Professional Quality of Life Among Non-Specialist Healthcare Workers Trained in Child and Adolescent Mental Health in Kenya: A Mixed-Methods Study

Abstract

Purpose To evaluate the effects of child and adolescent mental health training on professional quality of life and to explore contextual factors influencing these outcomes among non-specialist healthcare workers in Kenya. Methods A mixed-methods pre-post implementation evaluation with an explanatory qualitative follow-up was conducted. Quantitatively, 92 non-specialist healthcare workers were assessed pre-training and 65 at the 3-month follow-up using the Professional Quality of Life Scale-5 (ProQOL-5), measuring compassion satisfaction, burnout, and secondary traumatic stress. All participants completed a 5-day training on child and adolescent mental and behavioral disorders (CAMBD). Regression analyses examined changes in ProQOL outcomes. Qualitatively, five focus group discussions (n=5) were conducted with a purposive subset of trained participants (n=60) to explore contextual influences on workforce well-being. Results Despite significant improvements in knowledge, no significant changes were observed across the ProQOL subscales between pre-training and follow-up (p-values 0.56–0.74). Greater knowledge gain was associated with lower secondary traumatic stress (r =- 0.29, p = 0.02). Qualitative findings revealed persistent systemic constraints, including high patient volumes, weak referral pathways, medication shortages, and a lack of career advancement, that undermine workforce well-being. Participants described moral distress arising from the inability to provide adequate CAMBD care or to translate newly acquired skills into practice, despite enhanced competence. Conclusion While mental health training improved knowledge, professional quality of life among non-specialist healthcare workers remained largely unchanged. Findings suggest that workforce well-being in task-sharing mental healthcare is strongly shaped by health system constraints, underscoring the need for structural interventions alongside capacity-building.