Mental Health Knowledge, Perceived Risk, and Perceived Stigma Among Community Health Workers in Haiti, Malawi, and Rwanda: a cross-sectional study

Background Community health workers (CHWs) are key to disseminating mental health information and facilitating care in underserved population where stigma is common. This study assessed perceived risk, stigma, and mental health knowledge among CHWs in Haiti, Malawi, and Rwanda. Methods Between June and September 2023, we conducted a cross-sectional, in-person survey to collect data on mental health knowledge, perception and risk among 525 adult CHWs working in rural communities served by Partners In Health in Haiti, Malawi, and Rwanda. CHWs reported perceived risk for mental and physical illnesses relative to peers of similar age and sex. We used the Mental Health Knowledge Schedule (MAKS) and Stigma-9 Questionnaire (STIG-9). Descriptive statistics summarized demographic characteristics and responses which were compared by sex, country, and perceived risk. Results We enrolled 525 CHWs were enrolled with equal representation from Haiti, Malawi, and Rwanda. Most study participants were female (56.8%) and 35.4% were between 40 to 49 years. CHWs perceived their risk of developing mental illness to be similar to their risk of developing physical illnesses, with women reporting higher perceived risks for anxiety and depression compared to men. Participants from Haiti perceived they were at lower risk of suicidal ideation compared to their peers. The average MAKS score was 43.8 /60, with no significant differences by country (p = 0.189) or sex (p = 0.366)The most common knowledge gaps included failing to classify drug addiction as a mental illness, mistakenly classifying grief and stress as mental illnesses, and underestimating the prevalence of help-seeking behaviors and desire to be employed among individuals with mental health illness. The average STIG-9 score was 26.1/27, with women indicating slightly higher perceived stigma in all three countries. CHWs who perceived themselves to be at higher risk of mental illness exhibited lower knowledge about mental health and perceived higher levels of stigma in their communities. Conclusions This study highlighted specific mental health knowledge gaps among CHWs and indicated persistent perceived stigma towards those with mental illness in the communities where CHWs work. There is a need for targeted interventions to increase mental health knowledge among CHWs and reduce stigma towards mental illness in LMICs.