Strategies for supporting the implementation of a task-shared psychological intervention in South Africa’s chronic disease services: qualitative insights from health managers’ experiences of project MIND

ABSTRACT

Background

Although evidence indicates that task-shared psychological interventions can reduce mental health treatment gaps in resource-constrained settings, systemic barriers have limited their widespread implementation. Evidence on how to sustain and scale such approaches is scant. This study responds to this gap by examining the experiences of South African health managers involved in the implementation of a task-shared counselling service for Project MIND.

Objectives

To qualitatively describe managers’ experiences of implementing the MIND programme and their insights into potential strategies for supporting sustained implementation.

Methods

Two focus group discussions (FGDs) and eight in-depth interviews (IDIs) were conducted with managers of urban and rural primary care facilities in the Western Cape province. All managers were female and 30–50 years old. FGDs and IDIs used an identical semi-structured topic guide to explore the experiences of the MIND programme and perceived barriers to sustained implementation. Normalisation process theory (NPT) guided the thematic analysis.

Results

Four themes emerged that mapped onto the NPT constructs. First, managers noted that their relational work with staff to promote support for the intervention and reduce resistance was key to facilitating implementation. Second, managers emphasised the need for staff reorientation and upskilling to foster openness to mental health practice and for adequate time for quality counselling. Third, managers underscored the importance of strengthening linkages between the health and social service sectors to facilitate delivery of comprehensive mental health services. Finally, managers recommended ongoing monitoring of the service and communication about its impacts as strategies for supporting integration into routine practice.

Conclusions

Findings contribute to the emerging literature on strategies to support implementation of task-shared interventions in low- and middle-income countries. The findings highlight the leadership role of managers in identifying and actioning these strategies. Investing in managers’ capacity to support implementation of psychological interventions is critical for scale-up of these mental health innovations.

KEYWORDS:

• Psychological interventions
• global mental health
• implementation strategy
• low- and-middle-income countries

Responsible Editor Maria Emmelin

Responsible Editor Maria Emmelin

Acknowledgments

We thank all health managers and community health workers who participated in the study. We also acknowledge the assistance of Yuche Jacobs, Nombuso Moshiga and Lesley-Ann Erasmus-Claasen in implementing the Project MIND trial.

Author contributions

CBS and BM conceptualised the study. CBS and PPW conducted interviews and analysis and prepared the first draft which was reviewed by all authors. PPW was the second coder. JK and HM provided health systems expertise and facilitated engagement with managers. All authors contributed to the writing of the manuscript, edited various versions, and approved the final manuscript before submission.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethics and consent

Ethical approval was granted by the South African Medical Research Council (EC 004-2/2015), the University of Cape Town (089/2015) and the Western Cape Department of Health (WC2016_RP6_9). The MIND trial is registered with the Pan-African Clinical Trials Registry (PACTR201610001825403). Written informed consent for the FGDs and IDIs was obtained from each participant prior to collecting any data. All personal identifiers were removed from recorded interviews and transcribed scripts.

Paper context

This study presents health care managers’ insights into strategies for overcoming barriers to implementation of a task-shared psychological intervention within South African primary care facilities. These insights were used to develop a multicomponent strategy for supporting sustained implementation of the service. Findings contribute to the emerging literature on implementation strategies for mental health innovations in low- and middle-income countries. Findings may help others grappling with how to support implementation of evidence-based interventions in these settings.

Additional information

Funding

This study is funded jointly by the British Medical Research Council, Wellcome Trust, Department for International Development, the Economic and Social Research Council, the Global Challenges Research Fund (MR/M014290/1; Myers) and through funding from the South African Medical Research Council’s Office of AIDS and TB Research. CBS was partially supported as a postdoctoral fellow by funding from the South African Medical Research Council (SAMRC) through its Division of Research Capacity Development under the Intra-Mural Postdoctoral Fellowship Programme via funding from the South African National Treasury. The content of this manuscript is the sole responsibility of the authors and does not necessarily represent the official views of the funder.