Knowledge From the Afrikan World, For the World

PMC Articles

Barriers and facilitators to implementing a task-sharing mental health intervention for Sickle Cell Disease populations in low- and middle-income countries: a qualitative analysis using the Consolidated Framework for Implementation Research (CFIR)

PMCID: PMC12303879

PMID: 40735207

Abstract

Background People living with Sickle Cell Disease (SCD) experience higher rates of common mental disorders (CMD). There is an alarming treatment gap in the provision of adequate mental health services for CMDs in low- and middle-income countries (LMIC). One solution is the implementation of task-sharing interventions such as the Friendship Bench which utilizes concepts of problem-solving therapy (PST). This investigation uses a qualitative study design to evaluate the acceptability and feasibility of implementing a PST-based task-sharing mental health intervention for SCD populations in LMICs using the Consolidated Framework for Implementation Research (CFIR). Methods Purposive, convenience, and snowball sampling strategies were utilized to identify study participants targeting two key groups: (1) SCD stakeholders and (2) global mental health (GMH) experts. Key informant interviews were conducted between July–September 2024. A framework analysis approach was used by iterative deductive and inductive coding. Results were analyzed and synthesized into key themes and patterns, stratified by participant type to highlight variations across stakeholder perspectives. Results A total of 16 participants completed key informant interviews: 10 (62.5%) were SCD stakeholders and 6 (37.5%) were GMH experts. The geographic scope of work spans 12 countries, with 9 (75.0%) located in sub-Saharan Africa. Both SCD stakeholders and GMH experts expressed a shared consensus on the urgent need for mental health care tailored to SCD populations in LMIC settings. Implementing a task-sharing mental health intervention was viewed as acceptable, however, perspectives on its feasibility varied. Identified barriers included the absence of robust health care systems, limited prioritization and funding for mental health, a shortage of trained mental health professionals, and the pervasive stigma surrounding both SCD and mental health conditions. Conversely, facilitators included the potential receptiveness of SCD populations to mental health care delivered by task-sharing providers, the integration of mental health services within SCD clinics to avoid external referrals, and the cultural adaptability of PST-based interventions. Discussion Challenges associated with implementing task-sharing mental health interventions stem from larger systemic issues within healthcare systems and the integration of care. Task-sharing represents a critical component of the solution, but requires complementary, coordinated efforts to strengthen the health system holistically.

Full Text

Sickle Cell Disease (SCD) is a genetic blood disorder that leads to several chronic medical complications (1, 2). SCD is a lifelong disease with an overall lower quality of life, higher use of medical resources, and increased economic burden for patients, caregivers, and the healthcare system (1–3). The global burden of SCD is a significant public health issue with high mortality rates among those living in low- and middle-income countries (LMIC) (1, 4, 5). Over 8 million people were living with SCD globally in 2021, with more than 75% of whom residing in countries in sub-Saharan Africa (1). Nigeria reports the largest population affected with SCD and the highest burden of the disease globally (6–8).
Evidence-based interventions for SCD management primarily target SCD treatment goals including relieving symptoms, avoiding pain episodes, and preventing further medical complications (1, 5). Health-related quality of life (HRQoL) is a commonly utilized indicator to measure self-perceived health status, physical health, mental health, and overall function among those living with chronic conditions (9). People living with SCD experience poorer HRQoL overall, with many SCD providers and SCD researchers advocating that interventions for SCD management must improve HRQoL in addition to standard SCD treatment goals (10–12).
Experiencing mental health challenges is common in people living with SCD. The most prevalent psychiatric symptoms are depression and anxiety, collectively referred to as common mental disorders (CMD) (12–18). Depression rates in SCD adults globally report an average prevalence of 24% (as high as 85%) (19) compared to the global average of adults with depression of 5% (20). Additionally, there is strong evidence between pain frequency and higher depressive and anxiety symptoms (21). Social determinants of health that contribute to SCD-related mental health challenges include food and housing insecurity, unequal access to healthcare, and medical discrimination including accusations that patients are seeking recreational drugs when they are actually seeking relief from pain (22). SCD patients also experience stigma from SCD which has a complex relationship to mental health conditions and psychosocial HRQoL (22–24). This stigma is often rooted in misconceptions of SCD (e.g., that the disease is contagious) and cultural beliefs around SCD (e.g., that the disease is a “punishment for ancestral sins”) (22). Additionally, emotional pain (pain resulting from psychological experiences) may be an important component of physical pain (25). These stressors of social determinants of health, stigma, and pain exacerbate the symptoms of CMDs for people living with SCD. This evidence points to the strong need to incorporate mental health support in SCD care and management.
