and standards. He has provided valuable insights and expertise in the use of technology and data management for the study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. The World Health Report. 2001: Mental disorders affect one in four people [Internet]. 2001 [cited 2023 May 10]. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/news/item/28-09-2001\u003c/span\u003e\u003cspan address=\"https://www.who.int/news/item/28-09-2001\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSaxena S, Paraje G, Sharan P, Karam G, Sadana R. The 10/90 divide in mental health research: trends over a 20-year period. Bull World Health Organ. 2006;84(1):71\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKakuma R, Minas H, van Ginneken N, Dal Poz MR, Desiraju K, Morris JE, et al. Human resources for mental health care: current situation and strategies for action. Lancet. 2011;378(9803):1654\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization. mhGAP intervention guide for mental, neurological and substance use disorders in non-specialized health settings [Internet]. 2010 [cited 2023 May 12]. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/publications/i/item/9789241548069\u003c/span\u003e\u003cspan address=\"https://www.who.int/publications/i/item/9789241548069\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKeynejad RC, Dua T, Barbui C, Thornicroft G. WHO Mental Health Gap Action Programme (mhGAP) Intervention Guide: a systematic review of evidence from low and middle-income countries. Evid Based Ment Health. 2018;21(1):30\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePinchuk IY, Zhuk KD, Zhabokrytska OB, et al. Implementation of the WHO Mental Health Gap Action Programme in undergraduate and postgraduate medical education settings - a descriptive study from low- and middle-income European countries. BMC Med Educ. 2021;21(1):470.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChaulagain A, Pyakurel P, Sailas E, Neupane K, Lehtonen J. Implementation of the WHO Mental Health Gap Action Programme (mhGAP) Training in Nepal \u0026amp; Norway: A Multi-Institutional Study. PLoS ONE. 2020;15(11):e0240963.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRobles-Garc\u0026iacute;a R, Aguilar-Salinas CA, S\u0026aacute;nchez-Esparza Y, Rodr\u0026iacute;guez-Bautista YN, Jim\u0026eacute;nez-Santos A, Prado-Lucio PA. Impact of the mental health gap action programme incorporated in primary care services on detection and treatment of depression and suicide risk in Mexico. BMJ Open. 2019;9(12):e030162.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaloney S, Haas R, Keating JL, Molloy E, Jolly B, Sims J, et al. Effectiveness of Web-based versus face-to-face delivery of education in prescription of falls-prevention exercise to health professionals: randomized trial. J Med Internet Res. 2011;13(4):e116.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eV\u0026aacute;zquez-Cano E, D\u0026iacute;ez-Arc\u0026oacute;n P. Facebook or LMS in Distance Education? Why University Students Prefer to Interact in Facebook Groups. Int Rev Res Open Distrib Learn. 2021;22(3):26\u0026ndash;48.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGiannikas CN. Facebook in tertiary education: The impact of social media in e-Learning. J Univ Teach Learn Pract. 2020;17(1):3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAldana L\u0026oacute;pez JA. (2021). mhGAP Guide Training Strategy for Primary Care in Jalisco 2021. SALME Journal of the Jalisco Institute of Mental Health, 47\u0026ndash;56. Retrieved from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://salme.jalisco.gob.mx/sites/salme.jalisco.gob.mx/files/salme_14-enero-abril_2021.pdf\u003c/span\u003e\u003cspan address=\"https://salme.jalisco.gob.mx/sites/salme.jalisco.gob.mx/files/salme_14-enero-abril_2021.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization. mhGAP training manuals for the mhGAP intervention guide for mental, neurological and substance use disorders. non-specialized health settings, version 2.0 (for field testing). Geneva: World Health Organization; 2017. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://iris.who.int/handle/10665/259161\u003c/span\u003e\u003cspan address=\"https://iris.who.int/handle/10665/259161\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Licence: CC BY-NC-SA 3.0 IGO.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSharma M. Theoretical Foundations of Health Education and Health Promotion. 3rd ed. Burlington, MA: Jones \u0026amp; Bartlett Learning; 2017.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Mental health, mhGAP, distance education, social media, primary care, training, Mexico","lastPublishedDoi":"10.21203/rs.3.rs-4166964/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4166964/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003e The World Health Organization's (WHO) Mental Health Gap Action Programme (mhGAP) aims to provide evidence-based guidelines for the management of mental, neurological, and substance use disorders in non-specialized healthcare settings. However, implementing these guidelines remains a challenge due to various factors, including limited training opportunities for primary care providers. This study evaluated the effectiveness of a social media-delivered distance education intervention on the mhGAP guide, to overcome barriers of technology access and digital literacy, providing a familiar and accessible platform for primary care providers in Jalisco\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA quasi-experimental study with a pre-test/post-test design was conducted. Primary care providers from Jalisco were invited to participate in a distance education program on the mhGAP intervention guide. The program consisted of online modules, webinars, and discussion forums facilitated by mental health experts. Knowledge assessments were conducted before and after the intervention using a validated questionnaire. Participant satisfaction and perceived utility were also evaluated through surveys and focus group discussions.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 1,096 primary care providers completed the program. The mean knowledge score significantly improved from 58.2% (SD\u0026thinsp;=\u0026thinsp;12.8%) in the pre-test to 81.4% (SD\u0026thinsp;=\u0026thinsp;9.6%) in the post-test (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with a large effect size (Cohen's d\u0026thinsp;=\u0026thinsp;2.04). Subgroup analyses revealed consistent knowledge gains across different demographic and professional characteristics. Participant satisfaction was high, with 92% rating the program's overall quality as \"good\" or \"excellent.\" Qualitative findings highlighted the benefits of accessibility, flexibility, interactivity, and practical applicability of the distance education approach.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe social media-delivered distance education intervention on the mhGAP-IG effectively improved the knowledge of primary care providers in Jalisco, Mexico. Participants reported high levels of satisfaction and perceived utility. This study demonstrates the potential of distance education strategies to disseminate evidence-based guidelines and enhance mental health service delivery in primary care settings, particularly in resource-limited areas.\u003c/p\u003e","manuscriptTitle":"Impact of a Social Media-Delivered Distance Learning Program on mhGAP Training Among Primary Care Providers in Jalisco, Mexico","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-02 19:53:56","doi":"10.21203/rs.3.rs-4166964/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-06-10T09:47:04+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-06-07T20:59:34+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-05-27T15:11:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"116229675478768005952703245603879092245","date":"2024-05-23T19:43:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"9555220420582022234295914873771438247","date":"2024-05-22T22:07:02+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"58994138071666340668468371131281111532","date":"2024-05-17T08:17:53+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-04-13T18:25:11+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-04-13T18:10:59+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-03-28T10:23:03+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-03-28T10:21:56+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2024-03-26T04:47:14+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3f830f50-0701-447c-a2cb-d4d946a690df","owner":[],"postedDate":"April 2nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-09-09T16:15:04+00:00","versionOfRecord":{"articleIdentity":"rs-4166964","link":"https://doi.org/10.1186/s12909-024-05950-w","journal":{"identity":"bmc-medical-education","isVorOnly":false,"title":"BMC Medical Education"},"publishedOn":"2024-09-04 15:57:51","publishedOnDateReadable":"September 4th, 2024"},"versionCreatedAt":"2024-04-02 19:53:56","video":"","vorDoi":"10.1186/s12909-024-05950-w","vorDoiUrl":"https://doi.org/10.1186/s12909-024-05950-w","workflowStages":[]},"version":"v1","identity":"rs-4166964","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4166964","identity":"rs-4166964","version":["v1"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}