Table 2 Characteristics of included evidence-based task-sharing mental health intervention studies (N = 28 Studies from 37 articles)
Author (year) | Countr(ies) | Mental health conditions | Task-sharing model (provider and intervention type) | Implementation stage | How barriers and facilitators were assessed or derived | Key barriers reported | Key facilitators reported |
|---|---|---|---|---|---|---|---|
Common mental disorders (CMDs) only | |||||||
Pacichana-Quinayáz et al. (2016) [47] | Colombia | CMDs | CHWs deliver Common Elements Treatment Approach (CETA) to Afro-Colombian victims of violence | Implementation | Assessed through in-depth interviews with providers and program administrators | Organization: Structure & materials MH system: Infrastructure Societal: Historical & political context | Client: Skills & self-efficacy Intervention: Format |
Chatterjee et al. (2008) [48] | India | CMDs | Lay counselors lead collaborative stepped care intervention MANAS project (psychoeducation, antidepressants, group IPT) for CMDs in primary settings | Preparation | Assessed through interviews with providers, community members in exploration, preparation, and pilot phases | Client: Other personal attributes Intervention: Timing, duration, frequency; format | Intervention: Task-sharing provider (+peer) role; setting |
Patel et al. (2010)a [6] | India | CMDs | Lay counselors in primary care provide collaborative stepped-care intervention | Implementation | Discussed in context of study results (quantitative) | Intervention: Complexity Organization: Implementation climate | Intervention: Task-sharing provider (+peer) role Organization: Implementation climate |
Patel et al. (2011)a [49] | India | CMDs | Lay counselors in primary care provide collaborative stepped-care intervention | Implementation | Discussed in context of study results (quantitative) | N/A | Provider: Motivation/optimism |
Shinde et al. (2013)a [50] | India | CMDs | Lay counselors lead collaborative stepped care intervention MANAS project (psychoeducation, antidepressants, group interpersonal therapy) for CMDs in primary settings | Implementation | Assessed through qualitative evaluation: semi-structured interviews (SSIs) with users at two time points | Intervention: Cost (client) | Provider: Skills & self-efficacy Intervention: Task-sharing provider (+peer) role |
Spagnolo et al. (2018) [51] | Tunisia | CMDs | PHCPs trained on mhGAP-based intervention to improve mental health competencies and skills | Implementation | Assessed through case study including SSIs with providers | Provider: Skills & self-efficacy; KABI Intervention: Intervention source & rationale Societal: Historical & political context | Provider: Skills & self-efficacy Intervention: Training, supervision, integration |
Maulik et al. (2017) [52] | India | CMDs | CHWs identify CMDs, treated by PHCPs using mhGAP guidelines | Implementation | Assessed through mixed methods pre-post evaluation using quantitative service usage analytics | Client: KABI Intervention: Timing, duration, frequency | Intervention: Setting; Training, supervision, integration |
Tewari et al. (2017)a [53] | India | CMDs | CHWs identify CMDs, treated by PHCPs mhGAP guidelines | Implementation | Assessed through mixed methods pre-post evaluation using quantitative service usage analytics and in-depth interviews and focus group discussions with stakeholders | Client: Other personal attributes Societal: Economic conditions Stigma: Self-stigma | Client: Motivation/optimism; KABI Intervention: Task-sharing provider (+peer) role; setting |
Shields et al. (2016) [54] | India | CMDs | Allopathic mental health practitioners and faith-based healers cooperate to detect and treat mental health patients via pharmacotherapy | Preparation | Assessed through mixed data: quantitative user characteristics, SSIs with users, caregivers, providers | Organization: Structure & materials MH System: Human resources Stigma: Fam/Comm stigma | Client: Motivation/optimism Intervention: Task-sharing provider (+peer) role; training, supervision, integration |
Sibeko et al. (2018) [55] | South Africa | CMDs | CHWs trained on culturally adapted mhGAP program to provide chronic support including for mental illness | Preparation | Discussed in context of post-training evaluation of provider's knowledge and skills | Stigma: Provider stigma | Intervention: Engagement & reinforcements Organization: Structure & materials |
Murray et al. (2014) [56] | Iraq, Thailand | CMDs (Depression, Anxiety, Traumatic stress) | Lay counselors deliver CETA | Implementation | Discussed in context of intervention development | Intervention: Complexity Organization: Structure & materials MH System: Infrastructure | Provider: Social role & identity Intervention: Engagement & reinforcement; Packaging, adaptability, trialability |
Abas et al. (2016) [57] | Zimbabwe | CMDs (Depression, others) | Female CHWs deliver Problem-Solving Therapy (PST) during home visits (‘Friendship Bench’) | Sustainment | Assessed with focus group discussions and in-depth interviews with users, providers, program staff | Client: Other personal attributes Provider: Social role & identity Intervention: Training, supervision, integration | Provider: Social role & identity Intervention: Task-sharing provider (+peer) role; Setting |