Existing mental health interventions for SCD primarily highlight its use for pain management, with none specifically addressing CMDs and psychosocial HRQoL. Currently, mental health interventions for SCD fall under the categories of cognitive techniques, behavioral change techniques, increasing social support, and patient education, with innovative efforts to introduce digital-delivered (e.g., internet, mobile health) interventions. Cognitive Behavioral Therapy (CBT) is the predominant approach in mental health interventions for SCD, but outcome measures mainly focus on the management of pain (26–32).
There is a significant treatment gap in the provision of adequate mental health services for CMDs in LMICs. Up to 90% of individuals in need of mental health care do not receive it, and amongst those that utilize mental health services do not receive adequate treatment. This gap is driven by a severe shortage of mental health professionals, high cost of and financial barriers to care, and the pervasive stigma associated with seeking help related to mental health issues (33–35). Estimates suggest that LMICs only have 1.4 mental health professionals per 100,000 people, (36, 37) highlighting the urgent need to address this disparity in the treatment of mental health.
One effective solution to closing this treatment gap is the implementation of task-sharing interventions, which aims to expand access to mental health care amongst the most vulnerable populations (38, 39). Task-sharing involves redistributing care traditionally provided by mental health specialists (e.g., psychologists and psychiatrists) to non-specialists, such as community or lay health workers (LHW), through structured training and supervision (40, 41). This strategy has been widely adopted in global mental health initiatives and has proven to be an effective means of increasing mental health service delivery in resource-constrained settings. However, while various task-sharing mental health interventions to address CMDs are well-documented in LMICs, much of the literature emphasizes the need for further scaling and broader implementation of these programs (42–44).
One prominent example of an evidence-based task-sharing intervention, the Friendship Bench, utilizes concepts of problem-solving therapy (PST), a structured, step-by-step approach that empowers individuals to identify their problems and develop workable solutions (45). The Friendship Bench intervention was originally developed in Zimbabwe and has been extensively studied and demonstrated effectiveness in reducing CMDs broadly in other LMICs including Kenya, Malawi, and Tanzania (46–55). Delivered through six sessions by trained LHWs, the intervention uses a manualized script and is implemented within primary care facilities under the supervision of a mental health professional. The full description of the intervention and how it was developed are described elsewhere (51, 56, 57).
Current guidelines for the treatment and management of SCD lack a comprehensive approach to address the mental health needs of people living with this condition. The National Heart, Lung, and Blood Institute (NHLBI) published the Evidence-Based Management of Sickle Cell Disease: Expert Panel Report, 2014, (58) the World Health Organization (WHO) African Region WHO Sickle Cell Disease Package of Interventions, (59) the Sickle Pan-African Research Consortium (SPARCo) Standards of Care for Sickle Cell Disease in Sub-Saharan Africa, (60) the American Society of Hematology Clinical Practice Guidelines on Sickle Cell Disease, (61) the European Hematology Association Hemoglobinopathies Initiatives, (62) and the British Society for Hematology Guidelines for the Management of Sickle Cell Disease (63) provide detailed guidance to standardize and enhance the management of SCD. These guidelines address critical components of SCD care, such as pain management, the prevention of complications, and the use of disease-modifying therapies like hydroxyurea. However, these guidelines lack a clear and comprehensive emphasis on mental health care for people living with SCD.
