Lea MasamoOveka Jan2025-09-102025-09-102021-09https://dspace.ughe.org/handle/123456789/921Abstract Background: It is estimated that approximately 35% of all Ugandans have a mental illness, with at least 15% requiring treatment. However, 90% of those requiring treatment do not receive it. Under-investment in mental health has resulted in limited availability of providers and services, as well as increased stigma among the population. The Mental Health Facilitator program trains non-specialists to identify mental health conditions, assess and make appropriate referrals. This study aims to understand the knowledge, facilitators, and barriers to practice of MHFs trained in Uganda. Methods: Utilizing a cross-sectional convergent merged mixed methods study design, we assessed the knowledge, facilitators, and barriers to practice of MHFs trained in 2020 in Lira and Kampala, Uganda. Knowledge was assessed using the NBCC MHF standard curriculum evaluation test. A structured questionnaire was developed to identify practice levels, and a semi-structured focus group discussion and in-depth interview guide was used to determine the facilitators and barriers to MHF practice. The MHFs were matched to untrained community members who were purposively selected according to matching MHF demographics (i.e., gender, age, education level and location), at a ratio of 1 MHF: 2 untrained community members. Results: The study had a total of 64 participants, 22 MHFs and 42 community members. There was a significant association between knowledge levels and participant type (P= .003), location (P= .009) and occupation (P= <.001). MHF practice was associated with the MHFs age and the median number of cases they assessed (P= .027) and referred (P= .034). Furthermore, a statistically significant association was found between an MHFs location and the median number of cases they identified (P= .017), assessed (P= .044) and referred (P-= .017). Qualitatively, four themes were identified as facilitators and barriers to practice of MHFs in Lira and Kampala, Uganda. These are the contextual environment, interpersonal skills, and personal attributes of MHFs, community attributes and perceptions, and resource and support systems affect MHFs practice. Conclusion & Recommendations: MHFs trained in 2020 in Lira and Kampala were found to have more knowledge on mental health and facilitation than untrained community members. In addition, knowledge from the training is sufficiently retained after one year. Still, knowledge was not a determinant of practice as this was influenced by other factors such as; the mental health burden within the MHFs practice setting, MHF lived experiences and their medical and mental health related backgrounds. The MHF program is suitably implemented in high mental health burden rural settings, where access to alternative mental health care is limited, with established Page 6 of 74 collaboration between facility and community based MHFs, available resources and local support systemsentext::thesis