Impact of an mhGAP-based epilepsy training program on primary healthcare providers in Palestine: a quasi-experimental study in an under-resourced setting

BACKGROUND: In low- and middle-income countries (LMICs) such as Palestine, where healthcare systems are under-resourced and politically constrained, epilepsy is a prevalent neurological illness characterized by significant treatment gaps. Marginalized populations experience these gaps disproportionately. The WHO Mental Health Gap Action Program Intervention Guide (mhGAP-IG) seeks to rectify these disparities by training non-specialist primary healthcare practitioners in the management of priority diseases. This study evaluates the impact of a culturally adapted mhGAP-based epilepsy training on the knowledge, attitudes, and self-efficacy of primary healthcare providers (PHCPs) in the West Bank, Palestine. METHODS: Sixty-eight primary healthcare providers in the Hebron governorate engaged in a quasi-experimental pre-post design that included a control group. Participants were randomly assigned to an intervention group (n = 32), which received a 3-day mhGAP epilepsy training, or a control group (n = 36), which received no training. Validated assessments were employed to collect data at baseline and three months post-intervention. Outcomes were analyzed using non-parametric tests and Quade’s ANCOVA as the primary analysis, with effect sizes and 95% confidence intervals. RESULTS: Following the adjustment for baseline scores, the intervention significantly enhanced knowledge (p < 0.001, η² = 0.320) and self-efficacy (p < 0.001, η² = 0.106). Attitudes exhibited minimal change, probably due to ceiling effects and the brief follow-up duration. Despite requests for further psychosocial and stigma-reducing resources, participant feedback emphasized enhanced confidence in patient communication and seizure management. CONCLUSIONS: In a politically complex, resource-limited context, mhGAP-based training was associated with significant improvements in provider competence. Due to the lack of epilepsy monitoring units in Palestine and reliance on primary care for epilepsy management, task-sharing strategies are required. This intervention promotes equitable treatment of individuals with epilepsy in poor and rural settings by equipping non-specialist primary healthcare providers with essential skills. Utilizing task-sharing in primary care, the widespread implementation of culturally tailored training in comparable under-resourced settings can significantly reduce global health disparities and promote health equity.