Key informant interviews drew from a larger NHLBI funded study “mAnaging siCkle CELl disEase through incReased AdopTion of hydroxyurEa in Nigeria” (ACCELERATE), an implementation trial with an embedded clinical trial which examines the adoption of hydroxyurea as an evidence-based intervention to manage SCD in Nigeria. The study is a partnership between New York University (NYU) School of Global Public Health and the Center of Excellence for Sickle Cell Research and Training at the University of Abuja (CESRTA) in Abuja, Nigeria. CESRTA is the central administrative hub of SCD providers and researchers from 25 healthcare centers that comprise the Sickle Pan African Research Consortium NigEria Network (SPARC-NEt). In turn, SPARC-NEt is part of SPARCo, a larger consortium comprised of 7 countries—Ghana, Mali, Nigeria, Tanzania, Uganda, Zambia, and Zimbabwe—whose mission is to develop research capacity for SCD across Africa (64). Ethics approvals for the key informant interviews were obtained as part of the larger ACCELERATE study by the Institutional Review Boards of NYU Langone Health and the University of Abuja Teaching Hospital, and the Nigerian National Health Research Ethics Committee.
The qualitative study utilized the Consolidated Framework on Implementation Research (CFIR), a widely recognized implementation science determinant framework that can be used to understand, guide, and evaluate the factors that influence the successful implementation of interventions, treatments, or policies (65). CFIR is the most commonly cited framework to assess implementation of single interventions (66). The framework was revised in response to recommendations aimed at enhancing its applicability across diverse settings (referred to as CFIR 2.0) (67). CFIR 2.0 consists of 39 constructs organized into 5 key domains: (1) Innovation, (2) Process, (3) Individuals, (4) Inner Setting, and (5) Outer Setting. These domains assess the multifaceted elements that influence the uptake/adoption and sustainability of interventions. In this study, CFIR provided a structured framework to analyze and interpret the findings from the key informant interviews, specifically in relation to the implementation of PST-based task-sharing mental health interventions.
A semi-structured interview guide was developed based on CFIR concepts utilizing the CFIR Interview Guide Tool (68) and with input from experts in qualitative study design (AL), SCD research (EP), and GMH research (AS). Key informant interviews were conducted between July 2024 to September 2024 via the ZOOM videoconference platform by the lead author (JP) who has extensive experience in qualitative research methods. To mitigate potential interviewer bias, JP utilized the semi-structured interview guide and conducted interviews with active listening and reflective. Interviews were audio recorded using a handheld recorder, transcribed verbatim by NYU Stream Transcription Service, and de-identified. Interview transcripts were uploaded to Dedoose qualitative software (Version 9.0.17, SocioCultural Research Consultants LLC, Los Angeles, California, 2021). Before the interview, participants completed a brief demographic survey via REDCap (69) which captured anonymized information on areas of expertise, professional roles, educational background, geographic scope of their work, and gender.
A framework analysis approach was used to qualitatively analyze the key informant interviews (70). Framework analysis is an iterative process that involves both deductive (theory-driven) and inductive (data that emerges) coding. The process included:
The geographic scope of work for all participants spans 12 countries in total, with 9 countries (75.0%) located in sub-Saharan Africa: Botswana, Cameroon, Democratic Republic of Congo, Ghana, Nigeria, South Africa, Tanzania, Uganda, and Zimbabwe. The remaining countries include Bolivia, Brazil, and Jamaica (see Figure 1). The country with the most representation of scope of work was Jamaica (31.3%), followed by Nigeria (25.0%). Some participants reported conducting specific work in these 12 countries as well as a general scope of work at the regional level including Africa (25.0%), Asia (12.5%), the Caribbean (25.0%), Latin America (12.5%), and globally (i.e., all regions) (6.3%). All participant characteristics are found in Table 1.
There was broad consensus among SCD stakeholders and GMH experts regarding the urgent need for mental health care tailored to SCD populations. While task-sharing mental health interventions were generally regarded as highly acceptable to address this need, perspectives on its feasibility were mixed (see Table 2).
