03219nas a2200349   4500000000100000008004100001260004400042653000900086653001900095653002900114653001500143653002200158100001300180700001300193700001500206700001700221700001100238700001200249700001900261700001400280700001600294700001800310700001400328700001600342700001600358245016700374856009000541300000800631490000700639520220900646022001402855       2024                            d  bSpringer Science and Business Media LLC10aCFIR10aSustainability10aPublic mental healthcare10aMozambique10aSub-Sahara Africa1 aMootz JJ1 ade Vos L1 aStockton M1 aSweetland AC1 aKann B1 aSeijo C1 aBezuidenhout C1 aSuleman A1 aFeliciano P1 ados Santos PF1 aShelton R1 aPalinkas LA1 aWainberg ML00aProviders’ perspectives of barriers and facilitators to scale-up of mental health care in the public health delivery system of Mozambique: a qualitative inquiry  uhttps://bmchealthservres.biomedcentral.com/counter/pdf/10.1186/s12913-024-11594-9.pdf  a1-90 v243 a<p><strong>Background:</strong> A central challenge to closing the mental health treatment gap in low- and middle-income countries (LMICs) is determining the most effective pathway for delivering evidence-based mental health services. We are conducting a cluster-randomized, Type 2 hybrid implementation-effectiveness trial across 20 districts of Mozambique called the Partnerships in Research to Implement and Disseminate Sustainable and Scalable EBPs (PRIDE) program. Following training of nonspecialized providers in facilitation of evidence-based treatments for mental health and informed by the Consolidated Framework for Implementation Research (CFIR), we identified how PRIDE compares to care as usual and the perceived barriers and facilitators of implementation and modifications needed for widescale service delivery and scale-up.</p>

<p><strong>Methods:&nbsp;</strong>We conducted rapid ethnographic assessment using freelisting among 34 providers, followed by four focus group discussions (n=29 participants) with a subsample of psychiatric technicians and primary care providers from 14 districts in Nampula Province. We used Thematic Analysis to inductively apply open codes to transcripts and then deductively applied the CFIR domains and constructs to organize open codes.</p>

<p><strong>Results:&nbsp;</strong>The main Outer Setting constructs relevant to implementation were recognition that patient mental health needs were significant. Additionally, numerous community-level characteristics were identified as barriers, including distance between clinics; shortage of providers; and low awareness of mental health problems, stigma, and discrimination among community members towards those with mental health struggles. The PRIDE program was perceived to offer a relative advantage over usual care because of its use of task-sharing and treating mental illness in the community. PRIDE addressed Inner Setting barriers of having available resources and training and provider low self-efficacy and limited knowledge of mental illness. Providers recommended leadership engagement to give support for supervision of other task-shared professionals delivering mental healthcare.</p>
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