Community health worker-delivered counselling for common mental disorders among chronic disease patients in South Africa: a feasibility study
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Objectives: To examine the feasibility and acceptability of integrating a ‘designated’ approach to community health worker (CHW)-delivered mental health counselling (where existing CHWs deliver counselling in addition to usual duties) and a ‘dedicated’ approach (where additional CHWs have the sole responsibility of delivering mental health counselling) into chronic disease care. Design: A feasibility test of a designated and dedicated approach to CHW-delivered counselling and qualitative interviews of CHWs delivering the counselling. Setting: Four primary healthcare clinics in the Western Cape, South Africa allocated to either a designated or dedicated approach and stratified by urban/rural status. Participants: Forty chronic disease patients (20 with HIV, 20 with diabetes) reporting hazardous alcohol use or depression. Interviews with seven CHWs. Intervention: Three sessions of structured mental health counselling. Main outcome measures: We assessed feasibility by examining the proportion of patients who were willing to be screened, met inclusion criteria, provided consent, completed counselling and were retained in the study. Acceptability of these delivery approaches was assessed through qualitative interviews of CHWs. Results: Regardless of approach, a fair proportion (67%) of eligible patients were willing to receive mental health counselling. Patients who screened positive for depression were more likely to be interested in counselling than those with hazardous alcohol only. Retention in counselling (85%) and the study (90%) was good and did not differ by approach. Both dedicated and designated CHWs viewed the counselling package as highly acceptable but requested additional training and support to facilitate implementation. Conclusions: Dedicated and designated approaches to CHW-delivered mental health counselling were matched in terms of their feasibility and acceptability. A comparative efficacy trial of these approaches is justified, with some adjustments to the training and implementation protocols to provide further support to CHWs.
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Sample sizes for the mixed methods studies ranged from 40 to 4,865.
“for the mixed methods studies from 40 [78] to 4,865 [79]”
From A scoping review of substance use brief interventions in Africa (2024) · cites this paper as [78]
In chronic disease patients in South Africa, of the 553 screened, 262 (48%) were potentially eligible, 26% declined screening, 101 met inclusion criteria, 67 (66%) of eligible patients were interested, and only 40 returned for enrolment.
“Of the 553 chronic disease patients screened for recent alcohol use and depressed mood, 262 (48%) were potentially eligible for study inclusion and referred for eligibility screening. About a quarter (26%, n = 69) declined screening, mainly due to lack of time or interest. Of the 193 remaining patients, 101 met inclusion criteria. Sixteen patients (16%) were eligible on their AUDIT scores, 69 (58%”
From A scoping review of substance use brief interventions in Africa (2024) · cites this paper as [78]
In chronic disease patients in South Africa, all CHWs viewed the intervention as acceptable and beneficial to patients with chronic disease.
“All CHWs viewed the intervention as acceptable and beneficial to patients with chronic disease”
From A scoping review of substance use brief interventions in Africa (2024) · cites this paper as [78]
In chronic disease patients in South Africa, the primary outcomes supported the feasibility of a larger study.
“The primary outcomes supported the feasibility of a larger study.”
From A scoping review of substance use brief interventions in Africa (2024) · cites this paper as [78]
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- Authors
- Myers, B., Petersen-Williams, P., van der Westhuizen, C., Lund, C., Lombard, C., Joska, J. A., Levitt, N. S., Butler, C., Naledi, T., Milligan, P., Stein, D. J., & Sorsdahl, K.
- Affiliations
- South African Medical Research Council (ZA)
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- University of Cape Town (ZA)
- University of Oxford (GB)
- Western Cape Department of Health (ZA)
- Corresponding author
- Myers, Bronwyn
- ORCID
- Venue
- BMJ Open
- Publisher
- BMJ
- Published
- 2019-01
- Volume
- 9
- Issue
- 1
- Pages
- e024277
- ISSN
- 2044-6055 (ISSN-L)
- PMC
- PMC6340481
- OpenAlex
- W2909072240
- Cited by
- 62
- References
- 36
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 10 · 2023: 9 · 2022: 11 · 2021: 9 · 2020: 11 · 2019: 6
- FWCI
- 11.62
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- BMJ Open (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Portal (King's College London) (publishedVersion, other-oa)
- eSpace (Curtin University) (submittedVersion, cc-by)
- UEA Digital Repository (University of East Anglia) (submittedVersion)
- Funders
- Medical Research Council
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Health Professions › Emergency Medical Services › Global Health Workforce Issues
- Keywords
- community health workers, mental health counseling, common mental disorders, depression, hazardous drinking, chronic care, HIV, diabetes mellitus, primary care, feasibility, acceptability, mental health integration
- MeSH terms
- Adult, Alcoholism, Mental Disorders, Chronic Disease, Community Health Workers, Counseling, Delivery of Health Care, Depressive Disorder, Diabetes Mellitus, Feasibility Studies, Female, Humans, Male, Middle Aged, Patient Acceptance of Health Care, Primary Health Care, Problem Solving, South Africa, HIV Infections, Motivational Interviewing
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