Qualitative accounts of community health workers providing and shaping mental health support in climate-vulnerable...

Despite a clear need for mental health services in Bangladesh, there is limited access and provision, especially in areas vulnerable to the effects of climate change. Community health workers (CHWs) are commonplace primary care givers in rural communities and promise to deliver more culturally sensitive and pragmatic services. This study seeks to understand the experiences and perceptions of CHWs who have received basic training in mental health and are providing initial mental health support as the only providers of such care in underserved communities in Bangladesh. We conducted an exploratory qualitative study using in-depth interviews with 16 CHWs and one focus group discussion. Using Reflexive Thematic Analysis, we explored how CHWs introduced the stigmatized topic of mental health and balanced it with local beliefs. The training shifted CHWs' perceptions of mental health, and they adopted strategies to reduce stigma and build trust, such as using culturally appropriate language. Their understanding of community norms allowed them to act as bridges between local and formal mental health perspectives. CHWs shape and redefine the service they deliver through their unique positioning, which makes interventions more context-relevant and appropriate. We recommend strengthening the services CHWs' provide through continued training, material support, and formal recognition.