Evaluating the efficacy of the WHO QualityRights e-training in promoting the rights of persons with mental health conditions and psychosocial disabilities: a cluster randomised controlled trial in Ghana

Introduction People with mental health conditions and psychosocial disabilities frequently experience human rights violations. This study assessed the efficacy of the WHO QualityRights e-training in promoting their rights within the mental healthcare system. Methods In this cluster-randomised trial in three psychiatric hospitals in Ghana, we randomly selected units within each hospital and randomised them 1:1 to the intervention (WHO QualityRights e-training) or control arm (COVID-19 e-training). The intervention included presentations, videos, interactive exercises and forum discussions. Mental health professionals in these facilities were eligible participants. Primary outcomes were changes in knowledge about the rights of persons with mental health conditions and in the attitudes towards them, measured post-intervention using the WHO QualityRights Knowledge and Attitudes questionnaires. Secondary outcomes included changes at 3 and 6 months in knowledge, attitudes and mental health professionals’ practices related to substitute decision-making and coercion. Data analysts were masked to group assignment. Results Between 11 August 2021 and 13 April 2022, 28 clusters (14 per arm) were randomised and 252 participants enrolled (126 per arm); 179 (71%) were women. 206 (81.8%) completed the post-training follow-up. The intervention group showed significantly greater improvements in scores on the WHO QualityRights Knowledge (mean difference: 4.61 [95% CI 3.49 to 5.72], d=1.12) and Attitudes (−7.99 [95% CI −10.32 to −5.66], d=0.92) compared with the control group, with similarly significant results at 3 and 6 months. Additionally, intervention participants reported less frequent use of substitute decision-making and restraint (−2.60 [95% CI −4.05 to −1.16], d=0.52 at 3 months; −1.76 [95% CI −3.11 to −0.40], d=0.36 at 6 months). Conclusion This study showed that the WHO QualityRights e-training effectively improves mental health professionals’ knowledge and attitudes and can lead to reduction in providers’ use of substitute decision-making and coercion practices, thus suggesting a need for improved investment in rights-based interventions and further research.