Task-sharing mental health interventions are widely acknowledged and effectively utilized to address CMDs in LMICs (47). Adapting PST-based interventions for SCD populations was viewed as highly acceptable, however, feedback regarding their feasibility is mixed. It is noteworthy to observe that the challenges identified are not unique to SCD but common across many task-sharing mental health interventions. These challenges reflect broader systemic issues in health systems and the integration of care, which are essential for meeting mental health needs for individuals with chronic care conditions including SCD. Other considerations are what aspects of the Friendship Bench are most important for this population? Is it the physical bench? Is it the curriculum delivered by LHWs? These answers will help tailor task-sharing mental health interventions specific to SCD populations.
Findings from the interviews on improving mental health care is consistent with WHO advocacy for a collaborative care model, which integrates mental health treatment into primary care settings. In September 2025, the UN will host the “Fourth High-Level Meeting on Noncommunicable Diseases and Mental Health” aimed at discussing, defining, and committing to actionable national and policy recommendations that promote the integration of NCDs and mental health within national health financing systems (71, 72). While the focus of the meeting will be on NCDs such as cardiovascular diseases, diabetes, cancer, and chronic respiratory diseases, it may also pave the way for the inclusion of other NCDs, such as SCD. If global movements are mobilized, they could help address several of the barriers identified in the key informant interviews ultimately improving SCD care by integrating mental health services and advocating for comprehensive care. SCD care would improve for millions of people globally by incorporating mental health care and advocacy.

Sections

"[{\"pmc\": \"PMC12303879\", \"pmid\": \"40735207\", \"reference_ids\": [\"B1\", \"B2\", \"B1\", \"B3\", \"B1\", \"B4\", \"B5\", \"B1\", \"B6\", \"B8\"], \"section\": \"Introduction\", \"text\": \"Sickle Cell Disease (SCD) is a genetic blood disorder that leads to several chronic medical complications (1, 2). SCD is a lifelong disease with an overall lower quality of life, higher use of medical resources, and increased economic burden for patients, caregivers, and the healthcare system (1\\u20133). The global burden of SCD is a significant public health issue with high mortality rates among those living in low- and middle-income countries (LMIC) (1, 4, 5). Over 8 million people were living with SCD globally in 2021, with more than 75% of whom residing in countries in sub-Saharan Africa (1). Nigeria reports the largest population affected with SCD and the highest burden of the disease globally (6\\u20138).\"}, {\"pmc\": \"PMC12303879\", \"pmid\": \"40735207\", \"reference_ids\": [\"B1\", \"B5\", \"B9\", \"B10\", \"B12\"], \"section\": \"Introduction\", \"text\": \"Evidence-based interventions for SCD management primarily target SCD treatment goals including relieving symptoms, avoiding pain episodes, and preventing further medical complications (1, 5). Health-related quality of life (HRQoL) is a commonly utilized indicator to measure self-perceived health status, physical health, mental health, and overall function among those living with chronic conditions (9). People living with SCD experience poorer HRQoL overall, with many SCD providers and SCD researchers advocating that interventions for SCD management must improve HRQoL in addition to standard SCD treatment goals (10\\u201312).\"}, {\"pmc\": \"PMC12303879\", \"pmid\": \"40735207\", \"reference_ids\": [\"B12\", \"B18\", \"B19\", \"B20\", \"B21\", \"B22\", \"B22\", \"B24\", \"B22\", \"B25\"], \"section\": \"Introduction\", \"text\": \"Experiencing mental health challenges is common in people living with SCD. The most prevalent psychiatric symptoms are depression and anxiety, collectively referred to as common mental disorders (CMD) (12\\u201318). Depression rates in SCD adults globally report an average prevalence of 24% (as high as 85%) (19) compared to the global average of adults with depression of 5% (20). Additionally, there is strong evidence between pain frequency and higher depressive and anxiety symptoms (21). Social determinants of health that contribute to SCD-related mental health challenges include food and housing insecurity, unequal access to healthcare, and medical discrimination