Barriers and facilitators of retention to a psychosocial intervention among adolescents with common mental disorders in Harare: a qualitative study
Background: Common mental disorders, which account for a major proportion of disease burden globally, can have an onset in childhood and adolescence. The Friendship Bench is a psychosocial intervention aimed at reducing and treating common mental disorders and is provided at 42 City health department clinics in Harare, Zimbabwe. Yet research and anecdotal evidence suggests that adolescents do not remain engaged in this intervention. Reasons for lack of engagement often include demographic, psychosocial, logistical and cultural factors. Understanding the barriers and facilitators to retention amongst adolescents would help to improve retention and mental health outcomes among this vulnerable population. The aim of this study is to explore the barriers and facilitators that adolescents with common mental disorders experience in retention to the Friendship Bench. Methods: A qualitative study was conducted among adolescents who were aged 15-17 years at the time of accessing the Friendship Bench service. Twelve adolescents who visited the Friendship Bench between June 2016 and December 2017 were recruited using purposive sampling. Theoretical saturation was not reached due to recruitment barriers. The adolescents were recruited from five primary care clinics which were selected based on ease of access to the researcher. Semi-structured interviews with open-ended questions were employed to explore the barriers and facilitators adolescents faced in accessing the service, guided by Andersen’s Behavioural Model of Health services use. The interviews were conducted in a space convenient to the participant or at the participant’s local clinic grounds, and they lasted approximately 30 minutes. The adolescents were interviewed by two qualitative researchers and given the option on whether to be interviewed in Shona or English. Data was analysed using thematic analysis with NVivo 12. Results: Barriers to returning to the service included lack of privacy, school or work commitments, poor social support systems, and lack of a nearby clinic, resulting in having to travel far to access clinic services. Some participants who felt better saw no need to continue coming for sessions. Other emerging barriers found included lay health workers’ (LHWs’) attributes and forgetfulness. Important facilitators to retention included knowledge of what depression is, family support, experience with depressive symptoms, a nearby clinic, having other reasons to visit the clinic, and LHW attributes. Discussion: Given the study’s findings, it is recommended that mobile Friendship Benches and phonebased counselling applications be introduced, in addition to recruiting younger LHWs and male LHWs in order to improve retention. Provision should be made to locate Friendship Benches in more private or youth friendly spaces, to raise awareness on mental health issues in schools and communities and to involve parents and caregivers in the intervention development process. Further investigation into barriers and facilitators into psychosocial interventions is required, particularly with LHWs in order to get their perspective. Conclusion: By identifying barriers and facilitators that adolescents experience, this study contributes towards improving access and retention of adolescents to the Friendship Bench, as well as other psychosocial interventions aimed at adolescents in Zimbabwe.
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Department of Psychiatry and Mental Health