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Table 2 Characteristics of included evidence-based task-sharing mental health intervention studies (N = 28 Studies from 37 articles)

From: Barriers and facilitators to implementation of evidence-based task-sharing mental health interventions in low- and middle-income countries: a systematic review using implementation science frameworks

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
  1. CMD Common mental disorders, SSI Semi-structured interview, MNS Mental and neural systems disorders, MH Mental health, PHCPs Primary health care providers, CHWs Community health workers, KABI Knowledge, attitude, behavior, and intentions, Fam/Comm Family/community
  2. aArticles with Author (year) in italics refer to the same study as the last-listed non-italicized entry