including accusations that patients are seeking recreational drugs when they are actually seeking relief from pain (22). SCD patients also experience stigma from SCD which has a complex relationship to mental health conditions and psychosocial HRQoL (22\\u201324). This stigma is often rooted in misconceptions of SCD (e.g., that the disease is contagious) and cultural beliefs around SCD (e.g., that the disease is a \\u201cpunishment for ancestral sins\\u201d) (22). Additionally, emotional pain (pain resulting from psychological experiences) may be an important component of physical pain (25). These stressors of social determinants of health, stigma, and pain exacerbate the symptoms of CMDs for people living with SCD. This evidence points to the strong need to incorporate mental health support in SCD care and management.\"}, {\"pmc\": \"PMC12303879\", \"pmid\": \"40735207\", \"reference_ids\": [\"B26\", \"B32\"], \"section\": \"Introduction\", \"text\": \"Existing mental health interventions for SCD primarily highlight its use for pain management, with none specifically addressing CMDs and psychosocial HRQoL. Currently, mental health interventions for SCD fall under the categories of cognitive techniques, behavioral change techniques, increasing social support, and patient education, with innovative efforts to introduce digital-delivered (e.g., internet, mobile health) interventions. Cognitive Behavioral Therapy (CBT) is the predominant approach in mental health interventions for SCD, but outcome measures mainly focus on the management of pain (26\\u201332).\"}, {\"pmc\": \"PMC12303879\", \"pmid\": \"40735207\", \"reference_ids\": [\"B33\", \"B35\", \"B36\", \"B37\"], \"section\": \"Introduction\", \"text\": \"There is a significant treatment gap in the provision of adequate mental health services for CMDs in LMICs. Up to 90% of individuals in need of mental health care do not receive it, and amongst those that utilize mental health services do not receive adequate treatment. This gap is driven by a severe shortage of mental health professionals, high cost of and financial barriers to care, and the pervasive stigma associated with seeking help related to mental health issues (33\\u201335). Estimates suggest that LMICs only have 1.4 mental health professionals per 100,000 people, (36, 37) highlighting the urgent need to address this disparity in the treatment of mental health.\"}, {\"pmc\": \"PMC12303879\", \"pmid\": \"40735207\", \"reference_ids\": [\"B38\", \"B39\", \"B40\", \"B41\", \"B42\", \"B44\"], \"section\": \"Introduction\", \"text\": \"One effective solution to closing this treatment gap is the implementation of task-sharing interventions, which aims to expand access to mental health care amongst the most vulnerable populations (38, 39). Task-sharing involves redistributing care traditionally provided by mental health specialists (e.g., psychologists and psychiatrists) to non-specialists, such as community or lay health workers (LHW), through structured training and supervision (40, 41). This strategy has been widely adopted in global mental health initiatives and has proven to be an effective means of increasing mental health service delivery in resource-constrained settings. However, while various task-sharing mental health interventions to address CMDs are well-documented in LMICs, much of the literature emphasizes the need for further scaling and broader implementation of these programs (42\\u201344).\"}, {\"pmc\": \"PMC12303879\", \"pmid\": \"40735207\", \"reference_ids\": [\"B45\", \"B46\", \"B55\", \"B51\", \"B56\", \"B57\"], \"section\": \"Introduction\", \"text\": \"One prominent example of an evidence-based task-sharing intervention, the Friendship Bench, utilizes concepts of problem-solving therapy (PST), a structured, step-by-step approach that empowers individuals to identify their problems and develop workable solutions (45). The Friendship Bench intervention was originally developed in Zimbabwe and has been extensively studied and demonstrated effectiveness in reducing CMDs broadly in other LMICs including Kenya, Malawi, and Tanzania (46\\u201355). Delivered through six sessions by trained LHWs, the intervention uses a manualized script and is implemented within primary care facilities under the supervision of a mental health professional. The full description of the intervention and how it was developed are described elsewhere (51, 56, 57).