Abstract
BackgroundIntegration of depression services into infectious disease care is feasible, acceptable, and effective in sub-Saharan African settings. However, while the region shifts focus to include chronic diseases, additional information is required to integrate depression services into chronic disease settings. We assessed service providers’ views on the concept of integrating depression care into non-communicable diseases’ (NCD) clinics in Malawi. The aim of this analysis was to better understand barriers, facilitators, and solutions to integrating depression into NCD services.MethodsBetween June and August 2018, we conducted nineteen in-depth interviews with providers. Providers were recruited from 10 public hospitals located within the central region of Malawi (i.e., 2 per clinic, with the exception of one clinic where only one provider was interviewed because of scheduling challenges). Using a semi structured interview guide, we asked participants questions related to their understanding of depression and its management at their clinic. We used thematic analysis allowing for both inductive and deductive approach. Themes that emerged related to facilitators, barriers and suggested solutions to integrate depression assessment and care into NCD clinics. We used CFIR constructs to categorize the facilitators and barriers.ResultsAlmost all providers knew what depression is and its associated signs and symptoms. Almost all facilities had an NCD-dedicated room and reported that integrating depression into NCD care was feasible. Facilitators of service integration included readiness to integrate services by the NCD providers, availability of antidepressants at the clinic. Barriers to service integration included limited knowledge and lack of training regarding depression care, inadequacy of both human and material resources, high workload experienced by the providers and lack of physical space for some depression services especially counseling. Suggested solutions were training of NCD staff on depression assessment and care, engaging hospital leaders to create an NCD and depression care integration policy, integrating depression information into existing documents, increasing staff, and reorganizing clinic flow.ConclusionFindings of this study suggest a need for innovative implementation science solutions such as reorganizing clinic flow to increase the quality and duration of the patient-provider interaction, as well as ongoing trainings and supervisions to increase clinical knowledge.Trial registration This study reports finding of part of the formative phase of “The Sub-Saharan Africa Regional Partnership (SHARP) for Mental Health Capacity Building—A Clinic-Randomized Trial of Strategies to Integrate Depression Care in Malawi” registered as NCT03711786
Highlights
Integration of depression services into infectious disease care is feasible, acceptable, and effective in sub-Saharan African settings
Our study found that all 10 hospitals were providing non-communicable diseases’ (NCD) care, and all but two had a dedicated room for NCD services
NCD providers reported that limited knowledge and lack of training regarding screening with validated depression tools and systematic depression care, inadequacy of both human and material resources, high workload experienced by the NCD providers and lack of physical space for depression services would hinder integration of depression into NCD care at their facilities
Summary
Integration of depression services into infectious disease care is feasible, acceptable, and effective in sub-Saharan African settings. We assessed service providers’ views on the concept of integrating depression care into non-communicable diseases’ (NCD) clinics in Malawi. The aim of this analysis was to better understand barriers, facilitators, and solutions to integrating depression into NCD services. As the fifth-leading cause of disability-adjusted life years, mental illness accounts for nearly a third of years lived with disability [1]. This problem is especially high in low and middle-income countries (LMICs), which account for approximately three-quarters of this burden [2] and where depression is the most commonly presenting mental illness [1, 3]. Reserving mental health resources for the only most severely affected creates a gap in service across lower levels of the healthcare system, potentially leaving many individuals with less severe cases of depression undiagnosed and untreated
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