Rural Friendship Bench: A qualitative study in Zaka district, Zimbabwe.

Area of Science:

• Global Mental Health
• Public Health Interventions
• Task-Sharing Models

Background:

• The Friendship Bench, an evidence-based intervention for common mental disorders, was piloted in rural Zimbabwe.
• This intervention integrates problem-solving therapy with income-generating activities.
• The study assessed the intervention's acceptability, feasibility, and sustainability in a rural context, alongside local attitudes toward mental wellbeing.

Purpose of the Study:

• To evaluate the implementation of the Friendship Bench intervention in rural Zimbabwe.
• To understand local perspectives on mental wellbeing and the intervention's integration.
• To identify barriers and facilitators for task-sharing mental health interventions in rural settings.

Main Methods:

• Semi-structured interviews were conducted with patients (n=9), village health workers (n=12), nurses (n=6), and community leaders (n=5).
• A total of 32 in-depth interviews were completed using four distinct interview guides.
• Thematic analysis, employing an integrative deductive-inductive approach with a diverse coding team, was used for data analysis.

Main Results:

• Five key themes emerged: explanatory models of mental illness, clinical workflow and documentation, positive feedback on the Friendship Bench, accessibility, and feasibility.
• The intervention was found to be acceptable to the community.
• However, the current format of the intervention was neither feasible nor sustainable in the rural setting.

Conclusions:

• The Friendship Bench intervention, in its current form, was acceptable but not feasible or sustainable in rural Zimbabwe.
• Sociocultural context is crucial for developing effective rural task-sharing mental health interventions.
• Recommendations include a robust pilot phase with community involvement and adaptation to leverage social structures for deep community embedding.