Educational Background and Continuing Education Program Affecting Mental Health Nurses’ Literacy and Competence on Delivering Care at Primary Health Care in Indonesia

Document Type : Original Article


1 Faculty of Nursing, Universitas Hasanuddin, Makassar, Indonesia

2 School of Nursing, Faculty of Science and Technology, Universitas Sembilanbelas November Kolaka, Indonesia


Background and Objective: Knowledge, competencies, stigma and readiness are crucial among mental health nurses especially primary health care setting. This study aims to determine the knowledge, competencies, stigma, and readiness among nurses to deliver mental health nursing care in primary health care.

Materials and Methods: The study used a cross-sectional study, it conducted from May to October 2022. The participants were mental health nurses who were working in primary health care in Makassar County and recruited using the total sampling method, whose 45 PMH nurses . Data collected using the Mental Health Knowledge Schedule (MAKS), the Psychiatric Mental Health Nurse Practitioner Competencies Self-Rating, and The Reported and Intended Behaviour Scale (RIBS) The cross-cultural adaptation approach is used in all tools for adaptation and translation. The data was analysed using univariate and bivariate tests such as the Chi-Square test with significant level is < 0.05.

Results: There were 45 nurses who participated in this study, 93.3% were women, 68.9% have most bachelor's qualifications, 95.6% have good knowledge, 62.25 have competent levels, and 73.3% have positive stigma and readiness. Significant relationships were identified between nurse competence, educational background (p = 0.014), and participation in nursing or mental health training (p = 0.020).

Conclusion: The research findings show that most nurses have good knowledge, competence, stigma, and readiness to serve patients with mental health disorders. Recent education and participation in mental health training influence the competence of nurses in serving patients with mental disorders. Further study and a deeper understanding of each relevant factor's effect are urgently needed to enhance the treatment of mental illnesses and raise patient expectations in light of the numerous potential factors that may potentially influence nurses while caring for patients with mental health issues.


Acknowledgements: The researchers would like to thanks for all nurses who voluntarily participated in this study.

Availability of data and materials:  The anonymized datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Conflicts of interests: We declare that there is no conflict of interest.

Consent for publication: Not applicable

Ethical approval and consent to participate: The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Health Research Ethics Commission (KEPK) of Faculty of Public Health Hasanuddin University under approval letter number No: 9058/UN4.14.1/TP.01.02/2022. Informed Consent was conducted online via google form by all nurses as participants in this research.

Funding: This research have receive fund or grants from the Universitas Hasanuddin.

Author contributions: A. H and Y. Y, contributed to data analysis, drafted and critically revised the manuscript; A. H, Y. Y, A. M, F. R, contributed to data analysis, critically revised the manuscript; A. H, Y. Y, contributed to conception, design, and data analysis, drafted and critically revised the manuscript. All authors gave final approval and agree to be accountable for all aspects of the work.


Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this licence, visit

  1. Tim Riskesdas. Laporan Nasional RISKESNAS 2018. Badan Penelitian dan Pengembangan Kesehatan. 2018.
  2. Tim Riskesdas Provinsi Sulawesi Selatan. Laporan Provinsi Sulawesi Selatan RISKESNAS 2018.
  3. Universitas Gajah Mada. Minim Psikolog, Ribuan Penderita Gangguan Jiwa Belum Tertangani. 2015.
  4. Seksi Pelayanan Kesehatan Primer Dinkes Sulsel. Jumlah Puskesmas dan Kemampuan Pelayanan Kesehatan di Provinsi Sulawesi Selatan Tahun 2021. 2021.
  5. Dinkes Sulsel. Profil kesehatan Kota Makassar 2015. Dinas Kesehatan Provinsi Sulawesi Selatan.2016.
  6. Dinkes Sulsel. Profil Dinas Kesehatan Provinsi Sulawesi Selatan Tahun 2017. Dinas Kesehatan Provinsi Sulawesi Selatan. 2017.
  7. BPPSDMK. Nursing Staff Data used in Health Service Facilities at South Sulawesi Province. 2022.
  8. Olofsson CÖ, Wickman UL. District nurses' experiences of giving initial health care assessment to young adults applying for mental illness in primary care: a qualitative interview study. Primary Health Care Research & Development. 2023;24:e27. PMid:37062877 PMCid:PMC10130826
  9. Khalil AI, Al Ghamdi MA, Al Malki S. Nurses' knowledge, attitudes, and practices toward physical restraint and seclusion in an inpatients' psychiatric ward. International Journal of Culture and Mental Health. 2017 Oct 2;10(4):447-67.
  10. Dalky HF, Abu-Hassan HH, Dalky AF, Al-Delaimy W. Assessment of mental health stigma components of mental health knowledge, attitudes and behaviors among Jordanian healthcare providers. Community Mental Health Journal. 2020 Apr;56(3):524-31. PMid:31760548 PMCid:PMC10923396
  11. Abi Doumit C, Haddad C, Sacre H, Salameh P, Akel M, Obeid S, Akiki M, Mattar E, Hilal N, Hallit S, Soufia M. Knowledge, attitude and behaviors towards patients with mental illness: Results from a national Lebanese study. PloS one. 2019 Sep 16;14(9):e0222172. PMid:31525219 PMCid:PMC6746362
  12. Evans-Lacko S, Little K, Meltzer H, Rose D, Rhydderch D, Henderson C, Thornicroft G. Development and psychometric properties of the mental health knowledge schedule. The Canadian Journal of Psychiatry. 2010 Jul;55(7):440-8. PMid:20704771
  13. Alber L, Augustus L, Hahn S, Penkert J, Sauer R, DeSocio J. Applying Benner's model to psychiatric mental health nurse practitioner self-ratings of role competence. Journal of the American Psychiatric Nurses Association. 2009 Apr;15(2):126-37. PMid:21665801
  14. Evans-Lacko S, Rose D, Little K, Flach C, Rhydderch D, Henderson C, Thornicroft G. Development and psychometric properties of the reported and intended behaviour scale (RIBS): a stigma-related behaviour measure. Epidemiology and psychiatric sciences. 2011 Sep;20(3):263-71. PMid:21922969
  15. Gjersing L, Caplehorn JR, Clausen T. Cross-cultural adaptation of research instruments: language, setting, time and statistical considerations. BMC medical research methodology. 2010 Dec;10:1-0. PMid:20144247 PMCid:PMC2831007
  16. Syarifah, W. Pengalaman Perawat Jiwa Dalam Merawat Pasien Gangguan Jiwa Di Puskesmas Di Kota Padangsidimpuan: Study Fenomenologi [Bachelor Thesis]. Universitas Aufa Royhan. 2021
  17. Nugroho, A. A. Gambaran Tingkat Pengetahuan Perawat Puskesmas Tentang Penerapan Model Keperawatan Community Mental Health Nursing Di Kabupaten Banyumas [Bachelor Thesis]. Universitas Muhammadiyah Purwokerto. 2019.
  18. Szajna A, Udapi G, Nandagaon V, Sogalad M, Kamat A, Khande A, Patil S, Shanbhog S, Patil M, Williams K, Kelly P. Exploring the convergence of knowledge, attitudes, and practice towards mental illness among nurses in South India: A cross-sectional analysis. Asian Journal of Psychiatry. 2021 Aug 1;62:102696. PMid:34090250
  19. Moyo N, Jones M, Gray R. What are the core competencies of a mental health nurse? A concept mapping study involving five stakeholder groups. International Journal of Mental Health Nursing. 2022 Aug;31(4):933-51. PMid:35411621 PMCid:PMC9322662
  20. Lien YY, Lin HS, Tsai CH, Lien YJ, Wu TT. Changes in attitudes toward mental illness in healthcare professionals and students. International journal of environmental research and public health. 2019 Dec;16(23):4655. PMid:31766689 PMCid:PMC6926665
  21. Mårtensson G, Jacobsson JW, Engström M. Mental health nursing staff's attitudes towards mental illness: an analysis of related factors. Journal of psychiatric and mental health nursing. 2014 Nov;21(9):782-8.. PMid:24654776 PMCid:PMC4263306
  22. Elysabeth D, Libranty G, Natalia S. Hubungan tingkat pendidikan perawat dengan kompetensi aplikasi evidence-based practice correlation between nurse's education level with the competency to do evidence-based practice. Jurnal Koinonia: Fakultas Filsafat Universitas Advent Indonesia. 2015 Jun 30;1(01):14-20.
  23. Kohrt BA, Turner EL, Rai S, Bhardwaj A, Sikkema KJ, Adelekun A, Dhakal M, Luitel NP, Lund C, Patel V, Jordans MJ. Reducing mental illness stigma in healthcare settings: proof of concept for a social contact intervention to address what matters most for primary care providers. Social Science & Medicine. 2020 Apr 1;250:112852. PMid:32135459 PMCid:PMC7429294
  24. Vistorte AO, Ribeiro WS, Jaen D, Jorge MR, Evans-Lacko S, Mari JD. Stigmatizing attitudes of primary care professionals towards people with mental disorders: A systematic review. The International Journal of Psychiatry in Medicine. 2018 Jul;53(4):317-38. PMid:29807502
  25. Wang K, Link BG, Corrigan PW, Davidson L, Flanagan E. Perceived provider stigma as a predictor of mental health service users' internalized stigma and disempowerment. Psychiatry research. 2018 Jan 1;259:526-31. PMid:29156425 PMCid:PMC5742055
  26. Henderson C, Noblett J, Parke H, Clement S, Caffrey A, Gale-Grant O, Schulze B, Druss B, Thornicroft G. Mental health-related stigma in health care and mental health-care settings. The Lancet Psychiatry. 2014 Nov 1;1(6):467-82. PMid:26361202
  27. Ihalainen‐Tamlander N, Vähäniemi A, Löyttyniemi E, Suominen T, Välimäki M. Stigmatizing attitudes in nurses towards people with mental illness: A cross‐sectional study in primary settings in Finland. Journal of Psychiatric and Mental Health Nursing. 2016 Aug;23(6-7):427-37. PMid:27500395
  28. Morgan AJ, Reavley NJ, Ross A, San Too L, Jorm AF. Interventions to reduce stigma towards people with severe mental illness: Systematic review and meta-analysis. Journal of psychiatric research. 2018 Aug 1;103:120-33. PMid:29843003
  29. Wu Q, Luo X, Chen S, Qi C, Yang WF, Liao Y, Wang X, Tang J, Tang Y, Liu T. Stigmatizing attitudes towards mental disorders among non-mental health professionals in six general hospitals in Hunan Province. Frontiers in Psychiatry. 2020 Jan 10;10:946. PMid:31998161 PMCid:PMC6967835