\"}, {\"pmc\": \"PMC12303879\", \"pmid\": \"40735207\", \"reference_ids\": [\"B58\", \"B59\", \"B60\", \"B61\", \"B62\", \"B63\"], \"section\": \"Introduction\", \"text\": \"Current guidelines for the treatment and management of SCD lack a comprehensive approach to address the mental health needs of people living with this condition. The National Heart, Lung, and Blood Institute (NHLBI) published the Evidence-Based Management of Sickle Cell Disease: Expert Panel Report, 2014, (58) the World Health Organization (WHO) African Region WHO Sickle Cell Disease Package of Interventions, (59) the Sickle Pan-African Research Consortium (SPARCo) Standards of Care for Sickle Cell Disease in Sub-Saharan Africa, (60) the American Society of Hematology Clinical Practice Guidelines on Sickle Cell Disease, (61) the European Hematology Association Hemoglobinopathies Initiatives, (62) and the British Society for Hematology Guidelines for the Management of Sickle Cell Disease (63) provide detailed guidance to standardize and enhance the management of SCD. These guidelines address critical components of SCD care, such as pain management, the prevention of complications, and the use of disease-modifying therapies like hydroxyurea. However, these guidelines lack a clear and comprehensive emphasis on mental health care for people living with SCD.\"}, {\"pmc\": \"PMC12303879\", \"pmid\": \"40735207\", \"reference_ids\": [\"B64\"], \"section\": \"Setting\", \"text\": \"Key informant interviews drew from a larger NHLBI funded study \\u201cmAnaging siCkle CELl disEase through incReased AdopTion of hydroxyurEa in Nigeria\\u201d (ACCELERATE), an implementation trial with an embedded clinical trial which examines the adoption of hydroxyurea as an evidence-based intervention to manage SCD in Nigeria. The study is a partnership between New York University (NYU) School of Global Public Health and the Center of Excellence for Sickle Cell Research and Training at the University of Abuja (CESRTA) in Abuja, Nigeria. CESRTA is the central administrative hub of SCD providers and researchers from 25 healthcare centers that comprise the Sickle Pan African Research Consortium NigEria Network (SPARC-NEt). In turn, SPARC-NEt is part of SPARCo, a larger consortium comprised of 7 countries\\u2014Ghana, Mali, Nigeria, Tanzania, Uganda, Zambia, and Zimbabwe\\u2014whose mission is to develop research capacity for SCD across Africa (64). Ethics approvals for the key informant interviews were obtained as part of the larger ACCELERATE study by the Institutional Review Boards of NYU Langone Health and the University of Abuja Teaching Hospital, and the Nigerian National Health Research Ethics Committee.\"}, {\"pmc\": \"PMC12303879\", \"pmid\": \"40735207\", \"reference_ids\": [\"B65\", \"B66\", \"B67\"], \"section\": \"Study design and approach\", \"text\": \"The qualitative study utilized the Consolidated Framework on Implementation Research (CFIR), a widely recognized implementation science determinant framework that can be used to understand, guide, and evaluate the factors that influence the successful implementation of interventions, treatments, or policies (65). CFIR is the most commonly cited framework to assess implementation of single interventions (66). The framework was revised in response to recommendations aimed at enhancing its applicability across diverse settings (referred to as CFIR 2.0) (67). CFIR 2.0 consists of 39 constructs organized into 5 key domains: (1) Innovation, (2) Process, (3) Individuals, (4) Inner Setting, and (5) Outer Setting. These domains assess the multifaceted elements that influence the uptake/adoption and sustainability of interventions. In this study, CFIR provided a structured framework to analyze and interpret the findings from the key informant interviews, specifically in relation to the implementation of PST-based task-sharing mental health interventions.\"}, {\"pmc\": \"PMC12303879\", \"pmid\": \"40735207\", \"reference_ids\": [\"B68\", \"B69\"], \"section\": \"Study design and approach\", \"text\": \"A semi-structured interview guide was developed based on CFIR concepts utilizing the CFIR Interview Guide Tool (68) and with input from experts in qualitative study design (AL), SCD research (EP), and GMH research (AS). Key informant interviews were conducted between July 2024 to September 2024 via the ZOOM videoconference platform by the lead author (JP) who has extensive experience in qualitative research methods. To mitigate potential interviewer bias, JP utilized the semi-structured interview guide and conducted interviews with active listening and reflective. Interviews were audio recorded using a handheld recorder, transcribed verbatim by NYU Stream Transcription Service, and de-identified. Interview transcripts were uploaded to Dedoose qualitative software (Version 9.0.17, SocioCultural Research Consultants LLC, Los Angeles, California, 2021). Before the interview, participants completed a brief demographic survey via REDCap (69) which captured anonymized information on areas of expertise, professional roles, educational background, geographic scope of their work, and gender.