Provider perceptions and experiences integrating depression treatment into chronic healthcare services in Neno District, Malawi: a qualitative study.

backgroundIn low-resource settings, integrating mental health services into existing care platforms is critical to expanding access and improving quality of care. In Neno District, Malawi, the Integrated Chronic Care Clinic–Depression module (IC3D) clinical trial introduced depression screening and treatment, including antidepressant therapy (ADT) and group Problem Management Plus (PM+), within chronic care services. This study explored healthcare and lay providers’ experiences and perceptions of integrating depression care for patients with chronic conditions at these clinics.

methodsWe conducted an exploratory qualitative study using semi-structured key informant interviews with 18 depression care providers (eight clinical officers and ten counselors). Interviews were transcribed, translated from Chichewa to English, and analyzed thematically using Dedoose 9.0 to identify patterns in these providers’ perceptions of effectiveness, facilitators, barriers, and recommendations for care integration.

resultsFour key themes emerged from the interviews. First, providers reported positive perceptions of intervention effectiveness, noting improvements in patients’ mental, physical, and functional health, including blood pressure control and HIV viral suppression. Second, providers shared constructive feedback on elements of intervention facilitation, including the PM + user guide, group format, and ongoing training and mentorship. Third, providers identified key challenges which included transportation barriers, increased workload, and missed appointments. Finally, providers recommended ways to improve care delivery, such as allocating additional resources as well as expanding infrastructure and depression screening at additional patient entry points such as outpatient departments and palliative care.

conclusionsBased on provider testimony, the integration of depression care into chronic care services in Neno District, Malawi is perceived as feasible, acceptable, and impactful. Their insights underscore the value of structured mentorship, task-shifting, and holistic care approaches in low-resource settings. These findings will be used to inform government-led district-wide strategies and policy for strengthening behavioral and pharmacologic treatment of depression in Neno District, including recommendations to address logistical constraints, ensure consistent supervision and documentation, and expand screening access. Future research should explore strategies to improve the integrated depression model, including accounting for comorbid mental health conditions, and expanding access to screening and care.

trial registrationThe trial was registered with Clinical Trials. Gov: NCT04777006 (Registration Date: February 23, 2021).