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)

John Patena^1*Leah Elster¹Tania Hameed¹Sumedha Kulkarni¹Alden Yuanhong Lai¹Annika Sweetland²Joyce Gyamfi¹Temitope Ojo³Angela Odoms-Young⁴Charmaine Royal⁵Emmanuel Peprah¹

• ¹New York University School of Global Public Health, New York, United States
• ²Columbia University Vagelos College of Physicians and Surgeons/New York State Psychiatric Institute, New York, United States
• ³Washington University School of Medicine in St. Louis, St. Louis, United States
• ⁴Cornell University, New York, United States
• ⁵Duke University, Durham, North Carolina, United States

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.