\"}, {\"pmc\": \"PMC12303879\", \"pmid\": \"40735207\", \"reference_ids\": [\"B70\"], \"section\": \"Analysis\", \"text\": \"A framework analysis approach was used to qualitatively analyze the key informant interviews (70). Framework analysis is an iterative process that involves both deductive (theory-driven) and inductive (data that emerges) coding. The process included:\"}, {\"pmc\": \"PMC12303879\", \"pmid\": \"40735207\", \"reference_ids\": [\"F1\", \"T1\"], \"section\": \"Participant characteristics\", \"text\": \"The geographic scope of work for all participants spans 12 countries in total, with 9 countries (75.0%) located in sub-Saharan Africa: Botswana, Cameroon, Democratic Republic of Congo, Ghana, Nigeria, South Africa, Tanzania, Uganda, and Zimbabwe. The remaining countries include Bolivia, Brazil, and Jamaica (see Figure 1). The country with the most representation of scope of work was Jamaica (31.3%), followed by Nigeria (25.0%). Some participants reported conducting specific work in these 12 countries as well as a general scope of work at the regional level including Africa (25.0%), Asia (12.5%), the Caribbean (25.0%), Latin America (12.5%), and globally (i.e., all regions) (6.3%). All participant characteristics are found in Table 1.\"}, {\"pmc\": \"PMC12303879\", \"pmid\": \"40735207\", \"reference_ids\": [\"T2\"], \"section\": \"Qualitative themes\", \"text\": \"There was broad consensus among SCD stakeholders and GMH experts regarding the urgent need for mental health care tailored to SCD populations. While task-sharing mental health interventions were generally regarded as highly acceptable to address this need, perspectives on its feasibility were mixed (see Table 2).\"}, {\"pmc\": \"PMC12303879\", \"pmid\": \"40735207\", \"reference_ids\": [\"B47\"], \"section\": \"Discussion\", \"text\": \"Task-sharing mental health interventions are widely acknowledged and effectively utilized to address CMDs in LMICs (47). Adapting PST-based interventions for SCD populations was viewed as highly acceptable, however, feedback regarding their feasibility is mixed. It is noteworthy to observe that the challenges identified are not unique to SCD but common across many task-sharing mental health interventions. These challenges reflect broader systemic issues in health systems and the integration of care, which are essential for meeting mental health needs for individuals with chronic care conditions including SCD. Other considerations are what aspects of the Friendship Bench are most important for this population? Is it the physical bench? Is it the curriculum delivered by LHWs? These answers will help tailor task-sharing mental health interventions specific to SCD populations.\"}, {\"pmc\": \"PMC12303879\", \"pmid\": \"40735207\", \"reference_ids\": [\"B71\", \"B72\"], \"section\": \"Discussion\", \"text\": \"Findings from the interviews on improving mental health care is consistent with WHO advocacy for a collaborative care model, which integrates mental health treatment into primary care settings. In September 2025, the UN will host the \\u201cFourth High-Level Meeting on Noncommunicable Diseases and Mental Health\\u201d aimed at discussing, defining, and committing to actionable national and policy recommendations that promote the integration of NCDs and mental health within national health financing systems (71, 72). While the focus of the meeting will be on NCDs such as cardiovascular diseases, diabetes, cancer, and chronic respiratory diseases, it may also pave the way for the inclusion of other NCDs, such as SCD. If global movements are mobilized, they could help address several of the barriers identified in the key informant interviews ultimately improving SCD care by integrating mental health services and advocating for comprehensive care. SCD care would improve for millions of people globally by incorporating mental health care and advocacy.\"}]"

Metadata

"{\"section-at-acceptance\": \"Public Mental Health\"}"