Chibanda et al. (2011)a [58] | Zimbabwe | CMDs (depression, others) | Female CHWs deliver Problem-Solving Therapy (PST) during home visits (“Friendship Bench”) | Preparation | Assessed with mixed methods including questionnaire and for providers | N/A | Provider: Social role & identity Intervention: Task-sharing provider (+peer) role; setting |
Chibanda et al. (2017)a [59] | Zimbabwe | CMDs (depression, others) | Female CHWs deliver Problem-Solving Therapy (PST) during home visits (“Friendship Bench”) | Preparation | Assessed with SSIs with providers and clients post-intervention | Client: Other personal attributes Intervention: Setting | Provider: Social role & identity; skills & self-efficacy Intervention: Task-sharing provider (+peer) role |
Woods-Jaeger et al. (2017) [60] | Kenya, Tanzania | CMDs (PTS, grief) | Lay counselors deliver trauma-focused Cognitive Behavioral Therapy (TF-CBT) | Sustainment | Assessed through SSIs with providers | Client: Other personal attributes Intervention: Timing, duration, frequency Fam/Comm: Community | Provider: KABI; Skills & self-efficacy Intervention: Packaging, adaptability, trialability |
Dawson et al. (2016) [61] | Kenya | CMDs (PTSD, psychological distress) | CHWs deliver Problem Management Plus (PM+) for adults impacted by adversity to women in the community | Implementation | Discussed in context of intervention study results | Fam/Comm: Community | Intervention: Training, supervision, integration |
O’Donnell et al. (2014) [62] | Tanzania | CMDs (PTSD) | Lay counselors deliver group-based Cognitive Behavioral Therapy (CBT) to children with symptoms of grief and/or traumatic stress | Implementation | Discussed in context of intervention study results | N/A | Provider: Other personal attributes Intervention: Training, supervision, integration |
Common mental disorders (CMDs) and comorbid conditions | |||||||
Udedi et al. (2018) [63] | Malawi | CMDs with HIV (depression) | PHCPs, nurses, and CHWs screen and detect using algorithm-based care for depression (ABC-D) and treat with PST among patients living with HIV | Implementation | Assessed through stakeholder meetings, site visits, trainings | Provider: Skills & self-efficacy MH system: Infrastructure; human resources | Intervention: Task-sharing provider (+peer) role; engagement & reinforcements Organization: Implementation climate |
Depression only | |||||||
Indu et al. (2018) [64] | India | Depression | PHCPs and health workers delivered psychosocial and pharmacological treatment to women with depression | Implementation | Discussed in context of intervention study results | Client: Other personal attributes Intervention: Engagement & reinforcements | Intervention: Setting; timing, duration, frequency; cost |
Chowdhary et al. (2016) [65] | India | Depression | Lay counselors deliver treatment to patients with severe depression with CBT and mhGAP guidelines | Preparation; implementation | Assessed as part of intervention development, through focus group discussions with providers and in-depth interviews with supervisors and users | Intervention: Setting; timing, duration, frequency; packaging, adaptability, trialability | Provider: Other personal attributes Intervention: Intervention source & rationale; Training, supervision, integration |
Adewuya et al. (2017) [66] | Nigeria | Depression | PHC workers (including doctors, nurses/midwives, community health officers, and community health extension workers) trained to detect depression among primary care patients using mhGAP guidelines | Preparation | Assessed through questionnaires administered to health workers collecting data on diagnoses and perceived challenges | Provider: KABI Organization: Clinical resources MH system: Human resources | Intervention: Intervention source & rationale Fam/Comm: Community |
Petersen et al. (2012a) [11] | South Africa | Depression | CHWs deliver community-engaged mental health care | Preparation | Assessed through focus group discussions with providers and in-depth interviews with stakeholders (users, community members, mental health professionals), post-intervention | Provider: Social role & identity Societal: Sociocultural norms; historical & political context | Intervention: Format; engagement & reinforcements |
Petersen et al. (2012b)a [67] | South Africa | Depression | CHWs deliver adapted, manualized group-based Interpersonal Therapy (IPT) for female primary care patients screened with depression | Implementation | N/A | Client: Goals, health & emotions; other personal attributes | Intervention: Task-sharing provider (+peer) role; complexity; packaging, adaptability, trialability |
Tomlinson et al. (2015) [68] | South Africa | Depression | CHWs provide a home visit, Cognitive Behavioral Therapy (CBT), and psychoeducation-based intervention to women with antenatal depression | Implementation | Discussed in context of study results | N/A | Intervention: Intervention source & rationale; timing, duration, frequency Organization: Implementation climate |
