Successes and Challenges in Implementing Stepped Care for Mental Health in Jordan: A Qualitative Process Evaluation

The stepped care model is a hierarchical healthcare approach that matches treatment intensity to a patient's condition, ensuring efficient resource use while providing appropriate care. This study conducted a qualitative process evaluation to assess the feasibility, acceptability, and contextual suitability of a multicenter, parallel-group, superiority, randomized controlled trial addressing psychological distress among adults in Jordan. The trial applied the stepped care framework using two scalable WHO interventions adapted to the Jordanian context. Qualitative data was gathered through focus group discussions and phone interviews with 44 participants, facilitators, and assessors. Two themes emerged: (1) Navigating Transformations, highlighting participants' personal growth, including improved self-esteem, family dynamics, and coping mechanisms, alongside the benefits of group sessions and supportive relationships with facilitators; and (2) Navigating Challenges and Improvements, focusing on logistical and personal difficulties such as scheduling issues, and suggestions for improving accessibility and engagement. Findings support the feasibility of the stepped care model as a promising approach to providing accessible and effective mental health support in Jordan. The study calls for hybrid models integrating group and individual support while emphasizing the need for enhanced facilitator training and support systems.