Mwale Owen, Kasambala Caren, Houde Amruta, Mpinga Kondwani, Kayira Waste, Harawa Michael, Kamwiyo Myrrah, Isaacs Rachel, Nhlema Basimenye, Ruderman Todd, Liwimbi Olive, Udedi Michael, Kelly Ksakrad, McBain Ryan K
APZU, Partners In Health, Neno, Malawi.
Ministry of Health, Zomba Mental Hospital, Zomba, Malawi.
Glob Health Action. 2025 Dec;18(1):2500785. doi: 10.1080/16549716.2025.2500785. Epub 2025 May 9.
Major depressive disorder (MDD) frequently co-occurs with other medical conditions. Care integration and task shifting are two frameworks that may strengthen person-centered care among individuals with MDD and comorbid diagnoses, including for adults with limited access to healthcare resources living in rural settings within sub-Saharan Africa.
We assessed the acceptability and feasibility of group psychotherapy (Problem Management Plus [PM+]) integrated into chronic healthcare services in Neno District, based on key informant (KI) interviews with clients who received PM+ services from local counselors.
We conducted in-depth interviews with 31 KIs, comprising adult patients participating in group PM+ in rural Malawi. The interview covered facets such as knowledge acquisition, logistical considerations for organizing PM+ sessions, selection of appropriate venues, session format, and overall perceived acceptability. Themes were identified through thematic content analysis.
We identified five emergent themes: limited prior awareness and understanding of MDD, positive elements of the PM+ service delivery model, patients' perceived effectiveness of PM+, logistical challenges with effectively engaging PM+, and positive views on acceptability of PM+. Findings revealed a strong appreciation and enthusiasm for PM+, although KIs noted areas for improvement - including lengthy travel times to receive PM+, limited compensation and privacy, and counselors arriving late.
Insights from clients underscore the potential utility of group PM+ as a task-shifted model of MDD care that can be integrated into existing service packages in resource-limited settings, as well as opportunities for improvements such as reducing travel time to care and identifying venues with greater client privacy.
ClinicalTrials.gov identifier: NCT04777006.
重度抑郁症（MDD）常与其他医疗状况同时出现。护理整合和任务转移是两个框架，可能会加强对患有MDD和共病诊断的个体的以患者为中心的护理，包括居住在撒哈拉以南非洲农村地区、获得医疗资源有限的成年人。
基于对从当地咨询师那里接受问题管理强化疗法（PM+）服务的客户进行的关键信息提供者（KI）访谈，我们评估了在Neno区将团体心理治疗（问题管理强化疗法[PM+]）整合到慢性医疗服务中的可接受性和可行性。
我们对31名关键信息提供者进行了深入访谈，他们包括参与马拉维农村地区团体PM+治疗的成年患者。访谈涵盖了知识获取、组织PM+治疗课程的后勤考虑、合适场地的选择、课程形式以及总体感知的可接受性等方面。通过主题内容分析确定主题。
我们确定了五个新出现的主题：对MDD先前的认识和理解有限、PM+服务提供模式的积极因素、患者对PM+有效性的感知、有效开展PM+治疗的后勤挑战以及对PM+可接受性的积极看法。研究结果显示对PM+有强烈的赞赏和热情，尽管关键信息提供者指出了需要改进的方面——包括接受PM+治疗的路途时间过长、补偿有限和隐私问题，以及咨询师迟到。
客户的见解强调了团体PM+作为一种MDD护理任务转移模式的潜在效用，这种模式可以整合到资源有限环境中的现有服务包中，同时也强调了改进的机会，如减少就医路途时间和确定更能保护客户隐私的场地。
ClinicalTrials.gov标识符：NCT04777006。