elohilwe et al. (2019) [69] | South Africa | Depression | Lay counselors provide group CBT-based mhGAP intervention to depressed patients screened at primary care clinics | Implementation | Assessed with process evaluation consisting of in-depth interviews with stakeholders | Intervention: Engagement & reinforcements | Intervention: Task-sharing provider (+peer) role; setting; training, supervision, integration |
Rahman et al. (2008) [70] | Pakistan | Depression | CHWs provide cognitive CBT-based intervention (Thinking Healthy Program) to mothers with depression | Implementation | Discussed in context of intervention development process and study results | N/A | Provider: Social role & identity Intervention: Training, supervision, integration; packaging, adaptability, trialability |
Everitt-Penhale et al. (2019) [71] | South Africa | Depression | Nurses deliver an adapted CBT treatment for medication adherence and depression to individuals with HIV | Implementation | Assessed through SSIs with users post-intervention | N/A | Client: KABI Provider: Skills & self-efficacy Intervention: Task-sharing provider (+peer) role |
Matsuzaka et al. (2017) [72] | Brazil | Depression | CHWs provide Interpersonal Counseling (IPC; based on IPT) to treat depression | Implementation | Discussed in context of study results | Fam/Comm: Community Societal: Religion/spirituality Stigma: Fam/Comm stigma | Provider: Goals, health & emotions; KABI Intervention: Training, supervision, integration |
Munodawafa et al. (2017) [73] | South Africa | Depression: Perinatal | CHWs deliver psychosocial program (based on CBT, IPT, PST principles) for perinatal depression, part of AFFIRM in South Africa | Preparation | Assessed through SSIs with providers post-intervention | Client: Other personal attributes Provider: Skills & self-efficacy Fam/Comm: Community | Intervention: Timing, duration, frequency; cost Organization: Structure & materials |
Nyatsanza et al. (2016)a [74] | South Africa | Depression: Perinatal | CHWs deliver psychosocial program (based on CBT, IPT, PST principles) for perinatal depression, part of AFFIRM in South Africa | Exploration | N/A | Client: KABI Provider: Skills & self-efficacy Organization: Clinical Resources | Intervention: Intervention source & rationale; Training, supervision, integration; Engagement & reinforcements |
Zafar et al. (2014) [75] | Pakistan | Depression: Perinatal | CHWs deliver CBT-based maternal psychosocial wellbeing intervention (Five Pillars Approach) | Implementation | Assessed through qualitative data collected in three phases (adaptation, formative, implementation) including focus group discussions and in-depth interviews with various stakeholders | Client: Other personal attributes Fam/Comm: Family Societal: Sociocultural norms | Intervention: Timing, duration, frequency; format; design quality & packaging |
Serious mental illnesses (SMIs) | |||||||
Jordans et al. (2017) [76] | Nepal | SMI: Psychosis, epilepsy | PHCPs deliver mhGAP treatment | Implementation | Discussed in context of study results (quantitative) | N/A | Intervention: Intervention source & rationale; task-sharing provider (+peer) role; training, supervision, integration |
Serious mental illnesses (SMIs) and common mental disorders (CMDs) | |||||||
Fils-Aimé et al. (2018) [77] | Haiti | MNS | Team including B-level psychologists, PHCPs, and CHWs treat patients with MNS disorders via mobile clinics using mhGAP guidelines and IPT | Exploration | Assessed through mixed quantitative data (quality improvement questionnaire) and qualitative (interview with implementer) | Intervention: Timing, duration, frequency Stigma: Fam/Comm stigma | Intervention: Setting; training, supervision, integration |
Hanlon et al. (2014) [78] | Ethiopia, India, Nepal, South Africa, Uganda | MNS | CHWs help deliver mhGAP-informed interventions in their communities | Preparation | Assessed through qualitative ad-hoc “situation analysis tool” filled out by experts | Client: Other personal attributes Organization: Implementation climate MH System: Infrastructure | N/A |
Mendenhall et al. (2014)a [79] | Ethiopia, India, Nepal, South Africa, Uganda | MNS | CHWs help deliver mhGAP-informed interventions in their communities | Preparation | Assessed through focus group discussions and in-depth interviews with stakeholders | Provider: Skills & self-efficacy Intervention: Training, supervision, integration MH system: Infrastructure | Intervention: Intervention source & rationale; cost |
Gureje et al. (2015) [80] | Nigeria | MNS: Depression, psychosis, alcohol use, epilepsy | PHCPs detect and manage MNS using the mhGAP model | Implementation | Discussed in context of post-training quantitative and qualitative data (observations) | MH System: Infrastructure; human resources Stigma: Fam/Comm stigma | Intervention: Engagement & reinforcements; packaging, adaptability, trialability; training, supervision, integration |
Khoja et al. (2016) [81] | Afghanistan | MNS: Depression, psychosis, PTSD, and substance use | CHWs deliver mhGAP-based intervention to provide mental health consultation and referral to remote communities | Implementation | Discussed in context of intervention implementation and study results | N/A | Intervention: Cost; complexity Organization: Implementation climate |